Paramedic Care Principles and Practice, Volume 2, 6th Edition by Bryan TEST BANK by ACADEMIAMILL

TEST BANK Paramedic Care: Principles and Practice, Volume 2 6th Edition by Bryan Bledsoe

TABLE OF CONTENTS: Volume 2 Paramedicine Chapter 32 Pulmonology Chapter 33 Cardiology Chapter 34 Neurology Chapter 35 Endocrinology Chapter 36 Immunology Chapter 37 Gastroenterology Chapter 38 Urology and Nephrology Chapter 39 Toxicology Chapter 40 Hematology Chapter 41 Infectious Diseases and Sepsis Chapter 42 Psychiatric and Behavioral Disorders Chapter 43 Diseases of Ear, Nose, and Throat Chapter 44 Nontraumatic Musculoskeletal Disorders Chapter 45 Obstetrics and Gynecology Chapter 46 Neonatology Chapter 47 Pediatrics Chapter 48 Geriatrics Chapter 49 Abuse, Neglect, and Assault Chapter 50 The Challenged Patient Chapter 51 Acute Interventions for the Chronic Care Patient Chapter 52 Trauma and Trauma Systems Chapter 53 Mechanism of Injury Chapter 54 Hemorrhage and Shock Chapter 55 Soft Tissue Trauma Chapter 56 Burns Chapter 57 Head, Face, Neck, and Spinal Trauma Chapter 58 Chest Trauma Chapter 59 Abdominal and Pelvic Trauma Chapter 60 Orthopedic Trauma Chapter 61 Environmental Trauma Chapter 62 Special Considerations in Trauma

Volume 2 Paramedicine Chapter 32 Pulmonology 1) What is the most important intrinsic risk factor for respiratory disease? A) Environment B) Smoking C) Sedentary lifestyle D) Family history Answer: D Diff: 1 Page Ref: 1018 Standard: Medicine (Respiratory) Objective: 2 2) Air entering and leaving the lungs via inspiration and expiration is known as: A) ventilation. B) respirations. C) perfusion. D) oxygenation. Answer: A Diff: 1 Page Ref: 1022 Standard: Medicine (Respiratory) Objective: 1 3) The diaphragm is controlled by which nerve? A) Vagus B) Olfactory C) Abducens D) Phrenic Answer: D Diff: 1 Page Ref: 1023 Standard: Medicine (Respiratory) Objective: 3 4) An example of diffusion in the respiratory system is movement of: A) oxygen from the alveoli into the pulmonary capillaries. B) air from the outside environment into the lungs. C) oxygen from the tissues into the systemic capillaries. D) carbon dioxide from the alveoli into the pulmonary capillaries. Answer: A Diff: 2 Page Ref: 1026

Standard: Medicine (Respiratory) Objective: 4

5) Airway resistance is increased by: A) sympathetic nervous system stimulation. B) decreased elasticity of the chest wall. C) anticholinergic drugs. D) bronchospasm. Answer: D Diff: 2 Page Ref: 1024 Standard: Medicine (Respiratory) Objective: 4 6) Which patient is at risk for the most common cause of upper airway obstruction? A) 4-year-old male with croup B) 21-year-old female unconscious and supine on the floor C) 22-year-old female stung by a wasp D) 5-year-old female with epiglottitis Answer: B Diff: 2 Page Ref: 1040 Standard: Medicine (Respiratory) Objective: 7 7) Normal tidal volume in an average 70 kg adult is approximately how many milliliters? A) 1,500 B) 1,000 C) 750 D) 500 Answer: D Diff: 1 Page Ref: 1024 Standard: Medicine (Respiratory) Objective: 4 8) After a normal inspiration and expiration, an adult patient has about 2,400 mL of air remaining in the lungs, known as the: A) expiratory reserve volume. B) residual volume. C) functional residual capacity. D) vital capacity. Answer: C Diff: 1 Page Ref: 1025 Standard: Medicine (Respiratory) Objective: 4

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9) A 19-year-old female with difficulty breathing produces a peak expiratory flow rate of 425 lpm, indicating: A) moderate bronchoconstriction. B) mild bronchoconstriction. C) normal ventilatory state. D) severe bronchoconstriction. Answer: C Diff: 2 Page Ref: 1037 Standard: Medicine (Respiratory) Objective: 7 10) Stretch receptors in the lungs send a signal to the inspiratory center of the medulla, inhibiting its stimulation of the phrenic and intercostal nerves. This is known as what reflex? A) Cushing's B) Hering-Breuer C) Moro D) Cheyne-Stokes Answer: B Diff: 2 Page Ref: 1025 Standard: Medicine (Respiratory) Objective: 3 11) The most important factor in determining the respiratory rate is: A) arterial pCO2. B) arterial pO2. C) alveolar pCO2. D) alveolar pO2. Answer: A Diff: 1 Page Ref: 1025 Standard: Medicine (Respiratory) Objective: 3 12) You are working in the ED caring for a 55-year-old female with a long history of COPD. She is more short of breath today than usual and states she has an increased cough. She has a tympanic temperature of 99.8°F. You have drawn arterial blood gases with the patient on room air and when the report comes back, it shows that the patient has a pO2 of 52 mmHg. Which one is most likely? A) You have inadvertently drawn a venous sample. B) The patient is critically hypoxic and requires assisted ventilation. C) This is the typical value for this patient. D) The lab performed the test incorrectly. Answer: C Diff: 3 Page Ref: 1026 Standard: Medicine (Respiratory) Objective: 3

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13) Your ICU patient has ARDS with a pO2 of 62 mmHg, despite mechanical ventilation and oxygenation. What best explains this finding? A) It is a problem with perfusion. B) It is a problem with ventilation. C) It is a problem with the blood gas sample collection. D) It is a problem with gas diffusion in the lung. Answer: D Diff: 3 Page Ref: 1042 Standard: Medicine (Respiratory) Objective: 8 14) Most carbon dioxide from cellular metabolism reaches the alveoli by being transported: A) bound to hemoglobin. B) as bicarbonate ion. C) dissolved in plasma. D) as carbonic anhydrase. Answer: B Diff: 1 Page Ref: 1027 Standard: Medicine (Respiratory) Objective: 3 15) Pulmonary embolism is a problem of: A) interstitial edema. B) ventilation of lungs. C) thickness of the respiratory membrane. D) perfusion of the lungs. Answer: D Diff: 2 Page Ref: 1027 Standard: Medicine (Respiratory) Objective: 4 16) Normal exhalation involves all of the following EXCEPT: A) decreased intrathoracic volume. B) phrenic nerve stimulation. C) relaxation of the diaphragm. D) elastic recoil of lung tissue. Answer: B Diff: 1 Page Ref: 1024 Standard: Medicine (Respiratory) Objective: 3

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17) Obstructive sleep apnea is a problem of the: A) phrenic nerve. B) upper airway. C) medulla oblongata. D) larynx and vocal cords. Answer: B Diff: 2 Page Ref: 1028 Standard: Medicine (Respiratory) Objective: 4 18) Which of these provides evidence that a patient is using accessory muscles to breathe? A) The patient is using his diaphragm with inspiration. B) The patient's lips are pursed. C) There is noticeable contraction of the intercostal muscles. D) The patient is sitting up, leaning forward to breathe. Answer: C Diff: 2 Page Ref: 1031 Standard: Medicine (Respiratory) Objective: 5 19) You have been called to treat a patient complaining of difficulty breathing. Which of the findings should concern you the most? A) The patient is confused, agitated, and angry that you are trying to help him. B) The patient is sitting in the "tripod" position. C) The patient has a heart rate of 126. D) The patient can speak only one to two words between breaths. Answer: A Diff: 3 Page Ref: 1030 Standard: Medicine (Respiratory) Objective: 7 20) Your patient complains of coughing up "greenish-brown" sputum. This is most consistent with: A) cancer. B) bronchitis. C) seasonal allergies. D) pulmonary edema. Answer: B Diff: 2 Page Ref: 1033 Standard: Medicine (Respiratory) Objective: 7

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21) As you are palpating your patient's chest, he speaks, and you can feel the vibration through the chest wall. You should document this as: A) crepitus. B) tactile fremitus. C) bronchovesicular sounds. D) a pleural friction rub. Answer: B Diff: 1 Page Ref: 1033-1034 Standard: Medicine (Respiratory) Objective: 1 22) Capnometry measures the partial pressure of CO2 in: A) venous blood. B) arterial blood. C) expired air. D) inspired air. Answer: C Diff: 1 Page Ref: 1037 Standard: Medicine (Respiratory) Objective: 5 23) ETCO2 is recorded during which phase of the capnogram? A) I B) II C) III D) IV Answer: C Diff: 2 Page Ref: 1038-1039 Standard: Medicine (Respiratory) Objective: 5 24) Your patient is a 23-year-old female who is 30 weeks pregnant. She choked on some cheese while eating a piece of pizza. When asked if she can speak, she replies "yes," although with some difficulty. Your next step should be to: A) perform a series of abdominal thrusts. B) perform a series of chest thrusts. C) ask the patient to cough as hard as she can. D) attempt to remove the bolus of cheese with Magill forceps. Answer: C Diff: 2 Page Ref: 1041 Standard: Medicine (Respiratory) Objective: 7

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25) Your patient is a 20-year-old male with a peanut allergy who inadvertently ate some candy containing peanuts. He is complaining of a "lump" in his throat, his voice is hoarse with mild inspiratory stridor, and he appears anxious. You are giving oxygen by nonrebreathing mask and have started an IV. Next, you should: A) place the patient in a supine position and prepare for transtracheal ventilation. B) administer an induction agent and a paralytic and perform endotracheal intubation. C) administer epinephrine IM and diphenhydramine IV. D) administer 2.5 mg albuterol by nebulizer. Answer: C Diff: 2 Page Ref: 1041-1042 Standard: Medicine (Respiratory) Objective: 8 26) Your patient is a 60-year-old male with an acute exacerbation of COPD. You may consider giving the patient ipratropium because, in addition to reversing bronchospasm, it is helpful in: A) reducing inflammation. B) drying bronchial secretions. C) expectoration of mucus. D) stimulating the respiratory center in the medulla. Answer: B Diff: 2 Page Ref: 1045 Standard: Medicine (Respiratory) Objective: 8 27) Which of the following characteristics is least associated with emphysema? A) Polycythemia B) Cor pulmonale C) Barrel chest appearance D) Productive cough throughout the day Answer: D Diff: 2 Page Ref: 1045-1046 Standard: Medicine (Respiratory) Objective: 7 28) When using CPAP in patients with COPD, in general, PEEP should be: A) < 10 mm Hg. B) > 10 mm Hg. C) < 10 cm H2O. D) > 10 cm H2O. Answer: C Diff: 1 Page Ref: 1047 Standard: Medicine (Respiratory) Objective: 8

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29) Your patient is a 15-year-old asthmatic who has been having difficulty breathing for 45 minutes but does not have his Xopenex inhaler with him. Capnography shows an ETCO2 of 45 mmHg. The best way to interpret this finding is: A) this is a normal ETCO2, indicating that this is a mild asthma attack. B) the patient's ETCO2 first dropped as he began to hyperventilate but now is rising again and may continue to rise to dangerous levels. C) this is a high ETCO2, and the patient requires immediate ventilatory assistance to prevent respiratory arrest. D) this is a low ETCO2 indicating that the patient is hyperventilating and thus in the early stages of an asthma attack. Answer: B Diff: 3 Page Ref: 1049-1050 Standard: Medicine (Respiratory) Objective: 7 30) Your patient is a 24-year-old male Chinese citizen on vacation in the United States. He is in moderate distress, complaining of difficulty breathing and gives a four-day history of runny nose, sore throat, fever, chills, and general malaise with a productive cough. His sputum production was significantly worse when he woke this morning, and he developed difficulty breathing this afternoon. HR = 134, BP = 132/84, RR = 26, SaO2 = 90 percent. This presentation is most consistent with: A) pneumonia. B) tuberculosis. C) SARS. D) hantavirus pulmonary syndrome. Answer: C Diff: 3 Page Ref: 1053-1054 Standard: Medicine (Respiratory) Objective: 7 31) In which situation is a significant amount of carboxyhemoglobin most likely to be present? A) A patient who is being treated with nitrites for cyanide poisoning B) A patient with COPD who is short of breath with an SpO2 of 90 percent C) A patient found unresponsive in an apartment in which there is a gas furnace D) A patient who inhaled anhydrous ammonia fumes Answer: C Diff: 2 Page Ref: 1057 Standard: Medicine (Respiratory) Objective: 6

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32) Your patient is a 68-year-old male complaining of difficulty breathing for two days. He is sitting up, conscious, alert, and oriented and appears to be in mild respiratory distress. Physical examination reveals cool, dry, pink skin; he is thin with well-defined accessory muscles, and you note diffuse wheezing to all lung fields. HR = 102, BP = 136/96, RR = 20, SaO2 = 92 percent. The patient gives a 20-pack-a-year history of smoking. These findings are most typical of: A) emphysema. B) asthma. C) chronic bronchitis. D) congestive heart failure. Answer: A Diff: 2 Page Ref: 1045-1046 Standard: Medicine (Respiratory) Objective: 7 33) You have applied a CO-oximeter to your patient, and it is displaying an SpCO of 15 percent. Which of the following is the most appropriate interpretation of this finding? A) This is consistent with a fatal level of carbon monoxide poisoning. B) This is a normal reading for a smoker and nothing to worry about. C) This is a normal reading for a nonsmoker and nothing to worry about. D) This is consistent with mild carbon monoxide poisoning. Answer: D Diff: 2 Page Ref: 1058 Standard: Medicine (Respiratory) Objective: 5 34) You are working at the triage desk in the ED when a young man on crutches approaches the desk. He appears moderately short of breath. He states he had a cast put on his left leg seven days ago after surgery for a ruptured Achilles tendon. This morning, while he was watching television, he suddenly became short of breath. He has a history of asthma, for which he takes Xopenex as needed, and is taking Tylenol with codeine for pain related to his surgery. The patient's lung sounds are clear and equal, SpO2 is 90 percent on room air, heart rate is 100 and regular, respirations are 24 and slightly labored, blood pressure is 128/88, and the patient is afebrile. These findings are most consistent with: A) allergic reaction to codeine. B) asthma exacerbated by recent anesthesia. C) pneumonia secondary to recent anesthesia. D) pulmonary embolism associated with immobilization of the lower extremity. Answer: D Diff: 3 Page Ref: 1058 Standard: Medicine (Respiratory) Objective: 7

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35) You are caring for a patient with Guillain-Barré syndrome. The most likely cause of hypoxia in this patient would be: A) impaired perfusion. B) inadequate lung volume. C) impaired ventilation. D) increased thickness of the respiratory membrane. Answer: C Diff: 3 Page Ref: 1061 Standard: Medicine (Respiratory) Objective: 6 36) Which statement about severe adult respiratory distress syndrome (ARDS) is FALSE? A) PEEP is often required to adequately ventilate ARDS patients. B) The mortality rate is 20 to 30 percent. C) Pulmonary edema and disruption of the alveolar-capillary membrane contribute to respiratory failure in ARDS. D) The causes of ARDS can include pancreatitis, oxygen toxicity, sepsis, and tumor destruction. Answer: B Diff: 2 Page Ref: 1042 Standard: Medicine (Respiratory) Objective: 6 37) The amount of air moved in and out of the lungs during a normal, quiet respiration is called: A) tidal volume. B) dead space volume. C) inspiratory capacity. D) functional reserve capacity. Answer: A Diff: 1 Page Ref: 1024 Standard: Medicine (Respiratory) Objective: 3 38) The carpopedal spasms that occur due to hyperventilation syndrome are a result of a relative , secondary to . A) hypocalcemia, decrease in unbound calcium B) hypercalcemia, respiratory alkalosis C) hypocalcemia, increase in bound calcium D) hyponatremia, respiratory alkalosis Answer: C Diff: 3 Page Ref: 1035 Standard: Medicine (Respiratory) Objective: 6

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39) Your patient is a 52-year-old male complaining of shortness of breath. He is sitting up, alert, and oriented and appears to be in moderate respiratory distress. He states that he "always gets a chest cold in the winter" and describes a three-week history of productive cough and increasing shortness of breath. Physical examination reveals coarse rhonchi to the upper lobes bilaterally, air movement is decreased in the bases, and his skin is cool with peripheral cyanosis. You note that he is overweight and describes an 18-pack-a-year smoking history. Based on these clinical exam findings, the most clinically relevant finding you might also expect is: A) pursed-lipped breathing. B) JVD, ankle edema, and hepatic congestion. C) pulmonary edema and hypotension. D) barrel chest and increased anterior/posterior chest diameter. Answer: B Diff: 3 Page Ref: 1047 Standard: Medicine (Respiratory) Objective: 7 40) An increased hydrogen ion concentration in the cerebrospinal fluid causes the respiratory rate to become: A) erratic. B) decreased. C) unchanged. D) increased. Answer: D Diff: 2 Page Ref: 1025 Standard: Medicine (Respiratory) Objective: 3 41) Your patient is a 16-year-old male who attempted suicide. He is unconscious and apneic, lying supine on a garage floor. The family states they found the patient unconscious in the front seat of a car that was running in an enclosed garage. HR = 70, BP = 100/60, RR = 0. In addition to an IV of normal saline, which of the following is the most appropriate? A) Intubate, remove the patient from the garage, and transport to a hospital with a hyperbaric chamber. B) Remove the patient from the garage, initiate BVM ventilations with 100 percent oxygen, intubate, and transport to a hospital with a hyperbaric chamber. C) Remove the patient from the garage, initiate BVM ventilations with 100 percent oxygen, intubate, and transport to the nearest facility. D) Remove the patient from the garage, intubate, and transport to the nearest hospital. Answer: B Diff: 3 Page Ref: 1058 Standard: Medicine (Respiratory) Objective: 8

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42) Lung perfusion depends on all of these EXCEPT: A) efficient pumping of blood by the heart. B) intact pulmonary capillaries. C) an intact alveolar membrane. D) adequate blood volume. Answer: C Diff: 2 Page Ref: 1026 Standard: Medicine (Respiratory) Objective: 3 43) Your patient is a 24-year-old male who has been an in-patient in a rehabilitation hospital following surgical fixation of a fractured pelvis. Staff reports sudden development of hypotension and severe respiratory distress about 30 minutes ago. There is no other significant history. Physical exam findings include cold, diaphoretic skin with peripheral cyanosis; jugular venous distension; clear breath sounds bilaterally; and vitals as follows: HR = 134, BP = 74/50, RR = 28, SaO2 = 84 percent. What is most likely? A) Spontaneous tension pneumothorax B) Pulmonary embolism C) Myocardial infarction D) Idiopathic congestive heart failure Answer: B Diff: 3 Page Ref: 1058-1059 Standard: Medicine (Respiratory) Objective: 8 44) Which statement about pulse oximetry is FALSE? A) Oxygen saturation is the percentage of hemoglobin that is bound with some molecular structure. B) Pulse oximetry values can be expected to decrease within seconds in cases of developing hypoxia. C) Pulse oximetry should be used on all patients with respiratory complaints. D) Pulse oximetry has the ability to noninvasively measure total hemoglobin (SpHb) in addition to SpO2 and other parameters. Answer: B Diff: 1 Page Ref: 1039 Standard: Medicine (Respiratory) Objective: 5

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45) Which of the following is the most important determinant of ventilatory rate? A) Arterial PO2 B) Venous PCO2 C) Venous PO2 D) Arterial PCO2 Answer: D Diff: 1 Page Ref: 1025 Standard: Medicine (Respiratory) Objective: 3 46) Which of the following is the purpose of lung surfactant? A) Destroy and remove foreign material from the alveoli. B) Aid in the facilitated diffusion of oxygen across the alveolar membrane. C) Decrease the surface tension of water in the alveoli. D) Aid in the facilitated diffusion of carbon dioxide and oxygen across the alveolar membrane. Answer: C Diff: 1 Page Ref: 1022 Standard: Medicine (Respiratory) Objective: 3 47) You have intubated a 66-year-old female who was experiencing an acute exacerbation of her emphysema. What special consideration does this patient, with her specific pathology, require? A) She requires hyperventilation to blow off excess CO2. B) Oxygen flow should be limited to 4 lpm because of the hypoxic drive common in COPD patients. C) While ventilating, you should allow for a prolonged expiratory phase due to her disease. D) She requires frequent, deep suctioning. Answer: C Diff: 3 Page Ref: 1046 Standard: Medicine (Respiratory) Objective: 9 48) Your patient is a 72-year-old female, alert and oriented, sitting up in bed at a nursing home. She is in mild respiratory distress. The staff describes a four-day history of fever, malaise, and productive cough. The patient also states that she has been experiencing chills and chest pain with deep inspiration. Physical examination reveals rales and rhonchi in the right upper lobe and warm, moist skin. HR = 116, BP = 104/76, RR = 20, SaO2 = 93 percent. Based on the clinical exam findings, the most appropriate diagnosis would be: A) pneumonia. B) emphysema. C) congestive heart failure. D) chronic bronchitis. Answer: A Diff: 3 Page Ref: 1052-1053 Standard: Medicine (Respiratory) Objective: 7 14 Copyright © 2023 Pearson Education, Inc.

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49) Which pulmonary structure FIRST allows gas exchange as air enters the lungs? A) Respiratory bronchioles B) Alveolar ducts C) Alveolar sacs D) Terminal bronchioles Answer: A Diff: 1 Page Ref: 1021 Standard: Medicine (Respiratory) Objective: 3 50) Which of these is NOT a role of the upper respiratory system? A) Warm inspired air B) Filter inspired air C) Carry out gas exchange with inspired air D) Humidify inspired air Answer: C Diff: 1 Page Ref: 1019 Standard: Medicine (Respiratory) Objective: 3 51) Which of these would result in an increased respiratory rate? A) A decrease of cerebrospinal fluid PO2 B) Stimulation of chemoreceptors by an increase of PCO2 C) An increase of cerebrospinal fluid pH D) Stimulation of baroreceptors by an increase of PCO2 Answer: B Diff: 2 Page Ref: 1025 Standard: Medicine (Respiratory) Objective: 3 52) A 72-year-old female has a one-week history of 101°F fever, chills, and dark-brown sputum production. She also has rhonchi and rales throughout her right lung. If this condition is left untreated, it could result in: A) cardiogenic shock. B) chronic bronchitis. C) septic shock. D) pneumonia. Answer: C Diff: 2 Page Ref: 1052 Standard: Medicine (Respiratory) Objective: 6

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53) An intrinsic risk factor is one that is influenced: A) within the patient. B) outside the patient. C) by the atmosphere. D) by a carcinogen. Answer: A Diff: 2 Page Ref: 1018 Standard: Medicine (Respiratory) Objective: 2 54) Ventilation is: A) the diffusion of gases at the alveoli. B) the diffusion of the gas at the cellular level. C) the mechanical process of moving air in and out of the lungs. D) done to allow the gas to escape the chest wall. Answer: C Diff: 1 Page Ref: 1022 Standard: Medicine (Respiratory) Objective: 1 55) The diaphragm is innervated by the: A) renal nerve. B) renic nerve. C) pulmonary nerve. D) phrenic nerve. Answer: D Diff: 2 Page Ref: 1023 Standard: Medicine (Respiratory) Objective: 3 56) Lung compliance is described as: A) the ease with which the chest expands. B) the diameter of the chest wall. C) the depth at which the chest expands. D) the rate at which the chest expands. Answer: A Diff: 1 Page Ref: 1024 Standard: Medicine (Respiratory) Objective: 3

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57) The average adult tidal volume is: A) 750 mL. B) 1200 mL. C) 2400 mL. D) 500 mL. Answer: D Diff: 1 Page Ref: 1024 Standard: Medicine (Respiratory) Objective: 3 58) The most important determinant of ventilatory rate is: A) arterial PO. B) SpPO. C) arterial PCO2. D) arterial NaHCO3. Answer: C Diff: 2 Page Ref: 1025 Standard: Medicine (Respiratory) Objective: 3 59) A patient with COPD should present with a PO2 of: A) 35-45 mmHg. B) 70-80 mmHg. C) 50-60 mmHg. D) 94-96 mmHg. Answer: C Diff: 1 Page Ref: 1026 Standard: Medicine (Respiratory) Objective: 3 60) A majority of carbon dioxide in the body is transported as: A) bicarbonate ion. B) hydrogen ion. C) hemoglobin. D) plasma. Answer: A Diff: 2 Page Ref: 1027 Standard: Medicine (Respiratory) Objective: 3

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61) A sudden disruption of pulmonary perfusion caused by a blood clot is known as: A) pulmonary occlusion. B) pulmonary diffusion. C) pulmonary edema. D) pulmonary embolism. Answer: D Diff: 1 Page Ref: 1058 Standard: Medicine (Respiratory) Objective: 4 62) Obstructive sleep apnea is an example of: A) lower airway obstruction. B) upper airway obstruction. C) COPD. D) CHF. Answer: B Diff: 1 Page Ref: 1028 Standard: Medicine (Respiratory) Objective: 4 63) You are called to the home of a patient who suddenly "stopped breathing." The patient has a history of a neoplasm at C-3 and C-4. You suspect: A) impingement on the phrenic nerve. B) cervical fractures. C) lung cancer. D) myocardial infarction. Answer: A Diff: 3 Page Ref: 1029 Standard: Medicine (Respiratory) Objective: 6 64) Pulmonary shunting can be seen in patients with suspected: A) tension pneumothorax. B) hemothorax. C) pulmonary embolism. D) hypovolemic shock. Answer: C Diff: 2 Page Ref: 1030 Standard: Medicine (Respiratory) Objective: 4

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65) Which of the following is NOT part of the respiratory status assessment? A) Mental status B) Color C) Respiratory effort D) Lung compliance Answer: D Diff: 1 Page Ref: 1030-1031 Standard: Medicine (Respiratory) Objective: 5 66) You are assessing your respiratory patient. Of the following findings, which would concern you the most? A) Tachycardia B) Intercostal retractions C) Altered mental status D) Wheezing Answer: C Diff: 1 Page Ref: 1030 Standard: Medicine (Respiratory) Objective: 7 67) Your patient is complaining of "coughing up blood," or, in medical terms: A) hemothorax. B) hemoptysis. C) neoplasm. D) hemopulmonary spasm. Answer: B Diff: 1 Page Ref: 1032 Standard: Medicine (Respiratory) Objective: 1 68) You are evaluating a patient complaining of having a productive cough. The patient states the sputum is green to brown. You suspect: A) infection. B) inflammation. C) allergies. D) hemoptysis. Answer: A Diff: 1 Page Ref: 1033 Standard: Medicine (Respiratory) Objective: 6

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69) You are assessing a patient who is presenting with shortness of breath, JVD, and tracheal deviation. You suspect: A) flail chest. B) tracheal tugging. C) subcutaneous emphysema. D) tension pneumothorax. Answer: D Diff: 2 Page Ref: 1033-1034 Standard: Medicine (Respiratory) Objective: 7 70) Paradoxical movement is associated with: A) tension pneumothorax. B) hemothorax. C) flail chest. D) simple pneumothorax. Answer: C Diff: 2 Page Ref: 1033 Standard: Medicine (Respiratory) Objective: 7 71) Upon examining your patient, you note that he has clubbing of the fingers. You would suspect a history of: A) hypoxemia. B) neoplasm. C) hypertension. D) peripheral vascular disease. Answer: A Diff: 2 Page Ref: 1035 Standard: Medicine (Respiratory) Objective: 6 72) A disorder of lung diffusion that results from increased fluid in the interstitial space is known as: A) ARDS. B) COPD. C) AIDS. D) PHTN. Answer: A Diff: 1 Page Ref: 1042 Standard: Medicine (Respiratory) Objective: 6

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73) The hallmark treatment of ARDS is to: A) administer corticosteroids. B) treat the underlying condition. C) treat the increased fluid with diuretics. D) perform renal dialysis to remove the fluid. Answer: B Diff: 1 Page Ref: 1042 Standard: Medicine (Respiratory) Objective: 7 74) Which of the following is NOT a common obstructive lung disease encountered in the prehospital setting? A) Asthma B) CHF C) Emphysema D) Chronic bronchitis Answer: B Diff: 1 Page Ref: 1045 Standard: Medicine (Respiratory) Objective: 6 75) You respond to a patient with difficulty breathing. Upon assessment you notice that the patient is sitting in the tripod position, with marked JVD. The patient has clubbing of the fingers and new pitting edema. You should suspect: A) CHF. B) pulmonary emboli. C) cor pulmonale. D) pulmonary neoplasm. Answer: C Diff: 3 Page Ref: 1045 Standard: Medicine (Respiratory) Objective: 9 76) You are performing a physical exam on a patient with emphysema. You note that the patient has a pink hue to her skin. Given this skin finding, you should suspect: A) cor pulmonale. B) polycythemia. C) methahemoglobinemia. D) carboxyhemoglobinemia. Answer: B Diff: 2 Page Ref: 1046 Standard: Medicine (Respiratory) Objective: 7

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77) You are caring for a patient with chronic bronchitis. The patient has an SpO2 of 90 percent. You should: A) administer supplemental oxygen at high flow, 15 lpm via NRB. B) administer supplemental oxygen at high flow, via CPAP. C) administer supplemental oxygen at low flow, via nasal cannula. D) do nothing, as this is an expected reading. Answer: C Diff: 3 Page Ref: 1047 Standard: Medicine (Respiratory) Objective: 8 78) You are called to a patient with severe shortness of breath. Upon arrival, you find your patient in the tripod position, with pursed lips and audible wheezing. SpO2 is at 89 percent and capnography shows a "shark fin" pattern with an ETCO2 of 50. You should: A) administer a beta agonist. B) administer a beta antagonist. C) administer an alpha antagonist. D) administer an alpha agonist. Answer: A Diff: 3 Page Ref: 1049 Standard: Medicine (Respiratory) Objective: 8 79) You are called to care for a patient with severe shortness of breath. The patient has an SpO2 of 88 percent, audible wheezing, and a capnography reading of 54 with a shark fin wave form. You are administering albuterol for the second time without relief. You suspect: A) status epilepticus. B) status asthmaticus. C) anaphylaxis. D) septic shock. Answer: B Diff: 3 Page Ref: 1050 Standard: Medicine (Respiratory) Objective: 8 80) You arrive on the scene of a patient who complains of worsening shortness of breath for the past few days. The patient presents with an SpO2 of 90 percent, ETCO2 of 45, normal wave form, crackles, and a temperature of 101.5°F. You should suspect: A) CHF. B) COPD. C) pneumonia. D) ARDS. Answer: C Diff: 3 Page Ref: 1052-1053 Standard: Medicine (Respiratory) Objective: 9 22 Copyright © 2023 Pearson Education, Inc.

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81) You are called to the scene of a patient who has just attempted suicide by inhaling toxic fumes. You notice that the patient is coughing and has a hoarse voice. You suspect: A) tracheal rupture. B) laryngeal edema. C) subcutaneous emphysema. D) aspiration pneumonia. Answer: B Diff: 3 Page Ref: 1056 Standard: Medicine (Respiratory) Objective: 7 82) You arrive to find an unresponsive patient inside a running vehicle in his garage. Your destination should include a hospital with what capability? A) Hyperbaric oxygen B) Coronary angioplasty C) Neurosurgical capabilities D) Trauma facility Answer: A Diff: 2 Page Ref: 1058 Standard: Medicine (Respiratory) Objective: 8

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Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 33 Cardiology 1) Which of these risk factors has been proven to increase the risk of cardiovascular disease? A) Oral contraceptive use B) Type A personality C) Stress D) Lack of exercise Answer: D Diff: 1 Page Ref: 1065 Standard: Medicine (Cardiovascular) Objective: 2 2) Public education about cardiovascular disease focuses on: A) risk factors and signs and symptoms of CVD. B) CPR and public access defibrillation. C) CPR and signs and symptoms of CVD. D) risk factors and public access defibrillation. Answer: A Diff: 1 Page Ref: 1065-1066 Standard: Medicine (Cardiovascular) Objective: 2 3) The valve between the right atrium and right ventricle is known as the: A) bicuspid valve. B) pulmonic valve. C) tricuspid valve. D) aortic valve. Answer: C Diff: 1 Page Ref: 1067 Standard: Medicine (Cardiovascular) Objective: 3 4) Blood entering the left atrium arrives via the: A) bicuspid valve. B) superior and inferior vena cava. C) pulmonary vein. D) pulmonary artery. Answer: C Diff: 1 Page Ref: 1068 Standard: Medicine (Cardiovascular) Objective: 3

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5) The first part of the aorta as it leaves the heart is the: A) aortic arch. B) thoracic aorta. C) descending aorta. D) ascending aorta. Answer: D Diff: 1 Page Ref: 1068 Standard: Medicine (Cardiovascular) Objective: 3 6) Your patient is a 54-year-old male who is unresponsive and cyanotic and has agonal respirations. A "quick look" shows ventricular tachycardia. Which of these is most important when determining the immediate treatment of this patient? A) How long he has been "down" B) Whether he has a pulse C) Whether he is allergic to lidocaine D) Whether he has an implanted cardioverter-defibrillator Answer: B Diff: 2 Page Ref: 1115 Standard: Medicine (Cardiovascular) Objective: 16 7) ECG findings associated with hypokalemia include: A) U waves and flat T waves. B) U waves and an Osborn wave. C) an Osborn wave and a "J" wave. D) flattened T waves and a widened QRS complex. Answer: A Diff: 2 Page Ref: 1122 Standard: Medicine (Cardiovascular) Objective: 7 8) The presence of inverted T waves on an ECG can indicate: A) myocardial infarction. B) myocardial necrosis. C) myocardial ischemia. D) myocardial injury. Answer: C Diff: 2 Page Ref: 1087, 1179 Standard: Medicine (Cardiovascular) Objective: 7

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9) The pressure in the left ventricle at the end of diastole is called: A) afterload. B) preload. C) ejection fraction. D) stroke volume. Answer: B Diff: 1 Page Ref: 1073 Standard: Medicine (Cardiovascular) Objective: 1 10) Typical stroke volume is about how much of the volume of the left ventricle? A) 30 percent-40 percent B) 40 percent -60 percent C) 50 percent -70 percent D) 60 percent -80 percent Answer: C Diff: 1 Page Ref: 1071-1073 Standard: Medicine (Cardiovascular) Objective: 3 11) Which of these items may interfere with the normal function of an implanted cardiac pacemaker if it is too close to the chest? A) Magnet B) Cellular telephone C) Television remote control D) Hair dryer Answer: A Diff: 1 Page Ref: 1121 Standard: Medicine (Cardiovascular) Objective: 7 12) The first phase of the cardiac cycle is: A) systole. B) diastole. C) contraction. D) ejection. Answer: B Diff: 1 Page Ref: 1071 Standard: Medicine (Cardiovascular) Objective: 3

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13) For a resting potential in a cardiac cell to exist, there must be an: A) adequate number of potassium ions inside the cell and sodium ions outside the cell. B) adequate number of sodium ions inside the cell and potassium ions outside the cell. C) influx of calcium ions into the cell. D) ionic equilibrium between the inside and outside of the cell. Answer: A Diff: 2 Page Ref: 1077-1078 Standard: Medicine (Cardiovascular) Objective: 3 14) The proportion of the left ventricular volume that is pumped out of the heart during systole is the: A) ejection fraction. B) stroke volume. C) preload. D) afterload. Answer: A Diff: 2 Page Ref: 1071 Standard: Medicine (Cardiovascular) Objective: 1 15) Beta blockers generally have which of these effects? A) Increased cardiac conduction B) Decreased myocardial contractility C) Vasoconstriction D) Increased myocardial contractility Answer: B Diff: 2 Page Ref: 1073 Standard: Medicine (Cardiovascular) Objective: 9 16) Your patient is found sitting on the edge of the bathtub with cool, diaphoretic skin. She states she became lightheaded and nearly "passed out" while vomiting. Your cardiac monitor shows a sinus bradycardia at a rate of 48. Which of these is most likely? A) Sick sinus syndrome B) Use of sympathomimetic medications C) Disease of the cardiac conduction system D) Increased parasympathetic tone Answer: D Diff: 2 Page Ref: 1073 Standard: Medicine (Cardiovascular) Objective: 7

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17) When the ECG paper is traveling at the standard rate of 25 mm/sec, a large box in the horizontal direction equals: A) 0.08 seconds. B) 0.12 seconds. C) 0.20 seconds. D) 0.24 seconds. Answer: C Diff: 2 Page Ref: 1082 Standard: Medicine (Cardiovascular) Objective: 4 18) Which of these will occur with an increase in peripheral vascular resistance? A) Decreased stroke volume B) Increased ejection fraction C) Increased preload D) Decreased afterload Answer: A Diff: 2 Page Ref: 1073 Standard: Medicine (Cardiovascular) Objective: 3 19) There are 15 small boxes between R waves on an ECG tracing. What is the heart rate? A) 150 B) 120 C) 100 D) 20 Answer: C Diff: 2 Page Ref: 1082-1083 Standard: Medicine (Cardiovascular) Objective: 4 20) If the stroke volume decreased, which of these would occur to maintain the blood pressure at its current value? A) Increased heart rate and increased peripheral vascular resistance B) Decreased heart rate and decreased peripheral vascular resistance C) Increased heart rate and decreased peripheral vascular resistance D) Decreased heart rate and increased peripheral vascular resistance Answer: A Diff: 2 Page Ref: 1073 Standard: Medicine (Cardiovascular) Objective: 3

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21) You have administered a drug with potent beta-1 effects. Which of these effects should you most anticipate? A) Smooth muscle relaxation B) Peripheral vasoconstriction C) Increased heart rate D) Peripheral vasodilation Answer: C Diff: 2 Page Ref: 1073 Standard: Medicine (Cardiovascular) Objective: 9 22) You have administered a medication to a patient, resulting in a decreased speed of cardiac impulse conduction. This drug is most accurately described as having what type effect? A) Negative dromotropic B) Negative chronotropic C) Positive dromotropic D) Positive chronotropic Answer: A Diff: 2 Page Ref: 1075 Standard: Medicine (Cardiovascular) Objective: 3 23) Which of these endocrine substances acts as a marker for congestive heart failure? A) BNP B) Angiotensin C) ACTH D) Troponin Answer: A Diff: 1 Page Ref: 1076 Standard: Medicine (Cardiovascular) Objective: 3 24) To detect if life-threatening cardiac dysrhythmias are present, the paramedic must view the ECG in what type of lead? A) Double lead B) Single lead C) 12 lead D) 18 lead Answer: B Diff: 1 Page Ref: 1081 Standard: Medicine (Cardiovascular) Objective: 4

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25) The total duration of ventricular depolarization is represented by which waveform on the ECG? A) QRS B) QT C) PQ D) R-R Answer: A Diff: 2 Page Ref: 1083 Standard: Medicine (Cardiovascular) Objective: 5 26) Which of these statements concerning Q waves on the ECG is most accurate? A) Q waves are not a normal finding on the ECG. B) The absence of a Q wave is a significant pathophysiological finding. C) A Q wave is significant if it is 0.04 or more seconds wide. D) A Q wave is only significant in the presence of chest pain. Answer: C Diff: 2 Page Ref: 1087 Standard: Medicine (Cardiovascular) Objective: 5 27) Which of these is most characteristic of right heart failure? A) JVD, peripheral edema, and pulmonary edema B) Rales, cough productive of blood-tinged sputum C) Ascites, peripheral edema, and cyanosis D) JVD, peripheral edema, and liver and spleen engorgement Answer: D Diff: 2 Page Ref: 1149 Standard: Medicine (Cardiovascular) Objective: 10 28) The anterior surface of the heart is best viewed by ECG leads: A) II, III, and aVF. B) V1-V4. C) I and aVL. D) aVR, aVL, and aVF. Answer: B Diff: 2 Page Ref: 1087 Standard: Medicine (Cardiovascular) Objective: 15

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29) While monitoring a patient's cardiac rhythm, you note that there is no electrical activity after a PQRST complex for a period equal to exactly three of the previous R-R intervals. This is most accurately described as: A) sinus arrest. B) sinus pause. C) sinus arrhythmia. D) sinus block. Answer: D Diff: 3 Page Ref: 1092-1093 Standard: Medicine (Cardiovascular) Objective: 6 30) A 48-year-old male is sitting upright in bed in respiratory distress. He describes an acute onset of difficulty breathing and chest pain during the night that has been worsening for the past 3 hours. He also complains of nausea. Pain is described as a substernal pressure radiating to his left shoulder. Physical examination reveals cool, diaphoretic skin and rales on auscultation bilaterally. Medical history includes two prior myocardial infarctions. Medications include Zestril and metoprolol. HR = 132, BP = 140/100, RR = 25, SaO2 = 92 percent. Which of these is NOT indicated? A) Adenosine B) Enalapril C) Morphine D) Nitroglycerin Answer: A Diff: 3 Page Ref: 1133-1134 Standard: Medicine (Cardiovascular) Objective: 9 31) Which of these is the most likely result of increased pulmonary artery pressure? A) Increased left ventricular workload and cor pulmonale B) Increased right ventricular workload and cor pulmonale C) Decreased right atrial workload and right ventricular hypertrophy D) Increased left ventricular workload and congestive heart failure Answer: B Diff: 2 Page Ref: 1147-1148 Standard: Medicine (Cardiovascular) Objective: 10

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32) The difference between apical and peripheral pulse rates that results from decreased cardiac output (for example when the patient is in atrial fibrillation and the atria are failing to contract normally) is known as: A) pulsus paradoxus. B) pulse deficit. C) pulsus alternans. D) paroxysmal pulse pressure. Answer: B Diff: 2 Page Ref: 1102, 1129 Standard: Medicine (Cardiovascular) Objective: 8 33) Elastic and smooth muscle fibers are primarily found in which layer of the blood vessel? A) Collateralus B) Media C) Adventitia D) Intima Answer: B Diff: 1 Page Ref: 1070 Standard: Medicine (Cardiovascular) Objective: 3 34) What is the name of the finding that refers to a drop in systolic blood pressure of more than 10 mmHg with inspiration? A) Electrical alternans B) Pulsus alternans C) Pulse deficit D) Pulsus paradoxus Answer: D Diff: 2 Page Ref: 1150 Standard: Medicine (Cardiovascular) Objective: 8 35) Which of these most accurately differentiates cardioversion from defibrillation? A) Cardioversion is timed to be synchronous with the patient's R wave. B) Cardioversion requires fewer than 100 joules. C) The electrical stimulation of cardioversion travels at a slower rate through the myocardium. D) Cardioversion cannot be used in patients who have a pulse. Answer: A Diff: 2 Page Ref: 1136 Standard: Medicine (Cardiovascular) Objective: 10

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36) A 67-year-old male is unconscious, is sitting in a chair, and has agonal respirations. His wife states that he was up all night with difficulty breathing and chest discomfort but would not go to the hospital. Physical examination reveals pink, frothy sputum in the airway; cold, diaphoretic skin; and rales audible without a stethoscope. HR = 108, BP = 74 mmHg by palpation, RR = 4, SaO2 = 82 percent. The monitor shows sinus tachycardia. Which of these is the highest priority when treating this patient? A) Immediate transport B) Determining whether the patient has a Do Not Resuscitate order C) Dopamine infusion D) Ventilation Answer: D Diff: 3 Page Ref: 1121 Standard: Medicine (Cardiovascular) Objective: 16 37) Measures to treat cardiogenic shock include all of these EXCEPT: A) reducing stroke volume. B) increasing the contractile force. C) improving preload. D) reducing peripheral resistance. Answer: A Diff: 2 Page Ref: 1155 Standard: Medicine (Cardiovascular) Objective: 11 38) PSVT is least likely to occur secondary to: A) stress. B) Wolff-Parkinson-White syndrome. C) myocardial infarction. D) ingestion of caffeine. Answer: C Diff: 2 Page Ref: 1097-1098 Standard: Medicine (Cardiovascular) Objective: 7

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39) A 35-year-old male is complaining of a headache, blurred vision, nausea, and vomiting. He has a history of hypertension but is noncompliant with his medications. His pupils are equal and reactive, his skin is warm and dry, and his breath sounds are clear and equal bilaterally. HR = 122, BP = 202/138, RR = 12, SaO2 = 91 percent. In addition to monitoring his cardiac rhythm, administering oxygen, and starting an IV at a KVO rate, which of these is most appropriate? A) Labetalol, IV B) Diazepam, IV C) Nitroglycerin, SL D) Morphine, IV Answer: A Diff: 3 Page Ref: 1154 Standard: Medicine (Cardiovascular) Objective: 11 40) Which of these most accurately describes the etiology of Wolff-Parkinson-White syndrome? A) Presence of an accessory conduction pathway B) Idiopathic C) Increased automaticity D) Shifting supraventricular pacemaker sites Answer: A Diff: 2 Page Ref: 1098 Standard: Medicine (Cardiovascular) Objective: 7 41) Which of these is NOT considered a modifiable risk factor for coronary artery disease? A) Stress B) Gender C) Obesity D) Diet Answer: B Diff: 1 Page Ref: 1065 Standard: Medicine (Cardiovascular) Objective: 2 42) Signs and symptoms of decreased tissue perfusion secondary to cardiogenic shock include all of these findings EXCEPT: A) altered mental status. B) cold, diaphoretic skin. C) constricted pupils. D) tachypnea. Answer: C Diff: 2 Page Ref: 1155 Standard: Medicine (Cardiovascular) Objective: 10

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43) Which of these rhythms requires transcutaneous pacing? A) Supraventricular tachycardia B) Junctional tachycardia C) Sinus bradycardia D) Symptomatic third-degree AV block Answer: D Diff: 2 Page Ref: 1090-1091 Standard: Medicine (Cardiovascular) Objective: 9 44) A 64-year-old female is alert and oriented, in moderate respiratory distress, and complaining of chest pain. She describes an acute onset of right-sided chest pain that radiates across her chest. Physical examination reveals cold, diaphoretic skin; lung sounds with crackles bilaterally; JVD; and peripheral edema. Medical history includes hypertension, prior myocardial infarction, and heart failure. HR = 118, BP = 86/56, RR = 26, SaO2 = 92 percent. Which of these is appropriate in the prehospital treatment of this patient? A) Dopamine B) Nitroglycerin C) Amiodarone D) Morphine Answer: A Diff: 3 Page Ref: 1133 Standard: Medicine (Cardiovascular) Objective: 16 45) Which of these variables is affected by a properly working pacemaker? A) Automaticity B) Stroke volume C) Cardiac rhythm D) Ejection fraction Answer: C Diff: 2 Page Ref: 1119 Standard: Medicine (Cardiovascular) Objective: 6 46) An ECG monitor is useful for: A) determining cardiac output. B) detecting the total electrical activity within the heart. C) determining stroke volume. D) evaluating the effectiveness of cardiac contractions. Answer: B Diff: 1 Page Ref: 1080 Standard: Medicine (Cardiovascular) Objective: 4

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47) The heart sound produced by the closing of the aortic and pulmonary valves is: A) S4. B) S2. C) S3. D) S1. Answer: B Diff: 2 Page Ref: 1129 Standard: Medicine (Cardiovascular) Objective: 8 48) The most common cause of death resulting from myocardial infarction is: A) end-organ failure. B) inadequate tissue perfusion. C) heart failure. D) dysrhythmia. Answer: D Diff: 2 Page Ref: 1142 Standard: Medicine (Cardiovascular) Objective: 10 49) Which of these most accurately describes a Valsalva maneuver? A) Firmly pressing the carotid artery against the transverse process of the vertebra behind it B) Asking the patient to bear down as if to move his bowels with his nose and mouth closed C) Digital rectal stimulation D) Immersing the face in cold water Answer: B Diff: 2 Page Ref: 1073 Standard: Medicine (Cardiovascular) Objective: 9 50) Which of these is the least likely cause of PEA? A) Hypertension B) Hypovolemia C) Cardiac tamponade D) Tension pneumothorax Answer: A Diff: 2 Page Ref: 1121 Standard: Medicine (Cardiovascular) Objective: 7

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51) Your patient is a 58-year-old female who is confused and dyspneic. Her daughter called EMS because the patient complained of a fluttering sensation in her chest, followed a few minutes later by chest pain and an acute onset of confusion. She is pale and diaphoretic without a palpable radial pulse. The monitor shows a narrow complex rhythm at a rate of 180. Which of these is most appropriate? A) Valsalva maneuver B) IV adenosine C) Immediate synchronized cardioversion D) IV diltiazem Answer: C Diff: 3 Page Ref: 1130 Standard: Medicine (Cardiovascular) Objective: 16 52) A junctional escape beat occurs when: A) the AV junction becomes irritable and temporarily overrides the SA node. B) there is a conduction block between the SA node and AV node. C) there is an accessory pathway that causes reentry of the impulse at the AV node. D) the rate of the SA node is slower than that of the AV node. Answer: D Diff: 2 Page Ref: 1107 Standard: Medicine (Cardiovascular) Objective: 7 53) Release of acetylcholine at the neuroeffector junction would result in a(n): A) increase of both sympathetic and parasympathetic tone. B) positive dromotropic effect. C) negative chronotropic effect. D) positive inotropic effect. Answer: C Diff: 2 Page Ref: 1073 Standard: Medicine (Cardiovascular) Objective: 3 54) Myocardial ischemia may result in: A) J waves. B) ST segment depression. C) QRS duration greater than 0.12 seconds. D) inverted P waves. Answer: B Diff: 2 Page Ref: 1087 Standard: Medicine (Cardiovascular) Objective: 15

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55) Auscultation of an S3 is associated with: A) mitral valve prolapse. B) increased force of atrial contraction. C) aortic stenosis. D) congestive heart failure. Answer: D Diff: 2 Page Ref: 1129 Standard: Medicine (Cardiovascular) Objective: 8 56) Which of these ECG findings is least anticipated in a patient experiencing an acute myocardial infarction? A) Osborn wave B) ST elevation C) ST depression D) QRS greater than 0.12 seconds Answer: A Diff: 2 Page Ref: 1178 Standard: Medicine (Cardiovascular) Objective: 7 57) Excessive preload over time would lead to: A) decreased capacity of the left ventricle. B) strengthening of the left ventricle. C) increased ejection fraction of the left ventricle. D) weakening of the left ventricle. Answer: D Diff: 2 Page Ref: 1073 Standard: Medicine (Cardiovascular) Objective: 10 58) The base of the heart lies at the level of which rib? A) First B) Third C) Second D) Fourth Answer: C Diff: 1 Page Ref: 1066 Standard: Medicine (Cardiovascular) Objective: 3

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59) Your patient is a 32-year-old female, 30 weeks' pregnant, complaining of shortness of breath and palpitations. She is alert and oriented, though anxious; her skin is cool and moist, and her radial pulse is weak and rapid, but regular. HR = 180, BP = 100/72, RR = 24. The monitor shows supraventricular tachycardia. After applying oxygen by nonrebreather and starting an IV of normal saline, which of these is most appropriate? A) 150 mg of amiodarone B) Transport without further intervention C) 6 mg of adenosine D) 2 mg of Versed and cardioversion beginning at 50 joules Answer: C Diff: 3 Page Ref: 1099 Standard: Medicine (Cardiovascular) Objective: 16 60) Which of these occurs during depolarization of a cardiac cell? A) Sodium moves out of the cell. B) The cell becomes relatively more positively charged. C) Potassium moves into the cell. D) The cell becomes negatively charged. Answer: B Diff: 2 Page Ref: 1077-1078 Standard: Medicine (Cardiovascular) Objective: 3 61) Poiseuille's law specifically states that blood flow through a vessel is directly proportional to which power of the vessel's radius? A) Fourth power B) Third power C) Second power D) Tenth power Answer: A Diff: 1 Page Ref: 1070 Standard: Medicine (Cardiovascular) Objective: 3 62) Which of these is least likely to be associated with the pain of acute myocardial infarction? A) Pain described as sharp B) Discomfort lasting longer than 30 minutes C) Radiation to arms and neck D) Pain reproducible with palpation Answer: D Diff: 2 Page Ref: 1143-1144 Standard: Medicine (Cardiovascular) Objective: 10

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63) A 63-year-old male is alert and oriented, complaining of dizziness. He describes an acute onset of dizziness and near-syncope that has lasted for 15 minutes. He is also experiencing substernal chest pain radiating to his jaw, as well as nausea and weakness. Physical examination reveals cool, diaphoretic skin; delayed capillary refill; and mild crackles to the bases bilaterally. He has no significant medical history, but he takes 325 mg of aspirin a day. HR = 220, BP = 88/52, RR = 16, SaO2 = 92 percent. Which of these should be done first? A) Start an IV of normal saline B) Synchronized cardioversion C) Oxygen by nonrebreathing mask D) Administer 0.4 mg of nitroglycerin sublingually Answer: C Diff: 3 Page Ref: 1166 Standard: Medicine (Cardiovascular) Objective: 11 64) Your patient in atrial fibrillation has a heart rate of 108 on the monitor, but her radial pulse is 88/min. The patient is experiencing: A) paradoxical pulse. B) pulsus obliterans. C) pulse deficit. D) pulsus alternans. Answer: C Diff: 2 Page Ref: 1102 Standard: Medicine (Cardiovascular) Objective: 10 65) Paramedics use all of these interventions to treat congestive heart failure EXCEPT: A) sitting the patient upright. B) decreasing patient anxiety. C) administering oxygen D) administering fluid bolus. Answer: D Diff: 2 Page Ref: 1150 Standard: Medicine (Cardiovascular) Objective: 11

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66) A 48-year-old male is complaining of chest pain that he describes as dull, located substernally, but radiating to his neck. He rates the pain a 6 on a scale of 1 to 10 and complains of nausea and lightheadedness. His skin is cool and diaphoretic. HR = 96, BP = 124/82, RR = 14, SaO2 = 97 percent. The 12-lead ECG is nondiagnostic. In addition to oxygen, an IV of normal saline at a keep open rate, and transport to the emergency department, which of these would be most appropriate? A) Nitroglycerin, morphine, and furosemide B) Reassurance that likely his condition is not cardiac in nature C) Nitroglycerin D) Aspirin, nitroglycerin, and morphine Answer: D Diff: 3 Page Ref: 1133 Standard: Medicine (Cardiovascular) Objective: 16 67) The amount of resistance that must be overcome by the left ventricle during systole is called: A) stroke volume. B) preload. C) cardiac output. D) afterload. Answer: D Diff: 1 Page Ref: 1073 Standard: Medicine (Cardiovascular) Objective: 1 68) Signs and/or symptoms of a dissecting thoracic aneurysm include all of these EXCEPT: A) hypotension. B) chest pain. C) palpable pulsating mass. D) difficulty breathing. Answer: C Diff: 2 Page Ref: 1164 Standard: Medicine (Cardiovascular) Objective: 10 69) Your patient is a 73-year-old male who is sitting in a recliner, cyanotic, pulseless, and apneic. The patient's skin is cool and dry. The patient's wife last saw him an hour and a half ago. Which of these should you do first? A) Check for rigor mortis. B) Start CPR. C) Attach the monitor/defibrillator. D) Inform the patient's wife that he is dead and nothing can be done for him. Answer: A Diff: 2 Page Ref: 1161 Standard: Medicine (Cardiovascular) Objective: 14 41 Copyright © 2023 Pearson Education, Inc.

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70) The QRS complex represents: A) ventricular depolarization. B) atrial repolarization. C) atrial depolarization. D) ventricular repolarization. Answer: A Diff: 1 Page Ref: 1083 Standard: Medicine (Cardiovascular) Objective: 6 71) Pharmacological interventions initiated by prehospital care providers in the treatment of congestive heart failure exacerbation may include all of these EXCEPT: A) dopamine. B) atropine. C) furosemide. D) nitroglycerin. Answer: B Diff: 2 Page Ref: 1150-1151 Standard: Medicine (Cardiovascular) Objective: 11 72) Stroke volume × heart rate × systemic vascular resistance = A) blood pressure. B) ejection fraction. C) cardiac output. D) end-diastolic pressure. Answer: A Diff: 1 Page Ref: 1073 Standard: Medicine (Cardiovascular) Objective: 1 73) Cardioversion can be used to treat all of these rhythms EXCEPT: A) ventricular tachycardia with a pulse. B) rapid atrial fibrillation. C) ventricular fibrillation. D) supraventricular tachycardia. Answer: C Diff: 2 Page Ref: 1135-1136 Standard: Medicine (Cardiovascular) Objective: 9

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74) You have begun transcutaneous pacing of a 52-year-old male who is in third-degree heart block. He was initially unresponsive to all stimuli, with a pulse of 32, blood pressure 60 by palpation, and a respiratory rate of 12. Which of these is least helpful when determining the effectiveness of transcutaneous pacing? A) Evidence of mechanical capture of the ventricle B) Increased level of consciousness C) Evidence of electrical capture of the ventricle D) Increased blood pressure Answer: C Diff: 2 Page Ref: 1136 Standard: Medicine (Cardiovascular) Objective: 11 75) Claudication is significant because it: A) leads to glaucoma when left untreated. B) indicates the presence of atherosclerosis. C) results from inadequate coronary artery perfusion. D) results in inadequate cerebral perfusion. Answer: B Diff: 2 Page Ref: 1162 Standard: Medicine (Cardiovascular) Objective: 1 76) Common chief complaints and symptoms associated with cardiac disease include all of these EXCEPT (select most unlikely complaint): A) dyspnea. B) syncope. C) chest pain. D) vertigo. Answer: D Diff: 1 Page Ref: 1125 Standard: Medicine (Cardiovascular) Objective: 8 77) The lead to the left of the sternum at the fourth intercostal space is: A) V1. B) V2. C) V3. D) V4. Answer: B Diff: 2 Page Ref: 1170 Standard: Medicine (Cardiovascular) Objective: 15

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78) An accelerated junctional rhythm has a rate between A) 40, 60 B) 20, 40 C) 100, 150 D) 60, 100 Answer: D Diff: 1 Page Ref: 1109 Standard: Medicine (Cardiovascular) Objective: 7

and

per minute.

79) Which of these is most commonly associated with multifocal atrial tachycardia? A) Acute myocardial infarction B) Digitalis toxicity C) Pulmonary disease D) Use of cocaine, amphetamines, or caffeine Answer: C Diff: 1 Page Ref: 1096 Standard: Medicine (Cardiovascular) Objective: 10 80) The mitral valve is also known as the: A) pulmonic valve. B) right atrioventricular valve. C) left atrioventricular valve. D) tricuspid valve. Answer: C Diff: 1 Page Ref: 1067 Standard: Medicine (Cardiovascular) Objective: 3 81) A decrease in preload results in a(n): A) decrease in afterload. B) decrease in cardiac output. C) increase in stroke volume. D) decrease in peripheral vascular resistance. Answer: B Diff: 2 Page Ref: 1073 Standard: Medicine (Cardiovascular) Objective: 10

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82) Your patient has a history of progressively worsening angina that comes on at rest. This most commonly indicates what condition? A) Prinzmetal's angina B) Ludwig's angina C) Decubitus angina D) Unstable angina Answer: D Diff: 1 Page Ref: 1140 Standard: Medicine (Cardiovascular) Objective: 10 83) An early sign of hyperkalemia is: A) flat T waves on an ECG. B) widening of the QT interval. C) presence of an Osborn wave. D) tall, peaked T waves on an ECG. Answer: D Diff: 2 Page Ref: 1122-1123 Standard: Medicine (Cardiovascular) Objective: 7 84) The intrinsic firing rate of the AV node is A) 40, 60 B) 20, 40 C) 60, 80 D) 80, 100 Answer: A Diff: 1 Page Ref: 1079 Standard: Medicine (Cardiovascular) Objective: 3

beats per minute.

85) The predominant effect of a drug with primarily alpha properties would result in which of these? A) Vasodilation B) Increased heart rate C) Decreased heart rate D) Vasoconstriction Answer: D Diff: 2 Page Ref: 1073 Standard: Medicine (Cardiovascular) Objective: 3

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86) Which of these is the correct sequence of cardiac electrical activity? 1. AV node 2. Internodal pathways 3. Bundle of His 4. SA node 5. Purkinje fibers 6. Bundle branches A) 1, 2, 4, 3, 6, 5 B) 4, 1, 2, 3, 6, 5 C) 1, 2, 4, 3, 5, 6 D) 4, 2, 1, 3, 6, 5 Answer: D Diff: 2 Page Ref: 1079 Standard: Medicine (Cardiovascular) Objective: 3 87) A 12-lead ECG that reveals slight ST segment elevation; Q waves in leads II, III, and aVF; and ST elevation in V1 and V2 most indicate which of these? A) The patient is experiencing myocardial ischemia in her inferior wall that is extending into the septum. B) The patient is experiencing myocardial injury in her lateral wall. C) The patient has had a myocardial infarction in her inferior wall and is experiencing ischemia extending into the left ventricle. D) The patient is experiencing ischemia and injury in her left ventricle and septum. Answer: C Diff: 3 Page Ref: 1182 Standard: Medicine (Cardiovascular) Objective: 15 88) The pericardial cavity normally holds about _ A) 30, blood B) 1 to 2, serous fluid C) 100, blood D) 25, straw-colored lubricant Answer: D Diff: 1 Page Ref: 1066 Standard: Medicine (Cardiovascular) Objective: 3

mL of

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89) Your patient is a 55-year-old male who is in moderate distress and complaining of chest pain. He states that he experienced an acute onset of left-sided crushing chest pain while playing basketball with his grandson. He complains of weakness and near-syncope with exertion. His skin is pale, cool, and diaphoretic. HR = 40, BP = 72/40, RR = 20, SaO2 = 95 percent. The monitor shows a third-degree AV block. Which of these is most appropriate? A) Sedation and transcutaneous pacing B) Atropine, 0.5 mg, up to 2.0 mg C) Dopamine at 5 mcg/kg/min D) Aspirin, nitroglycerin, and morphine Answer: A Diff: 3 Page Ref: 1136 Standard: Medicine (Cardiovascular) Objective: 16 90) Which of these will not occur even though there is increased venous return to the heart? A) Myocardial stretch B) Afterload C) Stroke volume D) Myocardial contraction Answer: B Diff: 2 Page Ref: 1073 Standard: Medicine (Cardiovascular) Objective: 3 91) Which of these is NOT a consideration when deciding to withhold resuscitative efforts? A) Documentation of the patient's wishes B) Patient's age C) The nature of injury D) Indications of the "down time" Answer: C Diff: 1 Page Ref: 1161 Standard: Medicine (Cardiovascular) Objective: 14 92) Which of these ECG findings would indicate a possible pacemaker failure? A) Occasional QRS complexes without pacer spikes B) A QRS duration of 0.20 seconds C) Pacemaker spikes without associated QRS complexes D) A pacemaker spike preceding each P wave Answer: C Diff: 2 Page Ref: 1120 Standard: Medicine (Cardiovascular) Objective: 7

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93) An elevation of the ST segment is associated with: A) hyperkalemia. B) left ventricular hypertrophy. C) slowed conduction through the AV node. D) myocardial injury. Answer: D Diff: 2 Page Ref: 1139-1140 Standard: Medicine (Cardiovascular) Objective: 15 94) The single largest killer of Americans each year is: A) coronary artery disease. B) suicide. C) stroke. D) congestive heart failure. Answer: A Diff: 1 Page Ref: 1065 Standard: Medicine (Cardiovascular) Objective: 2 95) Which of these has NOT been proven to increase the risk of cardiovascular disease? A) Smoking B) Age C) Hypercholesterolemia D) Obesity Answer: D Diff: 1 Page Ref: 1065 Standard: Medicine (Cardiovascular) Objective: 2 96) The right atrioventricular valve is also referred to as which valve? A) Tricuspid B) Bicuspid C) Aortic D) Pulmonary Answer: A Diff: 1 Page Ref: 1067 Standard: Medicine (Cardiovascular) Objective: 3

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97) The left atrioventricular valve is also referred to as which valve? A) Tricuspid B) Mitral C) Aortic D) Pulmonary Answer: B Diff: 1 Page Ref: 1067 Standard: Medicine (Cardiovascular) Objective: 3 98) The right ventricle pushes blood to the lungs through the: A) pulmonary vein. B) pulmonary artery. C) pulmonary pathway. D) pulmonary vena cava. Answer: B Diff: 1 Page Ref: 1068 Standard: Medicine (Cardiovascular) Objective: 3 99) During which phase of the cardiac cycle does ventricular filling begin? A) Systole B) Diastole C) Refractory D) Absolute refractory Answer: B Diff: 1 Page Ref: 1071 Standard: Medicine (Cardiovascular) Objective: 3 100) The pressure in the ventricle at the end of diastole is called: A) afterload. B) Starling's law. C) stroke volume. D) preload. Answer: D Diff: 1 Page Ref: 1071 Standard: Medicine (Cardiovascular) Objective: 3

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101) Starling's law states that: A) the greater the contraction, the higher the afterload. B) the preload determines the cardiac output. C) the more the myocardial muscle is stretched, the greater the contraction. D) for every action, there is an equal and opposite reaction. Answer: C Diff: 1 Page Ref: 1073 Standard: Medicine (Cardiovascular) Objective: 3 102) Cardiac output is: A) stroke volume × heart rate. B) stroke volume × diastolic pressure. C) heart rate × preload. D) afterload × preload. Answer: A Diff: 1 Page Ref: 1073 Standard: Medicine (Cardiovascular) Objective: 3 103) Blood pressure is defined as: A) stroke volume × heart rate × SVR. B) stroke volume × diastolic pressure × SVE. C) heart rate × preload × SVR. D) afterload × preload × SVE. Answer: A Diff: 1 Page Ref: 1073 Standard: Medicine (Cardiovascular) Objective: 3 104) Brain natriuretic peptide (BNP) levels are useful in determining: A) CAD. B) CVA. C) CHF. D) COPD. Answer: C Diff: 2 Page Ref: 1076 Standard: Medicine (Cardiovascular) Objective: 3

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105) Cardiac muscle is different from smooth muscle in the fact that it has: A) different nerve pathways. B) automaticity. C) peristalsis. D) There is no difference. Answer: B Diff: 1 Page Ref: 1079 Standard: Medicine (Cardiovascular) Objective: 3 106) The intrinsic rate of the SA node is: A) set by the sympathetic nervous system. B) 15-40 bpm. C) 60-100 bpm. D) 40-60 bpm. Answer: C Diff: 1 Page Ref: 1079 Standard: Medicine (Cardiovascular) Objective: 3 107) The intrinsic rate of the AV node is: A) set by the sympathetic nervous system. B) 15-40 bpm. C) 60-100 bpm. D) 40-60 bpm. Answer: D Diff: 1 Page Ref: 1079 Standard: Medicine (Cardiovascular) Objective: 3 108) The intrinsic rate of the Purkinje system is: A) 10-20 bpm. B) 15-40 bpm. C) 60-100 bpm. D) 40-60 bpm. Answer: B Diff: 1 Page Ref: 1079 Standard: Medicine (Cardiovascular) Objective: 3

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109) On an ECG tracing, positive impulses are seen as: A) downward deflections. B) upward deflections. C) ST segment. D) J point. Answer: B Diff: 1 Page Ref: 1080 Standard: Medicine (Cardiovascular) Objective: 4 110) On an ECG tracing, negative impulses are seen as: A) downward deflections. B) upward deflections. C) ST segment. D) J point. Answer: A Diff: 1 Page Ref: 1080 Standard: Medicine (Cardiovascular) Objective: 4 111) You are evaluating your patient's ECG under fluorescent lights. You notice significant artifact due to: A) machine malfunction. B) 60 hertz interference. C) poor eyesight. D) road noise. Answer: B Diff: 2 Page Ref: 1080 Standard: Medicine (Cardiovascular) Objective: 4 112) One small box on the ECG paper indicates: A) 0.20 seconds. B) 0.04 seconds. C) 2 seconds. D) 4 seconds. Answer: B Diff: 1 Page Ref: 1082 Standard: Medicine (Cardiovascular) Objective: 4

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113) One large box on the ECG paper indicates: A) 0.20 seconds. B) 0.04 seconds. C) 2 seconds. D) 4 seconds. Answer: A Diff: 1 Page Ref: 1082 Standard: Medicine (Cardiovascular) Objective: 4 114) Atrial depolarization is represented on the ECG by the: A) P wave. B) ORS. C) T wave. D) J point. Answer: A Diff: 1 Page Ref: 1083 Standard: Medicine (Cardiovascular) Objective: 5 115) Ventricular depolarization is represented on the ECG by the: A) P wave. B) QRS complex. C) T wave. D) J point. Answer: B Diff: 1 Page Ref: 1083 Standard: Medicine (Cardiovascular) Objective: 5 116) Ventricular repolarization is represented on the ECG by the: A) P wave. B) QRS complex. C) T wave. D) J point. Answer: C Diff: 1 Page Ref: 1083 Standard: Medicine (Cardiovascular) Objective: 5

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117) Normal interval time for the PR interval is: A) 0.04-0.12 second. B) 0.33-0.42 second. C) 0.12-0.20 second. D) 1.20-2.00 seconds. Answer: C Diff: 1 Page Ref: 1086 Standard: Medicine (Cardiovascular) Objective: 5 118) Normal interval time for the QRS complex is: A) 0.04-0.12 second. B) 0.33-0.42 second. C) 0.12-0.20 second. D) 1.20-2.00 seconds. Answer: A Diff: 1 Page Ref: 1086 Standard: Medicine (Cardiovascular) Objective: 5 119) Normal interval time for the QT interval is: A) 0.04-0.12 second. B) 0.33-0.42 second. C) 0.12-0.20 second. D) 1.20-2.00 seconds. Answer: B Diff: 1 Page Ref: 1086 Standard: Medicine (Cardiovascular) Objective: 5 120) The five-step procedure for analyzing ECGs includes all of these EXCEPT: A) rate. B) P wave. C) QRS complex. D) V1. Answer: D Diff: 1 Page Ref: 1088 Standard: Medicine (Cardiovascular) Objective: 6

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121) Treatment of sinus tachycardia is aimed at: A) adenosine. B) calcium channel blockers. C) beta blockers. D) treating the underlying cause. Answer: D Diff: 1 Page Ref: 1091 Standard: Medicine (Cardiovascular) Objective: 9 122) You are transporting a patient who is having wild changes in his heart rate, an irregular R-R interval, and a history of taking Lanoxin. The patient is now becoming pale, cool, and clammy, with an MAP of 60. You should: A) not worry, as this is a normal presentation. B) begin TCP and consider a catecholamine infusion. C) infuse a calcium channel blocker. D) start an amiodarone drip. Answer: B Diff: 2 Page Ref: 1094 Standard: Medicine (Cardiovascular) Objective: 9 123) A potassium level of 3.0 would commonly be associated with which ECG finding? A) T wave merging with QRS B) Delta wave C) U wave D) Flattening T wave Answer: D Diff: 3 Page Ref: 1122 Standard: Medicine (Cardiovascular) Objective: 7 124) A potassium level of 8.0 would commonly be associated with which ECG finding? A) T wave merging with QRS B) Delta wave C) U wave D) Flattening T wave Answer: A Diff: 3 Page Ref: 1123 Standard: Medicine (Cardiovascular) Objective: 7

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125) Diaphoresis exhibited in a patient actively having an MI is due to: A) sympathetic response. B) parasympathetic response. C) increased metabolism. D) increased myocardial demand. Answer: A Diff: 2 Page Ref: 1126 Standard: Medicine (Cardiovascular) Objective: 8 126) A parasympatholytic agent used to treat symptomatic bradycardia is: A) Atrovent. B) Atropine. C) Epinephrine. D) Levophed. Answer: B Diff: 2 Page Ref: 1132 Standard: Medicine (Cardiovascular) Objective: 9 127) The loading dose of norepinephrine is: A) 2-4 mcg/min. B) 2-4 mg/ min. C) 8-10 mcg/min. D) 8-10 mg/min. Answer: C Diff: 2 Page Ref: 1133 Standard: Medicine (Cardiovascular) Objective: 9 128) Myocardial ischemia is caused by an imbalance of: A) oxygen supply and demand. B) oxygen bioavailability. C) free radical oxygen. D) sodium bicarbonate. Answer: A Diff: 1 Page Ref: 1139 Standard: Medicine (Cardiovascular) Objective: 10

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129) Vasospasms associated with chest pain are known as: A) stable angina. B) Prinzmetal's angina. C) variant angina. D) James' angina. Answer: B Diff: 2 Page Ref: 1139 Standard: Medicine (Cardiovascular) Objective: 10 130) A patient with known arteriosclerosis was outside doing lawn work when he started experiencing chest pain. Upon your arrival, the patient states that he has been resting and took a prescribed nitroglycerin tablet 5 minutes ago. The patient states that the pain is subsiding. You suspect: A) unstable angina. B) stable angina. C) Prinzmetal's angina. D) myocardial infarction. Answer: B Diff: 2 Page Ref: 1138 Standard: Medicine (Cardiovascular) Objective: 11 131) Life-threatening arrhythmias can result in death of the AMI patient as soon as: A) 3 hours after onset. B) 4 hours after onset. C) 2 hours after onset. D) 1 hour after onset. Answer: D Diff: 1 Page Ref: 1142 Standard: Medicine (Cardiovascular) Objective: 10 132) A pathological Q wave indicating infarction should measure: A) >0.004 second. B) <0.12 second. C) <0.32 second. D) >0.04 second. Answer: D Diff: 2 Page Ref: 1142 Standard: Medicine (Cardiovascular) Objective: 10

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133) The maximum window of time a fibrinolytic can be administered is: A) 8 hours after onset of symptoms. B) 12 hours after onset of symptoms. C) 24 hours after onset of symptoms. D) 6 hours after onset of symptoms. Answer: D Diff: 1 Page Ref: 1144 Standard: Medicine (Cardiovascular) Objective: 11 134) Sudden death is described as: A) any death without a direct known cause. B) any death occurring within 1 hour of onset of symptoms. C) any death occurring within 3 hours of onset of symptoms. D) all death is sudden death. Answer: B Diff: 1 Page Ref: 1156 Standard: Medicine (Cardiovascular) Objective: 10 135) Which of these is NOT a phase of cardiac arrest? A) Electrical phase B) Circulatory phase C) Rigor mortis phase D) Metabolic phase Answer: C Diff: 1 Page Ref: 1156 Standard: Medicine (Cardiovascular) Objective: 12 136) You are transporting a cardiac arrest patient when you achieve ROSC. You now want to keep the patient's systolic blood pressure in the range of: A) 120-130 mmHg. B) 60-70 mmHg. C) 80-100 mmHg. D) 20-40 mmHg. Answer: C Diff: 2 Page Ref: 1133 Standard: Medicine (Cardiovascular) Objective: 13

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137) You have been on the scene of a 55-year-old cardiac arrest patient for 30 minutes. You have full ALS care initiated, with no response to therapy. You should: A) consider termination of the arrest. B) transport immediately. C) keep working until you get a change. D) consider defibrillating at 360 joules. Answer: A Diff: 2 Page Ref: 1160-1161 Standard: Medicine (Cardiovascular) Objective: 14 138) You run a 12-lead ECG on a patient exhibiting chest pain. It reveals ST segment elevation in leads II, III, and aVF, with reciprocal in leads aVL and I. You suspect: A) anterior MI. B) lateral MI. C) inferior MI. D) high lateral wall MI. Answer: C Diff: 3 Page Ref: 1182 Standard: Medicine (Cardiovascular) Objective: 16 139) You are called for a patient experiencing SOB. The patient is also a diabetic, so you perform a 12-lead ECG. It shows ST segment elevation in leads V1, V2, V3, and V4 with reciprocal changes in leads V5, V6, II, III, and aVF. You suspect: A) septal-anterior MI. B) inferoseptal MI. C) lateral MI. D) inferior MI. Answer: A Diff: 3 Page Ref: 1183 Standard: Medicine (Cardiovascular) Objective: 16 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 34 Neurology 1) Your patient states that he often experiences a painful cramping and "freezing up" of his hands and feet while handwriting or walking, respectively. This best describes: A) torticollis. B) dystonia. C) palsy. D) myoclonus. Answer: B 59 Copyright © 2023 Pearson Education, Inc.

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Diff: 1 Page Ref: 1242 Standard: Medicine (Neurology) Objective: 1 2) Which of these is a risk factor for stroke? A) Atrial fibrillation B) Premature atrial contractions C) First-degree heart block D) Sinus arrhythmia Answer: A Diff: 1 Page Ref: 1217 Standard: Medicine (Neurology) Objective: 4 3) Which of these is caused by unilateral paralysis of cranial nerve VII? A) Dystonia B) Bell's palsy C) Autonomic dysreflexia D) Myoclonus Answer: B Diff: 1 Page Ref: 1238-1239 Standard: Medicine (Neurology) Objective: 1

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4) Your patient is a 55-year-old male with a history of seizures who is on the floor and experiencing tonic-clonic motor activity. His jaw is clenched, he has peripheral cyanosis, and there are frothy secretions in his airway. HR = 130, RR = 4 and shallow, SaO2 = 88 percent. Which of these is most appropriate? A) Suctioning the airway, inserting a nasopharyngeal airway, assisting respirations by bag-valvemask device with 100 percent oxygen B) Immediate nasal intubation and hyperventilation with 100 percent oxygen C) An IV of normal saline at a keep open rate, check blood glucose level, administer 3 mg of lorazepam, IV D) An IV of normal saline at a keep open rate, check blood glucose level, administer 5 mg of diazepam, IV Answer: A Diff: 3 Page Ref: 1236 Standard: Medicine (Neurology) Objective: 7 5) Your patient is a 45-year-old female type I diabetic with a history of a nonhealing foot ulcer. On examination, you find that her pedal pulse is present, but she lacks sensation in her foot. This is most likely due to: A) Brown-Séquard syndrome. B) Raynaud's disease. C) peripheral neuropathy. D) claudication. Answer: C Diff: 1 Page Ref: 1226 Standard: Medicine (Neurology) Objective: 6 6) Your patient is a 48-year-old female who is alert and oriented after a possible seizure. Her friends state they witnessed her slump to the floor and "shake" for about 15 seconds. She awoke in less than 1 minute and was "a bit groggy" for a few minutes. She does not believe she had a seizure but thinks she may have fainted. Which of these questions is LEAST important when differentiating seizure and syncope? A) "Are you allergic to any medications?" B) "What kind of medications do you take?" C) "Do you have a history of seizures?" D) "What happened just before the event?" Answer: A Diff: 2 Page Ref: 1235 Standard: Medicine (Neurology) Objective: 5

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7) You have been called for a 46-year-old female complaining of a headache. Which of these statements made by the patient should you find most concerning? A) "I have never had a headache this bad." B) "The pain gets worse when the lights are on." C) "I have never been nauseated like this with a headache before." D) "I took two Tylenol tablets 2 hours ago, and the pain is still there." Answer: A Diff: 2 Page Ref: 1238 Standard: Medicine (Neurology) Objective: 7 8) Your patient is a 76-year-old female who was initially lethargic but responded to verbal stimuli. According to family members, the patient experienced a sudden decrease in responsiveness. She had a left-sided facial droop, aphasia, a dilated and nonreactive right pupil, and a flaccid left arm. Lung sounds are decreased bilaterally. HR = 58, BP = 172/102, RR = 6 and shallow, SaO2 = 88 percent. As you start to treat her, the patient has a generalized seizure lasting about 30 seconds. She is now unresponsive. Which of these is most appropriate? A) Intubation, IV of normal saline at a keep open rate, cardiac monitor, blood glucose determination, sublingual nitroglycerin spray, transport without delay B) Hyperventilate by bag-valve-mask, IV of normal saline at a keep open rate, check blood glucose level, administer 25 gm of dextrose if needed, administer naloxone and thiamine, intubate if no improvement, transport without delay C) Intubation, IV of normal saline at a keep open rate, cardiac monitor, blood glucose determination, transport without delay D) Hyperventilate by bag-valve-mask, IV of normal saline at a keep open rate, diazepam 5 mg IV, intubate if no improvement, transport without delay Answer: C Diff: 3 Page Ref: 1233 Standard: Medicine (Neurology) Objective: 7 9) Your patient is a 32-year-old female who is alert but in significant distress, complaining of a migraine. She has a history of migraines, describes a gradual onset of headache this morning, and is now experiencing nausea and intense throbbing pain behind her temples. She is lying on a couch in a dim room and keeps her eyes closed while talking to you in a low voice. HR = 100, BP = 148/100, RR = 12, SaO2 = 99 percent. Which of these is most appropriate in the prehospital management of this patient? A) Morphine sulfate, IV in 2 mg increments, up to 10 mg B) NTG SL, 0.4 mg, up to 3 tablets or a diastolic blood pressure of 80 mmHg C) A calm, quiet environment and dim lights D) Lorazepam, 2 mg Answer: C Diff: 3 Page Ref: 1233 Standard: Medicine (Neurology) Objective: 6

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10) Your patient is a 62-year-old female who is alert and oriented and sitting at her kitchen table. Her husband describes an episode of slurred speech and facial drooping that lasted about 10 minutes and resolved just before your arrival. Physical examination is unremarkable. She has no significant medical history and takes no medications. HR = 78, BP = 134/78, RR = 12, SaO2 = 99 percent. Which of these is most likely? A) Absence seizure B) Stroke C) Ménière's disease D) Transient ischemic attack Answer: D Diff: 2 Page Ref: 1224-1225 Standard: Medicine (Neurology) Objective: 5 11) A series of two or more generalized motor seizures without an intervening period of consciousness is known as: A) status epilepticus. B) hypertonic seizures. C) a complex partial seizure. D) a petit mal seizure. Answer: A Diff: 1 Page Ref: 1236 Standard: Medicine (Neurology) Objective: 1 12) Which of these infectious childhood diseases would most likely result in paralysis? A) Spina bifida B) German measles C) Rubella D) Poliomyelitis Answer: D Diff: 1 Page Ref: 1244 Standard: Medicine (Neurology) Objective: 1 13) The most common cause of dementia is: A) Bell's palsy. B) stroke. C) Alzheimer's disease. D) Korsakoff's psychosis. Answer: C Diff: 2 Page Ref: 1241 Standard: Medicine (Neurology) Objective: 5

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14) A seizure that begins as an electrical discharge in a small area of the brain but spreads to include the entire cerebral cortex known as what type of seizure? A) Complex partial B) Myoclonic C) Generalized D) Simple partial Answer: C Diff: 1 Page Ref: 1234 Standard: Medicine (Neurology) Objective: 5 15) You should most highly suspect that a patient with tremors, periodic muscular rigidity, slowed movement, and impaired balance and coordination suffers from: A) peripheral neuralgia. B) amyotrophic lateral sclerosis. C) autonomic dysreflexia. D) Parkinson's disease. Answer: D Diff: 1 Page Ref: 1243 Standard: Medicine (Neurology) Objective: 1 16) Which of these should NOT be suspected as a potential cause of syncope? A) Hypovolemia B) Cardiac arrhythmia C) Hypoglycemia D) Euthermic Answer: D Diff: 2 Page Ref: 1236-1237 Standard: Medicine (Neurology) Objective: 5 17) A patient tells you that she experienced an episode of involuntary "shaking" in her arm. She describes a 1- to 2-minute-long episode of muscular jerking and contracting of her entire left arm. She remained consciousness, lacked an aura, and had no pain associated with the episode. This most indicates what type of seizure? A) Psychosomatic B) Simple focal C) Petit mal D) Absence Answer: B Diff: 1 Page Ref: 1233 Standard: Medicine (Neurology) Objective: 5

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18) Your patient is a 24-year-old male who is alert and oriented, complaining of severe "dizziness" and an earache for two days. He states that any movement of his head causes him to become very dizzy and nauseated. The patient's skin is warm and dry, his pupils are equal and reactive, and there is no gross neurological deficit. HR = 82, BP = 120/82, RR = 12, SaO2 = 99 percent. Which of these is most likely? A) Subdural hematoma B) Transient cerebral attack C) Hypersensitivity of the carotid sinus D) Labyrinthitis Answer: D Diff: 1 Page Ref: 1239 Standard: Medicine (Neurology) Objective: 5 19) You suspect your patient is experiencing a hemorrhagic stroke. He is confused, has a respiratory rate of 20, and a blood pressure of 178/88. Which of these additional findings would most increase your suspicion of increased intracranial pressure? A) Slurred speech B) Hallucinations C) Anterograde amnesia D) Heart rate of 50 Answer: D Diff: 2 Page Ref: 1218 Standard: Medicine (Neurology) Objective: 5 20) Which three cranial nerves are involved in the cardinal positions of gaze? A) I, III, and VI B) VI, VII, and X C) III, IV, and VI D) I, III, and IV Answer: C Diff: 2 Page Ref: 1216 Standard: Medicine (Neurology) Objective: 3

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21) You are transporting a male patient to the hospital for an evaluation after a possible seizure when you notice the patient's loss of consciousness. His muscles start to contract so that he is arching his back. This best describes which phase of a generalized seizure? A) Hypertonic B) Postictal C) Clonic D) Tonic Answer: A Diff: 2 Page Ref: 1234 Standard: Medicine (Neurology) Objective: 5 22) A patient with speech impairment following a stroke would have involvement in which lobe of the brain? A) Frontal B) Parietal C) Temporal D) Occipital Answer: C Diff: 2 Page Ref: 1209 Standard: Medicine (Neurology) Objective: 3 23) Your patient has a history of epilepsy and is experiencing loss of consciousness, tonic-clonic muscle activity, and erratic ocular movement. Based on this, you might also expect to find all of these EXCEPT: A) pinpoint pupils. B) urinary incontinence. C) impaired respiration. D) increased oral secretions. Answer: A Diff: 2 Page Ref: 1234 Standard: Medicine (Neurology) Objective: 4 24) Your female patient is experiencing sharp, stabbing, right-sided face pain of her upper and lower lips, cheek, and around her orbit. This best describes: A) a cluster headache. B) temporomandibular joint syndrome. C) trigeminal neuralgia. D) Bell's palsy. Answer: C Diff: 1 Page Ref: 1239 Standard: Medicine (Neurology) Objective: 4

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25) Which of these is a collection of genetic diseases characterized by progressive muscle weakness and skeletal muscle degeneration? A) Multiple sclerosis B) Myasthenia gravis C) Muscular dystrophy D) Amyotrophic lateral sclerosis Answer: C Diff: 1 Page Ref: 1242 Standard: Medicine (Neurology) Objective: 4 26) The dorsal roots of the spinal cord contain afferent fibers that transmit impulses from to . A) the central nervous system, motor nerves B) sensory nerves, central nervous system C) the central nervous system, sensory nerves D) motor nerves, the central nervous system Answer: B Diff: 2 Page Ref: 1210 Standard: Medicine (Neurology) Objective: 3 27) The most common cause of lower back pain is: A) sciatica. B) arthritis. C) idiopathic. D) osteomyelitis. Answer: C Diff: 1 Page Ref: 1245 Standard: Medicine (Neurology) Objective: 4 28) During a domestic disturbance your patient experienced a sudden onset of violent, bizarre movements of the extremities followed by unresponsiveness to verbal stimuli. On your arrival the bizarre movements begin again but stop suddenly when you firmly say, "Stop!" This most indicates what type of seizure? A) Absence B) Simple partial C) Complex partial D) Pseudo Answer: D Diff: 2 Page Ref: 1234 Standard: Medicine (Neurology) Objective: 5

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29) A 35-year-old male complains of a "pressure"-type headache to the back of his head and neck. He states that he woke up with the discomfort this morning, and the pain has steadily gotten worse through the day. He denies any radiation of the pain and denies photophobia but states that he is slightly nauseated. Based on this clinical presentation, the paramedic should be suspicious of what type of headache? A) Migraine B) Vascular C) Cluster D) Tension Answer: D Diff: 2 Page Ref: 1237 Standard: Medicine (Neurology) Objective: 4 30) All of these may cause a transient ischemic attack EXCEPT: A) intracranial hemorrhage. B) cerebrovascular spasm. C) hypotension. D) a small embolus. Answer: A Diff: 2 Page Ref: 1232 Standard: Medicine (Neurology) Objective: 4 31) Which of these complaints is most typical for a patient suffering an exacerbation of multiple sclerosis? A) "Each night I seem to get a fever and break out in a sweat." B) "I have no feeling in either my arms or my legs." C) "I cannot remember my address or phone number." D) "My legs feel heavy, and I am having trouble walking." Answer: D Diff: 2 Page Ref: 1242 Standard: Medicine (Neurology) Objective: 5 32) Which of these diseases involves inflammation followed by demyelination of the brain and spinal cord nerve fibers? A) Myasthenia gravis B) Muscular dystrophy C) Multiple sclerosis D) Alzheimer's disease Answer: C Diff: 1 Page Ref: 1242 Standard: Medicine (Neurology) Objective: 1

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33) The postsynaptic neurotransmitter of the sympathetic nerves is: A) dopamine. B) acetylcholine. C) norepinephrine. D) epinephrine. Answer: C Diff: 1 Page Ref: 1207 Standard: Medicine (Neurology) Objective: 3 34) A type of generalized seizure characterized by a rapid loss of consciousness and motor coordination, muscle spasms, and jerking motions is known as a(n): A) simple partial seizure. B) absence. C) tonic-clonic seizure. D) complex partial seizure. Answer: C Diff: 1 Page Ref: 1234 Standard: Medicine (Neurology) Objective: 4 35) Which of these is NOT characteristic of a migraine? A) Vomiting B) Low back pain C) Photosensitivity D) Throbbing headache Answer: B Diff: 2 Page Ref: 1237 Standard: Medicine (Neurology) Objective: 6 36) Which of these should NOT be part of the general management of a patient with altered mental status? A) Thiamine B) 50 percent dextrose C) IV with saline lock D) Hyperventilation with 100 percent oxygen Answer: D Diff: 2 Page Ref: 1221 Standard: Medicine (Neurology) Objective: 7

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37) Which of these is characterized by involuntary muscle twitching? A) Ataxia B) Trismus C) Myoclonus D) Dystonia Answer: C Diff: 1 Page Ref: 1243 Standard: Medicine (Neurology) Objective: 4 38) The most common cause of dementia in the elderly is: A) cerebrovascular disease. B) Alzheimer's disease. C) multi-infarct dementia. D) Parkinson's disease. Answer: B Diff: 1 Page Ref: 1241 Standard: Medicine (Neurology) Objective: 1 39) An eight-year-old male child is alert and oriented after a brief episode of eyelid fluttering and slight loss of muscle tone, which caused him to slump in his chair. His teacher reports that the child was inattentive for 15 to 20 seconds during the episode but was fine after. This most likely indicates what type of seizure? A) Generalized B) Absence C) Pseudo D) Simple partial Answer: B Diff: 1 Page Ref: 1234 Standard: Medicine (Neurology) Objective: 4 40) A seizure that remains confined to a limited portion of the brain, causing localized dysfunction, is what type of seizure? A) Tonic B) Absence C) Partial D) Petit mal Answer: C Diff: 1 Page Ref: 1234 Standard: Medicine (Neurology) Objective: 4

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41) Your patient is a 57-year-old male who is alert and oriented and complaining of a slight headache. His coworker states the patient "fainted." The patient describes feeling weak and lightheaded before the incident and "came to" lying on the floor. Medical history includes cardiovascular disease with a history of angina and hypertension. Medications include clopidogrel (Plavix), nitroglycerin, and metoprolol. Which of these is least helpful when formulating a field impression for this patient? A) Pulse oximetry B) Neurological exam C) Cardiac monitoring D) Orthostatic vital signs Answer: A Diff: 3 Page Ref: 1236-1237 Standard: Medicine (Neurology) Objective: 6 42) Which of these diseases is characterized by a progressive degeneration of the nerve cells that control voluntary movement, weakness, loss of motor control, difficulty speaking, and cramping? A) Muscular dystrophy B) Bell's palsy C) Multiple sclerosis D) Amyotrophic lateral sclerosis Answer: D Diff: 1 Page Ref: 1243 Standard: Medicine (Neurology) Objective: 4 43) Which of these is LEAST likely to be detrimental when treating a stroke patient? A) IV of lactated Ringer's solution B) Hyperventilation with 100 percent oxygen C) IV of 5 percent dextrose in water D) Administration of 50 percent dextrose, IV push Answer: A Diff: 2 Page Ref: 1232-1233 Standard: Medicine (Neurology) Objective: 6

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44) Which of these is least pertinent in the prehospital setting when obtaining the history of a patient with a suspected transient ischemic attack or stroke? A) History of diabetes B) History of cardiovascular disease C) Allergies D) Medications Answer: C Diff: 2 Page Ref: 1215-1216 Standard: Medicine (Neurology) Objective: 5 45) Your patient is a 19-year-old female who is exhibiting generalized seizure activity. Her roommate states that she had a seizure that lasted about 3 minutes. She remained unresponsive, then started having another seizure about 5 minutes after the first. The patient has peripheral cyanosis and copious oral secretions. Which of these is of HIGHEST priority for this patient? A) Starting an IV and administering 5 mg of diazepam B) Suctioning the airway, applying 15 liters per minute of oxygen by nonrebreathing mask C) Starting an IV, administering succinylcholine, and intubation D) Suctioning the airway, assisting ventilations with a bag-valve-mask device Answer: D Diff: 3 Page Ref: 1235-1236 Standard: Medicine (Neurology) Objective: 6 46) A form of spina bifida in which some of the spinal cord and meninges are protruding from a defect in the spine is a(n): A) meningioma. B) myelomeningocele. C) osteogenesis imperfecta. D) hydrocele. Answer: B Diff: 1 Page Ref: 1244 Standard: Medicine (Neurology) Objective: 1

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47) Your patient is a 52-year-old female who is alert but slightly confused after a syncopal episode lasting about 1 minute. She has no complaints, and your physical exam reveals no abnormalities aside from slight confusion. She has had a stroke and has a history of type II diabetes and hypertension. HR = 100, BP = 132/84, RR = 12, SaO2 = 99 percent. Which of these is the least likely cause of the patient's episode? A) Orthostatic hypotension B) Hypoglycemia C) Transient ischemic attack D) Transient cardiac arrhythmia Answer: A Diff: 3 Page Ref: 1236-1237 Standard: Medicine (Neurology) Objective: 5 48) You are transporting a male patient with the complaint of expressive aphasia and right upper extremity paralysis to the hospital. When calling the hospital, which of these pieces of information is it most critical to convey? A) History of hypertension B) SaO2 94 percent despite oxygen C) Time of symptom onset D) Blood pressure 168/82 mmHg Answer: C Diff: 2 Page Ref: 1225-1226 Standard: Medicine (Neurology) Objective: 6 49) Atrial fibrillation is most associated with which type of stroke? A) Hypoxic B) Thrombotic C) Embolic D) Hemorrhagic Answer: C Diff: 2 Page Ref: 1222 Standard: Medicine (Neurology) Objective: 4 50) All of these are assessed during the Cincinnati Prehospital Stroke Screen EXCEPT: A) memory. B) speech. C) facial droop. D) arm drift. Answer: A Diff: 1 Page Ref: 1228, 1229 Standard: Medicine (Neurology) Objective: 7

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51) The family members of a 72-year-old female state that the patient complained of a sudden, severe headache; had slurred speech; then became unresponsive. She responds to painful stimuli with decorticate posturing and has snoring respirations at a rate of 10 per minute. Her radial pulse is palpable but grossly irregular. According to her son, she also suffers from congestive heart failure, hypertension, and diabetes. Which of these should you do first? A) Attach the cardiac monitor. B) Manage the airway with a modified jaw-thrust maneuver. C) Check her blood sugar. D) Insert an endotracheal tube. Answer: B Diff: 2 Page Ref: 1214-1215 Standard: Medicine (Neurology) Objective: 7 52) The father of a 15-year-old male who has had a generalized seizure asks you why his son turned blue during the seizure. Which of these is the best answer? A) "The heart slows down and the blood pressure drops during a seizure, causing a lack of circulation to the skin." B) "The muscles used in breathing cannot work effectively during the seizure, decreasing the amount of oxygen in the blood." C) "It is a normal part of the seizure process and nothing to worry about." D) "The brain stem stops working during a seizure, which causes breathing to stop, decreasing the amount of oxygen in the blood." Answer: B Diff: 2 Page Ref: 1233 Standard: Medicine (Neurology) Objective: 4 53) Pseudoseizures are best controlled by: A) lorazepam. B) phenytoin. C) using physical restraints. D) a command to stop. Answer: D Diff: 2 Page Ref: 1234 Standard: Medicine (Neurology) Objective: 6

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54) While you are caring for a patient on the floor of her kitchen, she begins to have a generalized seizure. Which of these is the most appropriate first action? A) Move objects away from her and wait to see if the seizure stops. B) Insert an oropharyngeal airway. C) Restrain her so she does not injure herself. D) Start an IV, and administer 5 mg diazepam. Answer: A Diff: 2 Page Ref: 1235-1236 Standard: Medicine (Neurology) Objective: 6 55) Which of these is evaluated in the Los Angeles Prehospital Stroke Screen but is not part of the Cincinnati Prehospital Stroke Scale? A) Facial droop B) Arm drift C) Temperature D) Blood glucose level Answer: D Diff: 1 Page Ref: 1228-1229 Standard: Medicine (Neurology) Objective: 5 56) Your patient is a 49-year-old male complaining of a headache and weakness of his left arm, accompanied by nausea and vomiting. The information that would be most helpful in differentiating a brain abscess from a brain tumor is whether or not the patient: A) has had a seizure. B) exhibits nuchal rigidity. C) has had a change in the level of responsiveness. D) has a recent history of brain surgery. Answer: B Diff: 3 Page Ref: 1241 Standard: Medicine (Neurology) Objective: 5 57) You are examining a newborn and note that the meninges and spinal cord are protruding through an opening over the lower back. This is known as: A) a myelomeningocele. B) a meningocele. C) spina bifida occulta. D) poliomyelitis. Answer: A Diff: 1 Page Ref: 1244 Standard: Medicine (Neurology) Objective: 1

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58) What neurological problem results in a neural defect in which the fetal vertebrae do not close properly, often resulting in spinal cord dysfunction? A) Creutzfeldt-Jakob disease B) Spina bifida C) Guillain-Barré syndrome D) Multiple sclerosis Answer: B Diff: 2 Page Ref: 1244 Standard: Medicine (Neurology) Objective: 4 59) What is the innermost layer of meninges that directly overlies the central nervous system? A) Pia mater B) Dura mater C) Arachnoid membrane D) Cerebrospinal membrane Answer: A Diff: 1 Page Ref: 1207 Standard: Medicine (Neurology) Objective: 3 60) Which of these diseases is most likely to cause dementia in the patient? A) Pick's disease B) Multiple sclerosis C) Amyotrophic lateral sclerosis D) Spina bifida Answer: A Diff: 2 Page Ref: 1241 Standard: Medicine (Neurology) Objective: 4 61) Epilepsy affects roughly: A) 1 percent of the population. B) 5 percent of the population. C) 10 percent of the population. D) 15 percent of the population. Answer: A Diff: 1 Page Ref: 1204 Standard: Medicine (Neurology) Objective: 2

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62) The nervous system is divided into which two main parts? A) Central and autonomic B) Autonomic and cranial C) Peripheral and autonomic D) Central and peripheral Answer: D Diff: 1 Page Ref: 1204 Standard: Medicine (Neurology) Objective: 3 63) The entire central nervous system is covered by the (select BEST answer): A) dura mater. B) meninges. C) peritoneum. D) pia mater. Answer: B Diff: 1 Page Ref: 1207 Standard: Medicine (Neurology) Objective: 3 64) The area that connects the brain to the spinal cord is known as the: A) cerebellum. B) medulla oblongata. C) pons. D) foramen magnum. Answer: C Diff: 1 Page Ref: 1209 Standard: Medicine (Neurology) Objective: 3 65) The primary neurotransmitter of the sympathetic nervous system is: A) epinephrine. B) acetylcholine. C) reteplase. D) dopamine. Answer: A Diff: 1 Page Ref: 1213 Standard: Medicine (Neurology) Objective: 3

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66) The primary neurotransmitter of the parasympathetic nervous system is: A) epinephrine. B) acetylcholine. C) reteplase. D) dopamine. Answer: B Diff: 1 Page Ref: 1213 Standard: Medicine (Neurology) Objective: 3 67) The two mechanisms capable of producing alterations in mental state are: A) structural and toxic-metabolic. B) structural and RAAS. C) physiologic and RAS. D) cranial nervous and the central nervous system. Answer: A Diff: 1 Page Ref: 1213 Standard: Medicine (Neurology) Objective: 4 68) The acronym AVPU is used to quickly assess a patient's: A) mood. B) thought. C) mental status. D) judgment. Answer: C Diff: 1 Page Ref: 1226, 1233 Standard: Medicine (Neurology) Objective: 5 69) Increasing PaCO2 will cause: A) cerebral vasoconstriction. B) cerebral vasodilation. C) hyperventilation syndrome. D) ataxic respirations. Answer: B Diff: 2 Page Ref: 1229 Standard: Medicine (Neurology) Objective: 4

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70) Decreasing PaCO2 will cause: A) cerebral vasoconstriction. B) cerebral vasodilation. C) hyperventilation syndrome. D) ataxic respirations. Answer: A Diff: 2 Page Ref: 1229 Standard: Medicine (Neurology) Objective: 4 71) Posturing with the arms flexed and the legs extended is known as: A) decerebrate position. B) decorticate position. C) postictal position. D) neurogenic shock position. Answer: B Diff: 1 Page Ref: 1229 Standard: Medicine (Neurology) Objective: 4 72) You respond to a patient who has an AV shunt in place. You notice that the patient is unresponsive with the following vital signs: blood pressure, 180/100 mmHg; pulse: 48; respirations: 12 and irregular. You suspect: A) increased intracranial pressure. B) decreased intracranial pressure. C) seizure. D) normal status for an AV shunt patient. Answer: A Diff: 2 Page Ref: 1230-1231 Standard: Medicine (Neurology) Objective: 5 73) One cause of altered mental status that you are able to quickly rule out is: A) hyperglycemia. B) hypoglycemia. C) TIA. D) CVA. Answer: B Diff: 2 Page Ref: 1231 Standard: Medicine (Neurology) Objective: 7

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74) When evaluating a patient with a possible neurologic emergency, which acronym can help you remember the causes? A) TICKLES B) AVPU C) AEIOU-TIPS D) ISAL Answer: C Diff: 1 Page Ref: 1232-1233 Standard: Medicine (Neurology) Objective: 7 75) A condition seen in chronic alcoholics that causes ataxia, eye muscle weakness, and mental derangement is known as: A) Korsakoff's psychosis. B) Wolff-Parkinson-White syndrome. C) Wernicke's syndrome. D) Brugada syndrome. Answer: C Diff: 1 Page Ref: 1233 Standard: Medicine (Neurology) Objective: 4 76) You respond to a patient who is complaining of a sudden onset of a severe headache. The patient has a history of hypertension. You should suspect: A) occlusive stroke. B) hemorrhagic stroke. C) migraine. D) hypertensive urgency. Answer: B Diff: 2 Page Ref: 1236 Standard: Medicine (Neurology) Objective: 5 77) A TIA typically: A) resolves within 24 hours. B) never resolves. C) can be reversible with tPA. D) is caused by intracranial hemorrhage. Answer: A Diff: 1 Page Ref: 1243-1244 Standard: Medicine (Neurology) Objective: 4

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78) A tonic-clonic seizure is characterized by: A) flaccidity. B) movement of one area of the body. C) a period of apnea. D) increased muscle tone and rhythmic jerking. Answer: D Diff: 1 Page Ref: 1246 Standard: Medicine (Neurology) Objective: 4 79) Strokes affect more than how many people annually in the United States? A) 795,000 B) 140,000 C) 526,000 D) 295,000 Answer: A Diff: 1 Page Ref: 1206 Standard: Medicine (Neurology) Objective: 2 80) Which statement about neurological diseases in the United States is incorrect? A) 140,000 stroke victims die per year on average. B) Epilepsy affects 3 million people annually. C) 60,000 Americans are diagnosed with Parkinson's disease. D) 625,000 people in the United States suffer a first-time seizure. Answer: D Diff: 1 Page Ref: 1216 Standard: Medicine (Neurology) Objective: 2 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 35 Endocrinology 1) Which of these best explains the process of osmotic diuresis associated with hyperglycemia? A) Glucose in the urine lowers osmotic pressure inside the kidney tubule, preventing water reabsorption. B) Glucose in the urine raises osmotic pressure inside the kidney tubule, drawing water into the tubule. C) Decreased insulin levels result in decreased ADH secretion. D) Elevated blood glucose levels result in increased ADH secretion. Answer: B Diff: 2 Page Ref: 1259 Standard: Medicine (Endocrine Disorders) Objective: 3 81 Copyright © 2023 Pearson Education, Inc.

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2) Which statement about the epidemiology of Graves' disease is TRUE? A) Graves' disease typically manifests late in adulthood. B) Heredity does not predispose people to Graves' disease. C) Obesity and poor dietary habits increase the risk of Graves' disease. D) Graves' disease is about six times more common in women than in men. Answer: D Diff: 1 Page Ref: 1264 Standard: Medicine (Endocrine Disorders) Objective: 3 3) Which of these is NOT a modifiable risk factor for type II diabetes? A) Lack of exercise B) Obesity C) Heredity D) Poor diet Answer: C Diff: 1 Page Ref: 1261 Standard: Medicine (Endocrine Disorders) Objective: 3

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4) You encounter a patient complaining of polyuria, polyphagia, polydipsia, and abdominal pain. Based on these complaints, which of these would you also expect to find? A) Complaint of chest pain and shortness of breath B) Blood glucose of less than 70 mg/dL C) Kussmaul's respirations and a fruity breath odor D) Blood glucose between 80 and 120 mg/dL Answer: C Diff: 3 Page Ref: 1261-1262 Standard: Medicine (Endocrine Disorders) Objective: 4 5) Acute exacerbation of Addison's disease can lead to ECG changes and cardiovascular collapse as a result of electrolyte imbalance secondary to: A) increased mineralocorticoid secretion from the adrenal glands. B) potassium retention and sodium excretion. C) fluid retention, potassium excretion, and sodium retention. D) decreased mineralocorticoid secretion with increased sodium and potassium excretion. Answer: B Diff: 3 Page Ref: 1266 Standard: Medicine (Endocrine Disorders) Objective: 3 6) A type II diabetic with a blood glucose of 24 mg/dL and sonorous respirations would most likely be unconscious due to: A) glycogenolysis. B) cerebral hypoglycemia. C) gluconeogenesis. D) diabetic hypoxia. Answer: B Diff: 2 Page Ref: 1264 Standard: Medicine (Endocrine Disorders) Objective: 5

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7) Your patient is a 72-year-old male who is conscious but lethargic and sitting in a chair. His son states that the patient has been a bit slow lately and has been gaining weight. The medical history includes hypothyroidism and myocardial infarction. The patient has been compliant with his Synthroid and has nitroglycerin for use as needed. The patient responds to verbal stimuli, is confused, has a large tongue, and pale, cold, doughy skin. His only complaint is constipation. HR = 60 and regular, BP = 112/80, RR = 10 and shallow, SaO2 = 90 percent, temperature = 88°F, blood glucose = 180 mg/dL. Your treatment of this patient should include: A) infusion of 1 to 2 liters of warm normal saline. B) atropine 0.5 mg IV. C) rewarm with heat packs. D) oxygen, 4 lpm by nasal cannula. Answer: D Diff: 2 Page Ref: 1265-1266 Standard: Medicine (Endocrine Disorders) Objective: 5 8) Your patient is a 42-year-old male who is supine on the floor, responsive only to pain. His wife states that he has been extremely depressed recently and talked about suicide yesterday. The patient's skin is hot and dry, pupils are dilated and reactive to light bilaterally, and there is vomit around his mouth. HR = 138 and regular, BP = 110/62, RR = 16 and shallow. Temperature is 105.5°F. The patient has a history of hypothyroidism, for which he takes Synthroid. Your partner suctions the airway and initiates BVM ventilations with 100 percent oxygen and an oropharyngeal airway. In addition to monitoring the cardiac rhythm and starting an IV of normal saline, you should: A) perform synchronized cardioversion and intubate if the rhythm does not convert. B) intubate the trachea and request orders for propranolol, IV. C) intubate the trachea and request orders for diltiazem. D) administer 25 g of 50 percent dextrose and intubate if the level of responsiveness does not improve. Answer: B Diff: 3 Page Ref: 1265 Standard: Medicine (Endocrine Disorders) Objective: 5 9) Hyperglycemia is most likely a result of damage to which type of pancreatic cells? (Choose most accurate answer.) A) Alpha B) Beta C) Acinar D) Delta Answer: B Diff: 2 Page Ref: 1255-1256 Standard: Medicine (Endocrine Disorders) Objective: 2

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10) A three-year-old male patient has a history of an underdeveloped cell-mediated immune system. Which of the following most likely contributes to this deficiency? A) Hypoadrenalism B) HIV infection C) Type I diabetes mellitus D) Thymus gland insufficiency and a lack of thymosin secretion Answer: D Diff: 2 Page Ref: 1255 Standard: Medicine (Endocrine Disorders) Objective: 3 11) A patient presents with a history of frequent urination, signs and symptoms of dehydration, and a blood glucose of 958 mg/dL. There is no acetone odor on his breath. To which of the following can the absence of an acetone odor most likely be attributed? A) Elimination of ketoacids by the blood buffer system B) Elimination of ketoacids through Kussmaul's respirations C) The ability to use enough glucose to meet metabolic needs D) The ability to convert to the use of amino acids for energy metabolism Answer: C Diff: 2 Page Ref: 1263 Standard: Medicine (Endocrine Disorders) Objective: 4 12) Your patient is a 56-year-old male who is conscious and exhibits slurred speech, irritability, and cool, clammy skin. Blood glucose is 54 mg/dL. Proper treatment for this patient could include all of the following EXCEPT: A) 5 to 10 mg of glucagon IM. B) consideration of D10 IV if the patient cannot follow simple commands. C) IV of 0.9 percent sodium chloride. D) administration of oral glucose if the patient is able to swallow. Answer: A Diff: 3 Page Ref: 1264 Standard: Medicine (Endocrine Disorders) Objective: 5 13) Which of the following pathologies would necessitate the use of increased care in the preparation of an IV site because of skin fragility and increased risk of infection? A) Addison's disease B) Graves' disease C) Cushing's syndrome D) Myxedema Answer: C Diff: 2 Page Ref: 1266 Standard: Medicine (Endocrine Disorders) Objective: 3

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14) A chemical substance that is released into the blood by a gland and that controls or affects processes in other glands or body systems is a(n): A) enzyme. B) hormone. C) leukotriene. D) neurotransmitter. Answer: B Diff: 1 Page Ref: 1250 Standard: Medicine (Endocrine Disorders) Objective: 1 15) Prehospital management of an unresponsive patient with hypoglycemia should NOT include: A) administration of D50 IV. B) administration of glucagon IM. C) BVM ventilations with 100 percent O2 and an OPA. D) administration of oral glucose. Answer: D Diff: 1 Page Ref: 1264 Standard: Medicine (Endocrine Disorders) Objective: 5 16) Which of the following is least likely to be a precipitating factor of thyrotoxic crisis? A) Trauma B) Cold environment C) Infection D) Overdose of thyroid hormone Answer: B Diff: 2 Page Ref: 1265 Standard: Medicine (Endocrine Disorders) Objective: 3 17) A 36-year-old female is conscious and alert and complaining of palpitations. She denies chest pain, difficulty breathing, or loss of consciousness but becomes "dizzy" with exertion. She states that she has been experiencing agitation, insomnia, intolerance to heat, and weight loss. Physical exam reveals exophthalmos and an enlarged thyroid gland. HR = 142 and regular, BP = 110/70, RR = 14 and regular. Which of the following would be most effective in treating this patient? A) 250 cc fluid challenge B) Either 10 percent or 50 percent dextrose, IV C) Synchronized cardioversion D) Propranolol Answer: D Diff: 3 Page Ref: 1265 Standard: Medicine (Endocrine Disorders) Objective: 6

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18) Which of the following best describes the relationship between the hypothalamus and the endocrine system? A) The hypothalamus produces all of the releasing hormones that act on other endocrine organs. B) The hypothalamus is the link between the central nervous system and the endocrine system. C) The hypothalamus regulates most endocrine activities via positive feedback mechanisms. D) The hypothalamus is also known as the posterior pituitary gland. Answer: B Diff: 2 Page Ref: 1251 Standard: Medicine (Endocrine Disorders) Objective: 2 19) Immediately after birth, an infant is allowed to suckle at the mother's breast. Palpation of the uterus suggests that the uterus is contracting. This finding can be attributed to: A) secretion of oxytocin. B) secretion of estrogen and progesterone. C) inhibition of estrogen and progesterone. D) inhibition of oxytocin. Answer: A Diff: 2 Page Ref: 1254 Standard: Medicine (Endocrine Disorders) Objective: 2 20) A 63-year-old female with a history of hypothyroidism presents in a stuporous state, responsive only to pain. Physical exam reveals thin hair, a puffy face, an enlarged tongue, and cold, doughy skin. Her heart rate is 70 and regular, RR is 10 and regular, BP is 90/62, blood glucose level is 60 mg/dL, and temperature is 86°F via a tympanic thermometer. Your treatment of this patient should NOT include: A) active rewarming. B) endotracheal intubation. C) 50 percent dextrose, IV. D) IV fluids at a TKO rate. Answer: A Diff: 3 Page Ref: 1266 Standard: Medicine (Endocrine Disorders) Objective: 5

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21) Your patient is a 72-year-old male patient who is conscious but slow to respond to questions and commands. He has become increasingly lethargic, unemotional, and easily fatigued over the past two months. He has had a decreased appetite and has gained weight over the same period. The patient further states, "I'm constipated and always cold." Which of the following additional signs or symptoms would be consistent with this patient presentation? A) A "moon-faced" appearance and hyperpigmentation of the skin B) A puffy face, an enlarged tongue, and pale, doughy skin C) Hypothermia, tachycardia, and hypertension D) Goiter, atrial fibrillation, nausea, and vomiting Answer: B Diff: 3 Page Ref: 1265-1266 Standard: Medicine (Endocrine Disorders) Objective: 4 22) Which of the following explains the profound protein catabolism and gluconeogenesis associated with Cushing's syndrome? A) Cushing's syndrome affects normal fat deposition. B) Glucocorticoids cause sodium retention and increased blood volume. C) Cortisol is an antagonist to insulin. D) Increased epinephrine and norepinephrine release result in hypermetabolism. Answer: C Diff: 2 Page Ref: 1256 Standard: Medicine (Endocrine Disorders) Objective: 3 23) A patient has a fever of 105°F, irritability, delirium, tachycardia, vomiting, and hypotension. These signs and symptoms are most consistent with: A) thyrotoxic crisis. B) myxedema. C) Graves' disease. D) hypothyroidism. Answer: A Diff: 2 Page Ref: 1265 Standard: Medicine (Endocrine Disorders) Objective: 4

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24) A 24-year-old male is supine on the floor and unconscious with snoring respirations. You note a weak, rapid pulse and cool, diaphoretic skin. HR = 124 and regular, BP = 136/88, RR = 12 and regular. Blood glucose is 24 mg/dL. After manually opening the airway and providing oxygen, which of the following should be performed next? A) Start an IV and administer 25 g dextrose. B) Start an IV and administer 0.3 mg glucagon. C) Intubate the trachea, start an IV, and administer 25 g dextrose. D) Administer glucagon, 1 mg, IM. Answer: A Diff: 2 Page Ref: 1264 Standard: Medicine (Endocrine Disorders) Objective: 5 25) Your patient is a 39-year-old male with a history of alcoholism. He is unresponsive, with cool, clammy skin and a weak, rapid pulse of 108. BP = 128/92, RR = 12 and regular. Your partner manages the airway and assists ventilations, but you are unable to start an IV after three attempts. Which of the following is most appropriate at this point? A) Reattempt the IV while en route. B) Dextrose, 25 g, and thiamine, 100 mg, both IM C) Glucagon, 1.0 mg, and thiamine, 100 mg, both IM D) Glucagon 1.0 mg, IM Answer: C Diff: 2 Page Ref: 1264 Standard: Medicine (Endocrine Disorders) Objective: 6 26) Which of the following is associated with a greater predisposition for hypoglycemia due to decreased gluconeogenesis? A) Pancreatitis B) Cholecystitis C) Cardiac failure D) Renal failure Answer: D Diff: 2 Page Ref: 1264 Standard: Medicine (Endocrine Disorders) Objective: 3

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27) Your patient is a 42-year-old male who had surgery four years ago to remove his posterior pituitary gland because of a tumor. He stopped taking replacement hormones because they caused depression. Which of the following is the most likely consequence of the patient's noncompliance with hormone replacement therapy? A) Hypoglycemia B) Hypertension C) Reduced ability to fight infection D) Dehydration Answer: D Diff: 3 Page Ref: 1254 Standard: Medicine (Endocrine Disorders) Objective: 3 28) Your patient is a 45-year-old male who has been suffering from hypocalcemia since surgery to remove his thyroid gland six weeks ago. Of the following, which is most likely the cause of the patient's hypocalcemia? A) Increased function of residual thyroid tissue B) Loss of parathyroid gland function C) Loss of thyroid gland function D) Increase in parathyroid gland function Answer: B Diff: 2 Page Ref: 1255 Standard: Medicine (Endocrine Disorders) Objective: 3 29) A 34-year-old female, conscious, alert, and oriented, is complaining of a three-week history of increased appetite, weight loss, weakness, insomnia, and inability to tolerate heat. She has recently been frequently agitated and prone to mood swings. Based on these signs and symptoms, which of the following best describes the additional findings you could expect? A) Hyperpigmentation of the skin and hirsutism B) Heart block and hypotension C) Enlarged tongue and cool, puffy skin D) Exophthalmos and goiter Answer: D Diff: 3 Page Ref: 1264-1265 Standard: Medicine (Endocrine Disorders) Objective: 4

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30) Secretion of glucagon from the pancreas results in blood glucose levels. A) glucogenesis, decrease B) glycogenolysis, decrease C) glucogenesis, increase D) glycogenolysis, increase Answer: D Diff: 2 Page Ref: 1255 Standard: Medicine (Endocrine Disorders) Objective: 2

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31) A type I diabetic presents with deep, rapid respirations and a fruity odor on her breath. Which of the following would best help correct the underlying physiologic disturbance? A) Oxygen B) Dextrose C) Insulin D) Glucagon Answer: C Diff: 2 Page Ref: 1260 Standard: Medicine (Endocrine Disorders) Objective: 3 32) Your patient is a 68-year-old female who has been in a rehabilitation hospital for one week following hip replacement surgery. According to the staff, the patient is a type II diabetic and is being treated for a postoperative infection. The patient was lethargic yesterday and was found unresponsive this morning, just before your arrival. Physical exam reveals an accumulation of secretions in her airway, lung sounds clear and equal bilaterally, and skin and mucous membranes warm and dry. HR = 119, BP = 86/58, RR = 16, blood glucose = 864 mg/dL. In addition to initiating basic airway management measures and gaining IV access, which of the following is the best treatment for this patient? A) Intubate, give 1 to 2 L NS bolus and 25 g dextrose IV B) Oxygen by nonrebreather mask, NS at a KVO rate, and 50 mEq sodium bicarbonate IV C) BVM ventilations with supplemental oxygen, NS at a KVO rate D) Maintain the airway, administer 1 to 2 L NS bolus Answer: D Diff: 3 Page Ref: 1263 Standard: Medicine (Endocrine Disorders) Objective: 5

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33) Which of the following is least likely to result in hypoglycemia in a type I diabetic patient? A) Increased exercise level B) Taking insulin as usual but missing a meal C) Eating foods high in sugar D) Inadvertently administering too much insulin Answer: C Diff: 2 Page Ref: 1264 Standard: Medicine (Endocrine Disorders) Objective: 3 34) Your patient is a 32-year-old female who is alert and sitting at her kitchen table complaining of dizziness and near-syncope with exertion. She describes a four-day history of a 104°F fever, nausea, vomiting, and diarrhea unrelieved with over-the-counter medications. Physical examination reveals dry skin and mucous membranes, lung sounds clear and equal bilaterally. HR = 131 and regular, BP = 84/60, RR = 20 and regular, SaO2 = 98 percent, blood glucose = 58 mg/dL. She has a history of colitis, for which she often takes prednisone, but she has been noncompliant with her prednisone therapy for the past five days because she cannot afford to refill her prescription. The treatment for this patient should include: A) a 1 liter NS bolus IV. B) an IV of NS at KVO rate, dextrose IV, and 100 mg thiamine IV. C) a 1 liter NS bolus, IV, and dextrose IV. D) 15 lpm oxygen by nonrebreather, IV of NS at KVO rate, 25 g dextrose. Answer: C Diff: 3 Page Ref: 1268 Standard: Medicine (Endocrine Disorders) Objective: 6 35) A 16-year-old female with a history of diabetes is found unconscious in a high school bathroom following volleyball practice. She is tachycardic; has cool, clammy skin; is lethargic; is slightly combative; and is very confused. She is most likely experiencing: A) hypoglycemia. B) diabetic ketoacidosis. C) hyperglycemia. D) diabetic coma. Answer: A Diff: 2 Page Ref: 1264 Standard: Medicine (Endocrine Disorders) Objective: 4

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36) If a patient being treated for hypoparathyroidism stopped taking the medications prescribed for his condition, which of the following would be most likely to occur? A) Hypercalcemia B) Hyperkalemia C) Hypocalcemia D) Hypokalemia Answer: C Diff: 2 Page Ref: 1255 Standard: Medicine (Endocrine Disorders) Objective: 3 37) Which of the following would you expect to see immediately after the ingestion of a large meal? A) Increase of blood glucagon levels and a decrease of blood glucose levels B) Increase of blood glucose and blood insulin levels C) Decrease of blood glucose levels followed by an increase of blood insulin levels D) Increase of blood glucagon and blood glucose levels Answer: B Diff: 2 Page Ref: 1259 Standard: Medicine (Endocrine Disorders) Objective: 2 38) You have administered glucagon to a diabetic patient. Which of the following should occur? A) Stimulation of the pancreatic alpha cells, resulting in lipolysis B) Stimulation of the pancreatic beta cells, resulting in a decreased blood glucose level C) Glycogenesis, resulting in a decreased blood glucose level D) Glycogenolysis, resulting in an increased blood glucose level Answer: D Diff: 2 Page Ref: 1255 Standard: Medicine (Endocrine Disorders) Objective: 6 39) Your patient has a hormone-secreting tumor of the adrenal medulla. What hormone is most likely to be secreted by this tumor? A) Cortisol B) Dopamine C) Epinephrine D) ACTH Answer: C Diff: 2 Page Ref: 1256 Standard: Medicine (Endocrine Disorders) Objective: 3

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40) Which of the following hormones has the greatest effect on blood pressure homeostasis? A) Calcitonin B) Cortisol C) Parathyroid hormone D) Aldosterone Answer: D Diff: 3 Page Ref: 1256 Standard: Medicine (Endocrine Disorders) Objective: 2 41) Your diabetic patient asks you why he "passes out" when his blood sugar gets too low. Which of the following responses is most accurate? A) "When the blood sugar is low, the brain does not get enough oxygen." B) "Brain cells need a constant supply of glucose, or sugar, to function. Without sugar the brain cells cannot work to maintain consciousness." C) "When the blood sugar is low, the blood vessels relax and the blood pressure drops, causing you to faint." D) "The cells of the heart can only use glucose, or sugar, for energy. Without sugar the heart cannot effectively pump blood to the brain." Answer: B Diff: 3 Page Ref: 1258 Standard: Medicine (Endocrine Disorders) Objective: 3 42) Your diabetic patient asks you why diabetics need to take insulin. Which of the following answers is most accurate? A) "Insulin helps glucose enter the cells of the body so it can be used for energy." B) "Insulin helps the body eliminate excess glucose through the kidneys." C) "Insulin breaks down glucose into proteins so it can be used by the cells for energy." D) "Without insulin glucose is converted to ketone bodies, which are toxic in large quantities." Answer: A Diff: 3 Page Ref: 1258 Standard: Medicine (Endocrine Disorders) Objective: 3

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43) Which of the following most accurately represents the pathophysiological sequence of untreated type I diabetes? A) Oversecretion of insulin results in hypoglycemia; cells convert to the use of fats for energy resulting in the production of ketone bodies. B) Glucose is not absorbed through the gastrointestinal tract, resulting in hyposecretion of insulin and hypoglycemia. Lack of glucose results in anaerobic metabolism and acidosis. C) Hyposecretion of insulin prevents glucose from being broken down in the gastrointestinal tract; too much glucose is absorbed from the gastrointestinal tract resulting in hyperglycemia and ketoacidosis. D) Hyposecretion of insulin results in inability of glucose to enter cells; blood glucose levels rise, and cells convert to the use of fats for energy, resulting in the production of ketone bodies. Answer: D Diff: 2 Page Ref: 1259-1260 Standard: Medicine (Endocrine Disorders) Objective: 3 44) Which of the following is the most direct cause of polyuria in untreated diabetes? A) Hyperglycemia B) Hypoglycemia C) Too much insulin D) Too little insulin Answer: A Diff: 3 Page Ref: 1259 Standard: Medicine (Endocrine Disorders) Objective: 3 45) Which of the following most accurately describes the rationale for monitoring the cardiac rhythm in the hyperglycemic patient? A) The increased viscosity of the blood makes myocardial ischemia very likely. B) Polyuria can lead to electrolyte disturbances, resulting in cardiac dysrhythmias. C) Hyperglycemia causes ventricular irritability and increases the risk of ventricular fibrillation. D) All ALS patients must be monitored. Answer: B Diff: 3 Page Ref: 1259 Standard: Medicine (Endocrine Disorders) Objective: 4 46) Which of the following statements would be most typical of an undiagnosed diabetic? A) "I am so thirsty I have to keep a glass of water by my bed at night." B) "I have gained 10 pounds over the past two weeks." C) "It seems like I am dehydrated because I hardly urinate at all." D) "I haven't had much of an appetite. I am not hungry at all." Answer: A Diff: 3 Page Ref: 1260 Standard: Medicine (Endocrine Disorders) Objective: 4 95 Copyright © 2023 Pearson Education, Inc.

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47) Which of the following statements about hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is TRUE? A) Unlike diabetic ketoacidosis, HHNS is not life-threatening. B) Prehospital treatment of HHNS includes correcting metabolic acidosis. C) Aside from managing the ABCs, prehospital management is primarily aimed at correcting dehydration. D) Paradoxically, the definitive management of HHNS includes the administration of 50 percent dextrose. Answer: C Diff: 2 Page Ref: 1263 Standard: Medicine (Endocrine Disorders) Objective: 6 48) An emergency department physician tells you that the hyperglycemic diabetic you brought in earlier has a pH of 7.40. What is the likeliest explanation of this statement? A) The patient is a type II diabetic who was no longer secreting enough insulin to prevent the use of fats for energy. B) The patient is a type II diabetic who was secreting enough insulin to prevent the use of fats for energy. C) The patient is a type I diabetic who did not take his insulin and is therefore unable to use glucose for energy. D) The patient is a type I diabetic who took his insulin and did not eat, resulting in the breakdown of proteins for energy. Answer: B Diff: 3 Page Ref: 1261 Standard: Medicine (Endocrine Disorders) Objective: 3 49) Which of the following is the most reliable way to differentiate between a hyperglycemic emergency and a hypoglycemic emergency? A) Determine whether or not the patient took his insulin or oral antihyperglycemic medicines. B) Determine whether the patient is a type I or type II diabetic. C) Follow the conventional wisdom, "Pale, cool, wet: low; red, hot, dry: high." D) Assess the blood glucose level. Answer: D Diff: 1 Page Ref: 1261 Standard: Medicine (Endocrine Disorders) Objective: 4

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50) You have administered dextrose to a patient who was initially unresponsive with a blood glucose level of 23 mg/dL. Which of the following is the best indication that the patient's condition is improving? A) The heart rate decreases from 112 to 96 per minute. B) The patient seems less diaphoretic. C) The patient opens his eyes but is confused. D) The respiratory rate decreases from 24 to 16 per minute. Answer: C Diff: 2 Page Ref: 1264 Standard: Medicine (Endocrine Disorders) Objective: 6 51) You are assessing an unresponsive patient with a MedicAlert tag that indicates he is a diabetic. The patient's airway is patent, respirations are 20 per minute and adequate, radial pulse is rapid and weak, and the skin is warm and moist. You attempt to get a blood glucose reading, but your blood glucose monitor malfunctions. Which of the following is the best course of action? A) Administer 10 percent dextrose. B) Administer a 1 to 2 liter bolus of NS. C) Request another unit to respond to the scene with a blood glucose monitor. D) Request an order for 20 units of regular insulin. Answer: A Diff: 3 Page Ref: 1264 Standard: Medicine (Endocrine Disorders) Objective: 5 52) Your patient is a 24-year-old male with a history of type I diabetes. You were called to his place of employment because he was behaving bizarrely. On your arrival he is confused and combative with a blood glucose level of 41 mg/dL. Due to poor vasculature and the patient's combativeness, you have not been able to start an IV. Which of the following is the best course of action? A) Administer 1 mg glucagon, IM. B) Administer 5 mg Valium, IM, and attempt the IV again when the patient is less agitated. C) Administer 10 percent dextrose, IM. D) Use four-point restraints to restrain the patient and transport. Attempt the IV again if the patient becomes unresponsive. Answer: A Diff: 3 Page Ref: 1264 Standard: Medicine (Endocrine Disorders) Objective: 5

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53) Cushing's syndrome is a disorder of the: A) posterior pituitary gland. B) adrenal glands. C) thyroid gland. D) ovaries. Answer: B Diff: 1 Page Ref: 1266 Standard: Medicine (Endocrine Disorders) Objective: 3 54) Which of the following findings would be atypical in a patient with a history of Cushing's syndrome? A) Blood glucose level of 190 mg/dL B) Blood pressure of 154/86 mmHg C) Bruising of the extremities D) Temperature of 101°F Answer: D Diff: 2 Page Ref: 1266-1267 Standard: Medicine (Endocrine Disorders) Objective: 4 55) A finding of exophthalmos and goiter should increase your suspicion for a problem with the: A) anterior pituitary gland. B) posterior pituitary gland. C) thyroid gland. D) parathyroid gland. Answer: C Diff: 2 Page Ref: 1265 Standard: Medicine (Endocrine Disorders) Objective: 4 56) The endocrine system differs from the nervous system in that it: A) controls the body without nerve impulses. B) controls the body with specialized chemical messengers. C) doesn't regulate anything in the body. D) directly regulates the brain. Answer: B Diff: 1 Page Ref: 1250 Standard: Medicine (Endocrine Disorders) Objective: 2

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57) Homeostasis refers to: A) the tendency of the body to maintain an appropriate internal environment. B) the body's ability to regulate the external environment. C) intrinsic environmental regulatory factors. D) extrinsic environmental regulatory factors. Answer: A Diff: 1 Page Ref: 1250 Standard: Medicine (Endocrine Disorders) Objective: 1 58) The posterior pituitary produces which two hormones? A) Insulin and glucagon B) Epinephrine and norepinephrine C) Growth hormone and gonadotropin D) ADH and oxytocin Answer: D Diff: 1 Page Ref: 1252 Standard: Medicine (Endocrine Disorders) Objective: 2 59) The anterior pituitary gland releases TSH to: A) promote shivering. B) protect the vascular system. C) increase metabolism. D) decrease insulin. Answer: C Diff: 1 Page Ref: 1252 Standard: Medicine (Endocrine Disorders) Objective: 2 60) In response to an increase in blood sugar, the pancreas will release insulin to: A) produce more glucose. B) allow the glucose to permeate the cell membrane. C) allow glucose to be wasted in the urine. D) allow glucose to cross the blood-brain barrier. Answer: B Diff: 1 Page Ref: 1258 Standard: Medicine (Endocrine Disorders) Objective: 2

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61) You respond to an ill patient. Upon your arrival, the patient states that she has had an increase in urination, thirst, and general malaise. The patient's finger stick blood glucose reading is 550 mg/dL; her blood pressure is 110/80 mmHg; pulse is 100; respiratory rate is 26; ETCO2 is 29 percent; and you note an acetone odor. You suspect: A) HHNS. B) DKA. C) DNK. D) TNK. Answer: B Diff: 2 Page Ref: 1261-1262 Standard: Medicine (Endocrine Disorders) Objective: 4 62) You respond to an ill type 2 diabetic patient. Upon your arrival, the patient complains of not feeling well for a few days, and increasing blood glucose levels. The glucometer reads "High," and you do not smell any fruity odors on the patient's breath. You suspect: A) DKA. B) HHNS. C) TNK. D) TPA. Answer: B Diff: 2 Page Ref: 1263 Standard: Medicine (Endocrine Disorders) Objective: 4 63) You respond to an unresponsive patient. Upon exam, you get a finger stick blood glucose reading of "Low." Treatment should include administration of: A) insulin. B) epinephrine. C) dextrose. D) ASA. Answer: C Diff: 2 Page Ref: 1264 Standard: Medicine (Endocrine Disorders) Objective: 4 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 36 Immunology 1) Your patient is experiencing dyspnea and urticaria after ingesting penicillin. Auscultation of his lungs reveals diffuse expiratory wheezes. Which medication will best help correct your patient's bronchospasm? A) Epinephrine 1:1000 IM B) Ranitidine 50 mg IV 100 Copyright © 2023 Pearson Education, Inc.

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C) Solu-Medrol 125 mg IV D) 100 percent oxygen via nonrebreather mask 15 lpm Answer: A Diff: 2 Page Ref: 1278 Standard: Medicine (Immunology) Objective: 6 2) Which treatment would best halt the urticaria associated with an allergic reaction? A) Solu-Medrol B) Oxygen C) Dopamine and albuterol D) Epinephrine and diphenhydramine Answer: D Diff: 2 Page Ref: 1278 Standard: Medicine (Immunology) Objective: 5 3) Your patient is experiencing profuse hives, itching, dyspnea, coughing, tachycardia, and dizziness after eating seafood 5 minutes ago. You might also expect to see these additional signs or symptoms EXCEPT: A) laryngeal edema. B) bronchospasm. C) cyanosis. D) hypertension. Answer: D Diff: 1 Page Ref: 1275 Standard: Medicine (Immunology) Objective: 4

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4) Which sign associated with an allergic reaction should concern a caregiver the most? A) Urticaria B) Wheezing C) Warm, flushed skin D) GI distress Answer: B Diff: 2 Page Ref: 1270 Standard: Medicine (Immunology) Objective: 4 5) Which is the best description why the secondary response to an antigen is faster than the primary response? A) The secondary response uses memory cells, which immediately release antibodies specific to the antigen. B) The secondary response uses memory cells, which immediately release antigens specific to the antibodies. C) The primary response uses B and T cells specific to the antigens. D) The secondary response has fewer steps than the primary response, allowing it to progress faster. Answer: A Diff: 2 Page Ref: 1271 Standard: Medicine (Immunology) Objective: 2 6) Which of these treatment regimens for anaphylaxis lists the medications in the correct order of administration following oxygen? A) Dexamethasone, diphenhydramine, epinephrine B) Epinephrine, diphenhydramine, dexamethasone C) Epinephrine, dexamethasone, diphenhydramine D) Diphenhydramine, epinephrine, dexamethasone Answer: B Diff: 2 Page Ref: 1277-1278 Standard: Medicine (Immunology) Objective: 6 7) The first medication administered to a hypoxic patient experiencing acute bronchospasm, itching, and alterations of the mental status during an anaphylactic reaction should be: A) epinephrine. B) diphenhydramine. C) high-concentration oxygen. D) glucagon. Answer: C Diff: 2 Page Ref: 1278 Standard: Medicine (Immunology) Objective: 5

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8) Your patient is a conscious and alert 22-year-old female who was stung by a hornet. She states that she has "allergies to bee stings" and has been told that she could die if stung. Your physical examination reveals a 1-cm-diameter, red, edematous area where she was stung on the left forearm. Her skin is warm and dry, and her lung sounds are clear and equal bilaterally. HR = 12 and regular, BP = 122/82, RR = 12 and regular, SaO2 = 98 percent. The most appropriate treatment for this patient would include: A) 100 percent oxygen via nonrebreather mask 15 lpm, IV of NS 1-2 L, epinephrine 1:1000 0.3 mg IM, diphenhydramine 25 mg IV. B) IV as soon as possible with a crystalloid solution. C) 15 lpm oxygen by nonrebreather, epinephrine 1:1000 0.3 mg IM, diphenhydramine 25 mg IV, transport. D) transport only. Answer: B Diff: 3 Page Ref: 1276-1277 Standard: Medicine (Immunology) Objective: 4, 5, 65 9) Which statement about corticosteroid use in anaphylaxis treatment is TRUE? A) Administration of high-dose corticosteroids results in peripheral vasoconstriction. B) Corticosteroids stabilize mast cell and basophil membranes, preventing degranulation and histamine release. C) Corticosteroids can reduce the inflammation associated with anaphylaxis. D) Corticosteroids can help reverse bronchospasm associated with anaphylaxis. Answer: C Diff: 2 Page Ref: 1278 Standard: Medicine (Immunology) Objective: 5 10) Epinephrine administration typically results in all of these EXCEPT: A) hypotension. B) increased cardiac contractile force. C) increased peripheral vasoconstriction. D) tachycardia. Answer: A Diff: 2 Page Ref: 1278 Standard: Medicine (Immunology) Objective: 5

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11) Your patient is a 46-year-old male who is unconscious on his front lawn after being stung by a bee. You note angioneurotic edema. HR = 132, BP = 76/40, RR = 24 and shallow. You should first: A) administer high-concentration oxygen with a nonrebreather mask or similar device. B) administer epinephrine 1:1000 IM. C) start an IV of NS wide open and administer epinephrine 1:10,000 IV. D) intubate the patient. Answer: A Diff: 2 Page Ref: 1277 Standard: Medicine (Immunology) Objective: 5 12) Your patient is a 36-year-old female, conscious and alert, sitting at her desk and complaining of a rash and itchiness after taking a sulfa antibiotic. Physical examination reveals warm and dry skin, urticaria on her chest and back, lung sounds that are clear and equal bilaterally. HR = 100, BP = 132/78, RR = 14, SaO2 = 92 percent. What is the most appropriate treatment for this patient? A) Oxygen via nasal cannula, IV crystalloid solution, 5 mg epinephrine IV, 25 mg diphenhydramine IV B) Transport only C) Oxygen via nonrebreather mask, IV crystalloid solution, 25 mg diphenhydramine IV D) Oxygen via cannula, IV crystalloid solution, 0.3 mg epinephrine IM, 25 mg diphenhydramine IV, albuterol 2.5 mg via nebulizer Answer: D Diff: 3 Page Ref: 1277 Standard: Medicine (Immunology) Objective: 4 13) Which medication would be the best choice for reducing the bronchospasm and laryngeal edema associated with anaphylaxis? A) Albuterol B) Solu-Medrol C) Oxygen D) Dexamethasone Answer: A Diff: 2 Page Ref: 1279 Standard: Medicine (Immunology) Objective: 5

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14) Upon identifying an antigen in the bloodstream, B cells launch a chemical attack by producing antigens specific to the antibody. This is an example of what type of immunity? A) Secondary B) Humoral C) Antibody D) Cellular Answer: B Diff: 2 Page Ref: 1270 Standard: Medicine (Immunology) Objective: 1 15) Diphenhydramine is administered in anaphylaxis because it: A) blocks histamine receptors. B) is nonselective. C) reduces histamine release from mast cells and basophils. D) produces all of the above. Answer: D Diff: 2 Page Ref: 1278 Standard: Medicine (Immunology) Objective: 5 16) What is the desired physiologic reaction that occurs after the administration of a vaccine that contains live, attenuated viruses? A) The antibodies in the vaccine multiply in the body. B) The immune system will create specific antibodies to the viruses in the vaccine. C) The immune system will create specific antigens to the viruses in the vaccine. D) The viruses in the vaccine act as an antigen, resulting in a nonspecific immune response. Answer: B Diff: 3 Page Ref: 1271 Standard: Medicine (Immunology) Objective: 2

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17) A male patient presents with a puncture wound to his heel from stepping on a nail. He informs you that he is visiting from El Salvador and has never received a tetanus vaccination. At the emergency room he is administered tetanus immune globulin, as well as a tetanus vaccination. Which of the following best describes the rationale for this treatment? A) The tetanus immune globulin provides immediate protection, while the tetanus vaccination provides passive immunity by producing tetanus-specific antibodies. B) The tetanus immune globulin provides passive immunity, while the tetanus vaccination provides active immunity. C) The tetanus immune globulin provides IgE antibodies for immediate protection, while the tetanus vaccination provides natural immunity by producing tetanus-specific antibodies. D) The tetanus immune globulin provides IgG and IgM antibodies for immediate protection, while the tetanus vaccination provides passive immunity by producing tetanus-specific antibodies. Answer: B Diff: 2 Page Ref: 1272 Standard: Medicine (Immunology) Objective: 6 18) Which of these statements about the use of vasopressors in the treatment of anaphylaxis is TRUE? (Select BEST answer.) A) A norepinephrine infusion can correct the peripheral vasodilation that occurs secondary to SRS-A release by basophils and mast cells. B) A norepinephrine infusion encourages a net movement of plasma from the intravascular space to the vascular space, raising blood pressure. C) An epinephrine infusion can correct the peripheral vasodilation that occurs secondary to SRSA release by basophils and mast cells. D) A dopamine infusion can correct the peripheral vasodilation that occurs secondary to histamine release by basophils and mast cells. Answer: D Diff: 3 Page Ref: 1279 Standard: Medicine (Immunology) Objective: 5 19) Which medication is best for improving hypotension secondary to anaphylactic shock? A) Diphenhydramine B) Epinephrine C) Hydrocortisone D) Oxygen Answer: B Diff: 2 Page Ref: 1278 Standard: Medicine (Immunology) Objective: 5

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20) You are called to the home of a 28-year-old male who is complaining of hoarseness, a scratchy sensation in the back of his throat, and palpitations. The symptoms began about 30 minutes ago and have grown steadily worse ever since the patient ingested prescribed penicillin 1 hour ago. Patient management should NOT include which intervention? A) Epinephrine 1:1000 0.3 mg IM B) Administration of an IV beta blocker C) IV of crystalloid solution such as lactated Ringer's or normal saline D) High-concentration oxygen via nonrebreather mask Answer: B Diff: 2 Page Ref: 1277 Standard: Medicine (Immunology) Objective: 6 21) Your patient is a 43-year-old female with a history of peanut allergy. She is complaining of dizziness after eating a casserole that she later discovered contained peanuts. Your physical examination reveals warm, diaphoretic skin; a blotchy, red rash covering her chest and arms; and lung sounds that are clear and equal bilaterally. HR = 122, BP = 124/76, RR = 15 and regular, SaO2 = 97 percent. In addition to providing oxygen, appropriate treatment for this patient includes: A) IV of NS wide open, epinephrine 1:1000 SC, diphenhydramine IV. B) IV with crystalloid solution such as lactated Ringer's or normal saline. C) IV with crystalloid solution such as lactated Ringer's or normal saline, epinephrine 1:1000 IM, diphenhydramine IV. D) IV with crystalloid solution such as lactated Ringer's or normal saline, epinephrine 1:1000 IM, diphenhydramine IV, nebulized albuterol. Answer: C Diff: 3 Page Ref: 1277 Standard: Medicine (Immunology) Objective: 4 22) Your patient is a 48-year-old female who is supine on the floor of a neighborhood health clinic. She became unconscious after receiving 250 mg of IM doxycycline. Clinic staff reports that the patient "broke out in hives and lost consciousness." The patient is being ventilated by bag-valve-mask and has an IV of normal saline running wide open. A nurse practitioner on the scene informs you that, before your arrival, he administered 2 doses of 0.5 mg of epinephrine IM, 50 mg of diphenhydramine IV, and 1 L of NS. HR = 138; BP = 84/60; RR = 12/min, assisted with BVM; SaO2 = 94 percent. Of the following, which is the most appropriate continued treatment of this patient? A) Intubate, Solu-Medrol IV, 250 cc NS fluid challenge, transport B) Intubate, administration of dopamine IV infusion, rapid transport C) Continue administering fluids and transport to the nearest facility D) Initiate a second IV of NS wide open, intubate and hyperventilate, transport Answer: B Diff: 3 Page Ref: 1276-1277 Standard: Medicine (Immunology) Objective: 6 107 Copyright © 2023 Pearson Education, Inc.

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23) Your patient is a 31-year-old female complaining of dizziness and difficulty breathing after being stung by a bee. You note that she is extremely anxious, and your physical examination reveals a rapidly developing urticaria to her shoulders, neck, and face. Your partner has administered oxygen via a nonrebreather, initiated IV access, placed the patient on the cardiac monitor, and administered epinephrine SC and diphenhydramine IV. Despite this, you also note that her voice is quickly becoming hoarser and she has developed expiratory wheezes in all lung fields. HR = 128, BP = 100/70, RR = 20, SaO2 = 99 percent. What should be your major concern at this point, and what is the most appropriate treatment? A) Hypotension leading to cardiovascular collapse; administer fluids wide open and initiate a dopamine infusion B) Increased bronchospasm leading to respiratory arrest; administer albuterol via nebulizer C) Laryngeal edema leading to total airway occlusion; intubate D) Increased bronchospasm leading to respiratory arrest; administer epinephrine IV Answer: C Diff: 3 Page Ref: 1276 Standard: Medicine (Immunology) Objective: 6 24) The two most common causes of fatal anaphylaxis are A) shellfish, tree nuts B) hymenoptera stings, tree nuts C) hymenoptera stings, injected penicillin D) shellfish, sulfa drugs Answer: C Diff: 1 Page Ref: 1270 Standard: Medicine (Immunology) Objective: 3

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25) An allergen's most common route of entry in an anaphylactic reaction is: A) absorption. B) ingestion. C) injection. D) inhalation. Answer: C Diff: 1 Page Ref: 1272 Standard: Medicine (Immunology) Objective: 1

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26) Which of these statements about using antihistamines in the treatment of anaphylaxis is TRUE? A) Antihistamines displace histamine, then block histamine receptors. B) Antihistamines block histamine receptors and reduce histamine release from mast cells and basophils. C) Blocking of H1 receptors results in mild vasoconstriction, while the blocking of H2 receptors results in bronchodilation. D) Antihistamines block H1 and H2 receptors and prevent further release of histamine from B and T cells. Answer: B Diff: 2 Page Ref: 1278 Standard: Medicine (Immunology) Objective: 3 27) The administration of a vaccine results in what type of immunity? A) Induced passive B) Natural passive C) Natural induced D) Active Answer: D Diff: 1 Page Ref: 1271 Standard: Medicine (Immunology) Objective: 2 28) Which statement best explains the cause of the histamine and heparin release in response to exposure to an antigen? A) Humoral cells have initiated a chemical attack on the antigens. B) IgE antibodies have attached themselves to the membranes of basophils and mast cells, resulting in degranulation. C) IgG and IgM antibodies have activated basophils and mast cells, resulting in degranulation. D) IgE antibodies have activated the membranes of B and T cells, resulting in release of histamine and heparin. Answer: B Diff: 2 Page Ref: 1273 Standard: Medicine (Immunology) Objective: 2

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29) What is the best route for administering epinephrine to patients in severe anaphylactic shock refractory to initial interventions? A) SC B) ET C) IM D) IV Answer: D Diff: 1 Page Ref: 1278 Standard: Medicine (Immunology) Objective: 5 30) Immunity resulting from a direct attack on a foreign substance by specialized cells in the immune system is: A) primary immunity. B) humoral immunity. C) cellular immunity. D) secondary response. Answer: C Diff: 2 Page Ref: 1270 Standard: Medicine (Immunology) Objective: 2 31) Your partner experiences an itchy, red rash on her hands that stops at the wrists after using a new brand of glove your service purchased. Her skin is warm, dry, and nondiaphoretic; the rash is isolated to her hands; and her lung sounds are clear bilaterally. She has no other complaints. HR = 88, RR = 12, BP = 122/80. Of the listed treatments, which is most appropriate? A) Oxygen via nonrebreather mask 15 lpm, cardiac monitor, IV of NS KVO, epinephrine SC, diphenhydramine IM B) Oxygen via nasal cannula 4 lpm, cardiac monitor, IV of NS KVO, epinephrine IV, diphenhydramine IM C) Advise the dispatcher you will be going out of service D) Diphenhydramine IM Answer: D Diff: 3 Page Ref: 1278 Standard: Medicine (Immunology) Objective: 5

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32) Which of the following is a potentially life-threatening condition involving the head, neck, face, and upper airway? A) Hives B) Angioedema C) Urticaria D) Wheals Answer: B Diff: 1 Page Ref: 1270 Standard: Medicine (Immunology) Objective: 3 33) Your patient is a 19-year-old female who called EMS because she awoke with "itchy red patches" on her chest, back, and arms that "seem to come and go." As you obtain the history, you learn that she started taking Keflex, an antibiotic, two days ago to prevent infection in a laceration to her hand. In explaining to your patient what is going on, which of these statements would be the most accurate? A) "It looks like the infection in your hand has spread to the bloodstream. The toxins from the bacteria are causing a rash." B) "These look like hives. They occur during an allergic reaction. You may have developed an allergy to the antibiotic you are taking." C) "I cannot say what this is, but it is not an allergic reaction. Hives do not come and go as you have described." D) "This is a typical side effect of Keflex. It happens in most patients who take it." Answer: B Diff: 2 Page Ref: 1272 Standard: Medicine (Immunology) Objective: 3 34) Which body system is a complicated system responsible for combating infection? A) Immune B) Nervous C) Respiratory D) Cardiovascular Answer: A Diff: 1 Page Ref: 1270 Standard: Medicine (Immunology) Objective: 2

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35) The initial exposure of an individual to an antigen is referred to as what? A) Allergy B) Sensitization C) Hypersensitivity D) Active immunity Answer: B Diff: 1 Page Ref: 1272 Standard: Medicine (Immunology) Objective: 1 36) The immune response is a cascade that reacts to a: A) pathogen. B) toxin. C) bacteria. D) virus. Answer: A Diff: 1 Page Ref: 1270 Standard: Medicine (Immunology) Objective: 1 37) Following exposure to an allergen in which IgE antibodies are released, mast cells degranulate, releasing: A) histamine. B) epinephrine. C) insulin. D) T cells. Answer: A Diff: 1 Page Ref: 1273 Standard: Medicine (Immunology) Objective: 2 38) Histamine causes the all of these mechanisms to occur EXCEPT: A) bronchoconstriction. B) vasodilation. C) increased vascular permeability. D) increased intracranial pressure. Answer: D Diff: 1 Page Ref: 1273 Standard: Medicine (Immunology) Objective: 2

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39) You respond to a report of a patient with shortness of breath. Upon arrival, you find a patient who has been stung by a bee. The patient is displaying urticaria and wheezing. You suspect: A) anaphylaxis. B) asthma. C) meningitis. D) ARDS. Answer: A Diff: 2 Page Ref: 1275 Standard: Medicine (Immunology) Objective: 4 40) You respond to a patient who presents with shortness of breath after he took a dose of an antibiotic. You find your patient with audible stridor and urticaria. You should administer: A) SQ epinephrine 1:1000 0.3-0.5 mg. B) IM epinephrine 1:1000 0.3-0.5 mg. C) diphenhydramine 75 mg. D) albuterol 5 mg. Answer: B Diff: 3 Page Ref: 1277 Standard: Medicine (Immunology) Objective: 5 41) The standard dose of diphenhydramine for anaphylaxis is: A) 10-20 mg. B) 30-40 mg. C) 50-100 mg. D) 25-50 mg. Answer: D Diff: 2 Page Ref: 1278 Standard: Medicine (Immunology) Objective: 5 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 37 Gastroenterology 1) All of these are considered part of the lower gastrointestinal tract EXCEPT the: A) jejunum. B) large intestine. C) ileum. D) duodenum. Answer: D Diff: 1 Page Ref: 1296 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5 113 Copyright © 2023 Pearson Education, Inc.

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2) All of these contribute to the pathogenesis of diverticulosis EXCEPT: A) decreased colon motility. B) herniation of mucosa and submucosa through the teniae coli. C) increased colon pressure. D) low-fiber diet. Answer: A Diff: 2 Page Ref: 1299 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5 3) Your patient, who has a history of cholecystitis, is experiencing pain in her right shoulder. She is most likely experiencing what type of pain? A) Somatic B) Visceral C) Referred D) Peritoneal Answer: C Diff: 1 Page Ref: 1304-1305 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 2

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4) Your patient is a 22-year-old female in mild distress that is complaining of left lower quadrant abdominal pain and nausea. Which of these questions would be least helpful when determining the etiology of her abdominal pain? A) "When did the pain start?" B) "How would you describe the pain: dull, sharp, constant, intermittent?" C) "Are you having any vomiting or diarrhea?" D) "Have you ever had a sexually transmitted disease?" Answer: D Diff: 1 Page Ref: 1286-1287 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 7 5) Your patient is a 44-year-old female complaining of a three-day history of localized abdominal pain in her midepigastric region after eating. The pain tends to subside with antacids. Today she is experiencing nausea, and the pain did not subside with antacids. The patient gives a history of smoking and moderate alcohol consumption. The patient's skin is warm and dry, and she has a blood pressure of 128/88, a heart rate of 84, and respirations of 20. Your course of treatment should consist of: A) sodium bicarbonate IV. B) transporting the patient in a position of comfort and giving reassurance. C) high-concentration oxygen by nonrebreathing mask. D) IV of NS with 250 cc fluid bolus. Answer: B Diff: 3 Page Ref: 1287 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 4 6) While palpating the lower abdomen of a 63-year-old male complaining of back pain, you note a pulsating mass. You should: A) ask the patient to take a deep breath, then palpate the mass while he exhales. B) ask your partner to confirm the finding. C) determine if the mass is fixed or freely mobile in the abdomen. D) stop palpating. Answer: D Diff: 2 Page Ref: 1287 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 3

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7) Your patient is a 42-year-old male with a history of alcohol abuse who is in severe distress with dysphagia and hematemesis. You note that he is becoming lethargic and is having trouble keeping his head up. His skin is cool and clammy. HR = 138, BP = 82/56, RR = 8, SaO2 = 90 percent. Proper treatment of this patient would include all of these EXCEPT: A) IV of NS with fluid challenge. B) aggressive suctioning of the airway and intubation. C) dopamine infusion. D) placing the patient in shock position. Answer: C Diff: 2 Page Ref: 1291 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 4 8) Your patient is a 46-year-old male truck driver who is sitting on a toilet complaining of bleeding with defecation. He states that he had to strain significantly to produce a bowel movement, then noted blood on his stool afterward. He claims no significant medical history, has had no recent illness, and takes no medications. You note the presence of bright red blood on the surface of his stool. Of these, which is the most likely cause of his clinical condition? A) Crohn's disease B) Colitis C) Upper GI bleed D) Hemorrhoids Answer: D Diff: 1 Page Ref: 1300 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 6 9) Your patient is a 12-year-old male who is conscious and alert and complaining of diffuse abdominal pain. He states that the pain began about 3 hours after eating supper. He has had severe diarrhea and some vomiting. Any of these could be therapeutic EXCEPT: A) diazepam. B) Compazine. C) IV of NaCl or lactated Ringer's solution. D) Zofran. Answer: A Diff: 2 Page Ref: 1293 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 4

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10) Which three mechanisms can produce visceral pain? A) Peritonitis, cholecystitis, and a ruptured abdominal aorta B) Blunt trauma, penetrating trauma, and medical illness C) Somatic, referred, and peritonitis D) Distension, ischemia, and inflammation Answer: D Diff: 1 Page Ref: 1284 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 2 11) Your patient is a 68-year-old female who is being treated for colon cancer. She is conscious and alert, in mild distress, and complaining of progressive weakness over the past three days. Palpation of her abdomen reveals tenderness to the lower right quadrant. Her skin is pale, cool, and dry, and you note the smell and appearance of melena in her stool. HR = 108, BP = 100/60, RR = 12, SaO2 = 97 percent. Proper treatment of this patient might include: A) IV of normal saline with a 250 mL fluid challenge, repeated if necessary. B) IV of 5 percent dextrose solution at 30 mL per hour. C) two large-bore IVs of lactated Ringer's solution, wide open. D) two large-bore IVs of normal saline, 20 mL/kg fluid bolus. Answer: D Diff: 2 Page Ref: 1290 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 7 12) Your male patient complaining of abdominal pain describes his pain as a dull, crampy sensation that is making him nauseous. The patient is most likely describing what type of pain? A) Visceral B) Referred C) Somatic D) Parietal Answer: A Diff: 1 Page Ref: 1284 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1

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13) Which of these correctly lists the organs and regions of the gastrointestinal tract in sequence after the stomach? A) Duodenum, jejunum, ileum, descending colon, transverse colon, ascending colon, rectum, anus B) Duodenum, ileum, jejunum, large intestine, anus, rectum C) Jejunum, duodenum, ileum, large intestine, anus, rectum D) Duodenum, jejunum, ileum, ascending colon, transverse colon, descending colon, rectum, anus Answer: D Diff: 1 Page Ref: 1289 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5 14) Your patient is a 68-year-old female complaining of diffuse abdominal pain. She has a history of intestinal hernias and adhesions from previous abdominal surgery. Your suspicion should be highest for: A) appendicitis. B) diverticulitis. C) bowel obstruction. D) ulcerative colitis. Answer: C Diff: 1 Page Ref: 1301-1302 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 7 15) Your patient is a 38-year-old female with a history of Crohn's disease. She is conscious and alert and complaining of abdominal pain. She describes a one-week history of increasingly diffuse, crampy abdominal pain. She also states that she has had nausea and vomiting, fever, and diarrhea the past two days. Physical examination reveals that her skin is warm and dry and that her abdomen is tender to palpation in all quadrants with no masses or distension noted. HR = 100, BP = 118/78, RR = 14, SaO2 = 99 percent. Which of these treatments is appropriate in the prehospital management of this patient? A) Diphenydramine B) Ketorolac (Toradol) C) Methylprednisolone D) Antiemetics Answer: D Diff: 2 Page Ref: 1298-1299 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 7

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16) Increased hepatic resistance to blood flow, as happens in cirrhosis, results in: A) hepatic arterial hypertension and obstruction of the common bile duct. B) portal vein hypertension and esophageal varices. C) portal artery hypertension and ascites. D) hepatic vein hypertension and hepatic vein aneurysm. Answer: B Diff: 1 Page Ref: 1290-1291 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5 17) Bleeding in the gastrointestinal tract proximal to the ligament of Treitz is considered to be in the: A) small intestine. B) lower GI tract. C) upper GI tract. D) colon. Answer: C Diff: 1 Page Ref: 1289 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5 18) Which of these properly accounts for the differences between visceral and somatic pain? A) Spilled organ contents and bacteria can result in visceral pain, while somatic pain is caused by organ distension. B) Visceral pain originates in the walls of hollow organs, while somatic pain originates in skeletal muscle. C) The nerves that carry somatic pain impulses enter the spinal column at various levels, while the nerves that carry visceral impulses enter the spinal column via specific nerve routes. D) The nerves that carry visceral pain impulses enter the spinal column at various levels, while the nerves that carry somatic impulses enter the spinal column via specific nerve routes. Answer: D Diff: 2 Page Ref: 1284-1285 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 2 19) Pain that is well localized, allowing an examiner to pinpoint the area of irritation is known as what type of pain? A) Parietal B) Visceral C) Referred D) Somatic Answer: D Diff: 1 Page Ref: 1285 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 2

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20) Your patient is a 66-year-old female who is conscious and alert, complaining of a one-week history of progressive "lightheadedness" with exertion. She also complains of mild nausea; dark, sticky stools; and pain in her lower abdomen. Which of these is the most likely cause of this patient's condition? A) Acute cholecystitis B) Diverticulosis C) Gastrointestinal bleeding D) Ingestion of an iron- or a bismuth-containing medication Answer: C Diff: 1 Page Ref: 1290 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 3 21) Your patient is a 19-year-old male complaining of a two-day history of abdominal pain described as diffuse and colicky, located around his umbilical area. He also states a loss of appetite and a low-grade fever over the same period. Palpation of his abdomen reveals tenderness and guarding to the periumbilical area. Of these, which is the most likely cause of his clinical condition? A) Bowel obstruction B) Appendicitis C) Peptic ulcer disease D) Cholecystitis Answer: B Diff: 1 Page Ref: 1303-1304 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 3 22) Murphy's sign is: A) bruising around the umbilicus. B) pain produced by pressing under the right costal margin in the presence of an inflamed gallbladder. C) pain produced by pushing 1 to 2 inches above the iliac crest on a line to the umbilicus. D) petechial hemorrhage of the abdominal wall. Answer: B Diff: 1 Page Ref: 1305 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1

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23) McBurney's point, a common site of pain secondary to appendicitis, is located: A) at the midway point of a line from 1 to 2 inches above the right iliac crest to the umbilicus. B) 2 inches above the umbilicus in the midline. C) 1 to 2 inches above the iliac crest in the right midaxillary line. D) at the midway point of a line from the symphysis pubis to the right anterior, superior iliac crest. Answer: A Diff: 1 Page Ref: 1303 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1 24) Your patient is a 24-year-old male complaining of a one-week history of abdominal pain. He describes the pain as in the upper right quadrant, dull and reproducible with movement and palpation. He also describes a decreased appetite, weight loss, and clay-colored stool over the same period. Of these, which is the most likely cause of his clinical condition? A) Colitis B) Cholecystitis C) Acute hepatitis D) Pancreatitis Answer: C Diff: 2 Page Ref: 1306-1307 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 3 25) The mortality rate of ruptured esophageal varices is: A) over 35 percent. B) 10 to 15 percent. C) 20 to 30 percent. D) 15 percent. Answer: A Diff: 1 Page Ref: 1290 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5 26) Your 43-year-old male patient is alert and oriented and is complaining of abdominal pain. He states that he is experiencing nausea and has vomited twice. Which of these is the most appropriate follow-up question? A) "What were you doing when the vomiting started?" B) "Do you drink more than three alcoholic beverages a day?" C) "Did you become dizzy or faint while you were vomiting?" D) "What did the material you vomited look like?" Answer: D Diff: 2 Page Ref: 1286 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 6

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27) Your patient is a 44-year-old female with a history of hiatal hernia. She is complaining of diffuse abdominal pain. All four quadrants are tender to palpation. She also states that she has vomited numerous times and describes the presence of bile. You note that her abdomen is slightly distended, and auscultation of her abdomen reveals absent bowel sounds. Of these, which is the most likely cause of her clinical condition? A) Pancreatitis B) Cholecystitis C) Diverticulitis D) Bowel obstruction Answer: D Diff: 3 Page Ref: 1301-1302 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 6 28) A 52-year-old male is in moderate distress and complaining of nausea and vomiting. He describes a three-day history of left upper quadrant abdominal pain described as sharp and radiating to his back. You note a slightly distended abdomen. He called EMS today when he developed nausea and vomiting. He denies any change of bowel habits and states he has a history of alcoholism. Of these, which is the most likely cause of his clinical condition? A) Pancreatitis B) Hepatitis C) Peptic ulcer disease D) Gastroenteritis Answer: A Diff: 1 Page Ref: 1306 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 7 29) Which of these questions would best help you determine if the pathology of a patient's complaint has been progressing? A) "On a scale of 0 to 10, with 10 being the worst pain possible, how would you have rated the pain when it started? How would you rate the pain now?" B) "When did your pain first start?" C) "Have you ever felt this pain before?" D) "On a scale of 1 to 10, with 10 being the worst pain possible, how would you rate this pain?" Answer: A Diff: 1 Page Ref: 1286-1287 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 6

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30) Gastrointestinal emergencies account for what percentage of emergency room visits annually? A) 5 B) 10 C) 2.5 D) 7.5 Answer: A Diff: 1 Page Ref: 1284 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 3 31) A 46-year-old female alcoholic is hypotensive, in severe distress, complaining of dysphagia, and vomiting bright red blood. Of these, which is the most likely cause of this patient's clinical condition? A) Hemorrhagic pancreatitis B) Acute gastroenteritis C) Esophageal varices D) Acute gastric ulcer perforation Answer: C Diff: 1 Page Ref: 1290-1291 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 7 32) A 56-year-old female is conscious and alert and complaining of diarrhea and nausea. The patient describes a two-day history of her symptoms and states that the pain is "all over her abdomen." All four quadrants are tender to palpation. She also describes hematochezia. PMH includes CAD, and she recently began taking 325 mg of ASA once a day. Of these, which is the most likely cause of her clinical condition? A) Diverticulitis B) Peptic ulcer C) Acute pancreatitis D) Acute gastroenteritis Answer: D Diff: 2 Page Ref: 1292-1293 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 7

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33) Your patient is a 25-year-old female who is complaining of pain in the midline of the lower abdomen. Which of these questions helps least when determining the etiology of the patient's pain? A) "Do you feel nauseated?" B) "Are you having any pain with urination?" C) "Are you experiencing pain anywhere other than your lower abdomen?" D) "When was your last menstrual period?" Answer: A Diff: 2 Page Ref: 1286-1287 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 6 34) Which of these statements about hepatitis is TRUE? A) Hepatitis is caused by a wide range of potential causes. B) All types of hepatitis are typically fatal within six months to two years. C) The most common cause of hepatitis is alcohol abuse. D) All types of hepatitis lead to chronic liver disease. Answer: A Diff: 2 Page Ref: 1306-1307 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5 35) Which of these statements would be most typical of a patient with hepatitis? A) "It seems like everything has a yellow tinge to it." B) "I have sharp pain on the left side of my abdomen." C) "I have to urinate all the time." D) "My stools are really light in color." Answer: D Diff: 2 Page Ref: 1306-1307 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5 36) Which of these is the most common chief complaint related to acute pancreatitis? A) Headache B) Intense abdominal pain C) Blood in the stool D) Diarrhea Answer: B Diff: 2 Page Ref: 1305 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5

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37) Which of these assessment findings should you most expect in a patient with chronic pancreatitis? A) Dark-colored urine B) Right lower quadrant pain C) Clay-colored stool D) Hypotension Answer: D Diff: 2 Page Ref: 1305 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 6 38) Upon palpation of your patient's abdomen you note that it is very tender under the right costal margin. This should be documented as a positive: A) Murphy's sign. B) Cullen's sign. C) McBurney's sign. D) Grey-Turner's sign. Answer: A Diff: 2 Page Ref: 1305 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1 39) Pain at McBurney's point is associated with: A) cholecystitis. B) kidney stones. C) appendicitis. D) pancreatitis. Answer: C Diff: 2 Page Ref: 1303 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1 40) Your patient is a 55-year-old male whose wife called EMS after the patient complained of bright red bleeding during a bowel movement. The patient refuses transport, stating he has hemorrhoids and has had similar bleeding in the past. Which of these statements is most appropriate? A) "I'm sure you are right; there is nothing to worry about." B) "Similar bleeding can be caused by more serious conditions." C) "This does not sound like hemorrhoids." D) "Even though this sounds like hemorrhoids, the bleeding may become life-threatening." Answer: B Diff: 2 Page Ref: 1300 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 3

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41) Which of these best explains the underlying problem in diverticulitis? A) Infection in an outpouching of the distal colon B) Ulceration of the lining of the colon C) Increased motility of the colon with increased mucus production D) The presence of polyps in the sigmoid colon Answer: A Diff: 2 Page Ref: 1299 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 6 42) Which of these would be most typical of a patient suffering from diverticulitis? A) Dark, tarry stools B) Diffuse abdominal pain C) Left lower quadrant pain D) Inability to have a bowel movement Answer: C Diff: 2 Page Ref: 1299 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 6 43) A Mallory-Weiss tear is a disorder of the: A) stomach. B) liver. C) rectum. D) esophagus. Answer: D Diff: 1 Page Ref: 1290 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5 44) Esophageal varices are most associated with: A) kidney disease. B) liver disease. C) gastroesophageal reflux disease. D) pancreatitis. Answer: B Diff: 1 Page Ref: 1291 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5

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45) What is the most common cause of chronic gastroenteritis? A) Microbial infection B) Floral infection C) Elevated cortisol D) Use of NSAIDs Answer: A Diff: 2 Page Ref: 1293 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 6 46) With occlusion of the SMA or IMA vascular structures, what gastrointestinal emergency may occur? A) Renal infarction B) Hepatic encephalitis C) Pancreatitis D) Mesenteric ischemia Answer: D Diff: 2 Page Ref: 1302 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5 47) Which of these mechanisms is NOT characteristic for a rectal foreign body? A) Adhesion progression B) Accidental trauma C) Accidental swallowing of something D) Tumor growth Answer: B Diff: 2 Page Ref: 1300-1301 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 7 48) Abdominal pain that is dull in nature and cannot be narrowed to one specific area is known as: A) referred pain. B) somatic pain. C) visceral pain. D) Kehr's sign. Answer: C Diff: 1 Page Ref: 1284 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 2

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49) Abdominal pain that is sharp in nature and can be localized is known as: A) referred pain. B) somatic pain. C) visceral pain. D) Kehr's sign. Answer: B Diff: 1 Page Ref: 1285 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 2 50) Abdominal pain that is originating in a region other than where it is felt is known as: A) referred pain. B) somatic pain. C) visceral pain. D) Kehr's sign. Answer: A Diff: 1 Page Ref: 1285 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 2 51) You are examining a patient who was recently involved in a traumatic incident. You notice that the patient is now exhibiting periumbilical ecchymosis. This is known as: A) Grey Turner's sign. B) Cullen's sign. C) Edwards' sign. D) rigidity sign. Answer: B Diff: 1 Page Ref: 1287 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 6 52) You are examining a patient who is exhibiting signs of hypovolemia. Upon inspection of the patient's flank, you notice ecchymosis. This is known as: A) Grey Turner's sign. B) Cullen's sign. C) Edwards' sign. D) rigidity sign. Answer: A Diff: 1 Page Ref: 1287 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 6

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53) Persistent abdominal pain is considered a surgical emergency when lasting longer than: A) 2 days. B) 2 hours. C) 6 days. D) 6 hours. Answer: D Diff: 1 Page Ref: 1286 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 6 54) The main purpose of the GI tract is: A) to convert food into nutrients for the body. B) to expel waste products. C) to facilitate metabolism. D) glucogenolysis. Answer: A Diff: 1 Page Ref: 1289 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1 55) You respond to a call of an ill person. Upon arrival, you find your patient complaining of diffuse abdominal pain and hematemesis. When asked, the patient states that the emesis was "coffee ground" in nature. You suspect: A) lower GI bleed. B) upper GI bleed. C) melena. D) esophageal varices. Answer: B Diff: 2 Page Ref: 1290 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5 56) You respond to a patent who complains of having dark, tarry stools. Upon arrival, you notice that the patient is pale, cool, and clammy. After initiation of two large-bore IVs, your initial fluid bolus should be: A) 10 mL/kg. B) 20 mL/kg. C) 250 mL. D) 1000 mL. Answer: B Diff: 2 Page Ref: 1290 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 6

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57) The cause of esophageal varices can be attributed to: A) pulmonary hypertension. B) portal hypertension. C) pulmonary hypotension. D) portal hypotension. Answer: B Diff: 1 Page Ref: 1290-1291 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 38 Urology and Nephrology 1) Which structures may be affected in a urinary tract infection in a female patient? A) Vagina, bladder, urethra B) Bladder, ureters, vagina C) Urethra, bladder, kidney D) Kidney, bladder, fallopian tubes Answer: C Diff: 1 Page Ref: 1329 Standard: Medicine (Genitourinary/Renal) Objective: 2 2) Which of the following statements best explains why urinary tract infections are more common in females than in males? A) The presence of estrogen in the lining of the female reproductive tract makes the mucous membranes more prone to infection. B) Bacteria from the vagina commonly enter the female urethra. C) The female urethra is shorter than those in males, more easily allowing bacteria to enter the rest of the urinary tract. D) Males have more acidic urine, which is effective in eliminating bacteria from the urinary tract. Answer: C Diff: 2 Page Ref: 1329 Standard: Medicine (Genitourinary/Renal) Objective: 5 3) Which statement is TRUE of the changes in blood chemistry and composition in a patient with chronic renal failure? A) Blood glucose decreases. B) H+ excretion leads to alkalosis. C) Polycythemia occurs. D) Urea and creatinine levels increase. Answer: D 130 Copyright © 2023 Pearson Education, Inc.

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Diff: 2 Page Ref: 1322 Standard: Medicine (Genitourinary/Renal) Objective: 5

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4) Which of these would most likely increase the incidence of a urinary tract infection? A) Prior history of renal calculi B) Lack of sexual activity C) Urinary stasis D) Male gender Answer: C Diff: 2 Page Ref: 1329 Standard: Medicine (Genitourinary/Renal) Objective: 1 5) Tenderness associated with pyelonephritis is best evaluated by percussing: A) in the midline, just superior to the symphysis pubis. B) just lateral to the spine slightly superior to the sacroiliac joint. C) laterally, just superior to the superior iliac crest. D) over the CVA. Answer: D Diff: 1 Page Ref: 1330 Standard: Medicine (Genitourinary/Renal) Objective: 4 6) A patient undergoes neurological changes during hemodialysis. What is the most likely cause of these neurologic abnormalities? A) Acute myocardial infarction B) Hyperglycemia C) Hypotension D) Accumulated blood urea Answer: D Diff: 2 Page Ref: 1327 Standard: Medicine (Genitourinary/Renal) Objective: 6 7) Your patient is a 30-year-old male complaining of pain radiating from the left flank into the groin. He states that it began as a vague pain in his flank, then became very sharp and radiating. Based on his description of his pain, you would also expect him to complain of: A) inability to urinate. B) purulent urethral discharge. C) fever. D) painful urination. Answer: D Diff: 2 Page Ref: 1330 Standard: Medicine (Genitourinary/Renal) Objective: 5

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8) Treatment of a patient in acute renal failure may include each of these interventions EXCEPT: A) IV normal saline. B) dialysis. C) furosemide. D) potassium. Answer: D Diff: 2 Page Ref: 1322 Standard: Medicine (Genitourinary/Renal) Objective: 5 9) Fifty percent dextrose solution is placed on side A of a membrane and 25 percent dextrose is placed on side B of a membrane. Assuming the membrane is permeable to water, but not solutes, what will happen? A) Water may move freely in both directions, but there will be no net movement of water. B) Net movement of water from side B to side A will occur. C) Net movement of water from side A to side B will occur. D) Water will not move in either direction. Answer: B Diff: 2 Page Ref: 1313 Standard: Medicine (Genitourinary/Renal) Objective: 2 10) A 76-year-old patient with acute interstitial nephritis presents with oliguria, altered mental status, and edema to his face, hands, and feet. Of the following, which best describes the pathophysiology behind these clinical findings? A) Increased GFR results in retention of water, electrolytes, and metabolic waste. B) Na+ and K+ excretion results in diuresis and dehydration. C) Decreased GFR results in retention of water, electrolytes, and metabolic waste. D) H+ excretion results in diuresis and alkalosis. Answer: C Diff: 3 Page Ref: 1323 Standard: Medicine (Genitourinary/Renal) Objective: 5

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11) Your patient is a 32-year-old female who is alert and complaining of dysuria. She describes a three-day history of pain with urination and urinary urgency and difficulty. She describes the pain as a 4 on a scale of 1 to 10. Physical examination reveals tenderness on palpation of the lower abdomen bilaterally and warm, dry skin. HR = 88, BP = 126/78, RR = 12, SpO2 = 99 percent. The most appropriate action is: A) oxygen, IV fluids, morphine. B) expedite transport in position of comfort. C) oxygen, IV fluids. D) IV fluids, ibuprofen. Answer: B Diff: 2 Page Ref: 1328 Standard: Medicine (Genitourinary/Renal) Objective: 6 12) Which statement about hemodialysis is TRUE? A) Blood is removed from the body, wastes are collected in a filter, and blood is then returned to the body. B) Dialysate is placed in the abdominal cavity, the peritoneum acts as a dialysis membrane, and dialysate is then removed from the abdominal cavity. C) Dialysate enters the circulation through the venous site of a fistula and leaves through the arterial side of the fistula. D) Dialysis approximates the physiology of the nephron by placing blood on one side of a semipermeable membrane and dialysate on the other side. Answer: D Diff: 2 Page Ref: 1325-1326 Standard: Medicine (Genitourinary/Renal) Objective: 5 13) In healthy individuals, which of these is NOT a function of the kidney? A) Excretion of glucose B) Secretion of erythropoietin C) Excretion of wastes D) Regulation of water and electrolyte balance and pH Answer: A Diff: 1 Page Ref: 1312 Standard: Medicine (Genitourinary/Renal) Objective: 2

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14) All of these are common complications of renal dialysis EXCEPT: A) bleeding from the needle puncture site. B) dysfunction of the fistula. C) air embolism. D) localized infection at the needle puncture site. Answer: C Diff: 2 Page Ref: 1326 Standard: Medicine (Genitourinary/Renal) Objective: 5 15) Which finding is most suggestive of cystitis? A) Abdominal distension B) Suprapubic tenderness to palpation C) Flank pain radiating to the groin D) Diffuse, periumbilical abdominal pain Answer: B Diff: 3 Page Ref: 1318 Standard: Medicine (Genitourinary/Renal) Objective: 4 16) A patient with no prior history of renal disease is experiencing restlessness, agitation, dysuria, and flank pain radiating into the groin. Appropriate treatment for this patient would consist of all of these interventions EXCEPT: A) IV fluid therapy. B) position of comfort. C) Lasix IV. D) morphine. Answer: C Diff: 2 Page Ref: 1328 Standard: Medicine (Genitourinary/Renal) Objective: 6 17) All of these findings can be associated with urinary tract infection EXCEPT: A) cystitis. B) cholecystitis. C) prostatitis. D) pyelonephritis. Answer: B Diff: 1 Page Ref: 1329 Standard: Medicine (Genitourinary/Renal) Objective: 5

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18) Your patient is an 83-year-old male with a fever of 103°F. In addition, the patient is confused and combative. Heart rate = 132, respirations = 20, blood pressure = 100/70, SpO2 = 95 percent on room air, and blood glucose level = 90 mg/dL. During your examination you note that the patient has a Foley catheter and that the collection bag appears not to have been emptied for quite some time. The bag is full of dark, cloudy urine with sediment at the bottom of the bag. Which of the following is most appropriate? A) Acetaminophen suppository B) BLS transport without intervention C) Furosemide D) Intravenous fluid therapy with normal saline Answer: D Diff: 2 Page Ref: 1330 Standard: Medicine (Genitourinary/Renal) Objective: 6 19) Which of these is least likely to lead to acute renal failure? A) Pneumonia B) Urethral obstruction C) Interstitial nephritis D) Heart failure with hypotension Answer: A Diff: 2 Page Ref: 1320 Standard: Medicine (Genitourinary/Renal) Objective: 4 20) Your patient is a 68-year-old male who is conscious but confused and lying on his kitchen floor. The patient offers no complaint other than wishing to be helped up from the floor. The patient can tell you that he "slipped a few days ago" and has been on the floor since. Physical examination reveals dry, cool skin; dry mucous membranes; clear lung sounds bilaterally; and no indications of trauma. HR = 112, BP = 98/70, RR = 14, SaO2 = 96 percent. Your partner finds an appointment card indicating the patient missed a hemodialysis appointment two days ago. Which of the following is the best course for managing this patient? A) 1,000 mL fluid bolus B) 250 mL fluid bolus C) IV of NS at a keep open rate D) Dopamine infusion Answer: B Diff: 3 Page Ref: 1325 Standard: Medicine (Genitourinary/Renal) Objective: 6

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21) All of the following symptoms are consistent with urinary tract infection EXCEPT: A) passing hard, granular material in the urine. B) difficulty beginning and continuing to void. C) tenderness over one or both flanks. D) frequent urge to urinate. Answer: A Diff: 2 Page Ref: 1330 Standard: Medicine (Genitourinary/Renal) Objective: 5 22) Which of these would interfere with urine production? A) Benign prostatic hypertrophy B) Renal calculi C) Tumor in the renal pelvis D) Toxic damage to the nephrons Answer: D Diff: 1 Page Ref: 1322 Standard: Medicine (Genitourinary/Renal) Objective: 2 23) Which of these best describes the mechanism of action of ACE inhibitors? A) They inhibit sodium reabsorption, causing increased excretion of sodium. B) They increase the GFR directly. C) They inhibit the conversion of angiotensin I to angiotensin II. D) They inhibit the formation of renin in the renin-angiotensin system. Answer: C Diff: 2 Page Ref: 1314 Standard: Medicine (Genitourinary/Renal) Objective: 2 24) Your patient is complaining of pain secondary to epididymitis. Where should you expect the pain to be located? A) Flank B) Testes C) Suprapubic region D) Lower left or right quadrant, depending on which side is affected Answer: B Diff: 1 Page Ref: 1318 Standard: Medicine (Genitourinary/Renal) Objective: 3

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25) Your patient is a 68-year-old female who is conscious but confused and lying supine in bed without complaint. Her daughter states that the patient was recently diagnosed with a bladder infection and has been taking antibiotics. She also states that her mother has not produced urine for two days, during which she has become increasingly confused. Physical examination reveals swelling to the face, hands, and feet; cool and moist skin; and lung sounds that are clear and equal bilaterally. HR = 104, BP = 142/88, RR = 14, SaO2 = 96 percent. In addition to administering oxygen and monitoring the cardiac rhythm, which of the following courses of action is most appropriate? A) IV of NS with 250 cc fluid challenge B) 12-lead ECG, IV of NS KVO C) IV of NS KVO, furosemide, 40 mg D) IV of NS KVO Answer: B Diff: 3 Page Ref: 1319 Standard: Medicine (Genitourinary/Renal) Objective: 6 26) Your patient has a history of benign prostatic hypertrophy. Which of the following complaints is most consistent with this history? A) "It seems like I urinate a gallon at a time." B) "My urine is cloudy and has a strong odor." C) "I can't seem to urinate." D) "I have blood in my urine first thing in the morning." Answer: C Diff: 1 Page Ref: 1311 Standard: Medicine (Genitourinary/Renal) Objective: 5 27) Your patient is a 35-year-old male whom you suspect of having a kidney stone. All of the following would be consistent with this impression EXCEPT: A) hematuria. B) a description of "knifelike" pain. C) restlessness. D) fever. Answer: D Diff: 2 Page Ref: 1328 Standard: Medicine (Genitourinary/Renal) Objective: 5

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28) You are called to a local physician's office where you find a 52-year-old male patient with a history of chronic renal failure. He is conscious but disoriented. The physician reports that the patient's wife brought him in because he has had a "chest cold," missed dialysis yesterday, and is now "acting strangely." Physical examination reveals cool, diaphoretic skin; edema to dependent areas, and lung sounds with rhonchi in the right upper lobe. HR = 118, BP = 142/100, RR = 20 and deep, SaO2 = 97 percent, blood glucose = 79 mg/dL. Bloodwork performed by the physician in his office indicates a pH of 7.2. In addition to 15 liters per minute of oxygen by nonrebreathing mask and an IV of normal saline at a keep open rate, which of the following is most appropriate for this patient in the prehospital setting? A) IV sodium bicarbonate, 1 mEq/kg B) IV magnesium sulfate, 10 g C) IV dextrose, 25 g D) IV furosemide, 120 mg Answer: A Diff: 2 Page Ref: 1324 Standard: Medicine (Genitourinary/Renal) Objective: 6 29) The leading cause(s) of end-stage renal failure is (are): A) renal calculi and kidney infection. B) acute renal failure. C) uncontrolled diabetes mellitus and hypertension. D) kidney infection. Answer: C Diff: 1 Page Ref: 1322 Standard: Medicine (Genitourinary/Renal) Objective: 5 30) Which statement about chronic renal failure (CRF) is accurate? A) CRF is diagnosed when 70 percent of the nephrons are lost and the patient is clinically unstable. B) The only treatment for CRF is a kidney transplant. C) CRF is reversible if the cause is found and treated. D) Hemodialysis can reverse CRF, but CAPD cannot. Answer: A Diff: 2 Page Ref: 1322 Standard: Medicine (Genitourinary/Renal) Objective: 5

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31) Oxygen can benefit patients with chronic renal failure because it is common for patients with chronic renal failure to be: A) anemic due to the blood loss associated with hemodialysis. B) anemic due to decreased production of RBCs. C) hypoxic secondary to associated congestive heart failure. D) hypoxic secondary to associated hypotension. Answer: B Diff: 2 Page Ref: 1322 Standard: Medicine (Genitourinary/Renal) Objective: 5 32) On-scene you are presented with a confused patient suffering from altered mental status. Additionally, in front of the family, the patient is very irritable and verbally abusive toward all present, including EMS. His wife states that his "kidneys are no good" and he also has "sugar" problems. Your assessment indicates that he is dyspneic with pale skin that is covered with a fine white sediment. His radial pulse is weak, rapid, and irregular. Additionally, you note edema to his hands, feet, and face. Crackles are noted to the lungs bilaterally and he has a dialysis graft on his right forearm. Your partner reports that his heart rate is 164, respirations 26, blood pressure 176/90, and SpO2 = 87 percent. After applying high-concentration oxygen, which action should you perform next? A) Administer furosemide, 120 mg B) Infuse a 1000 mL bolus of NS C) Determine the blood glucose level D) Administer sodium bicarbonate, 50 mEq Answer: C Diff: 3 Page Ref: 1313-1314 Standard: Medicine (Genitourinary/Renal) Objective: 6 33) In order for hemodialysis to be effective in ridding the body of excess electrolytes, which of the following statements must be TRUE? A) The dialysate must contain electrolytes in the same concentration as in the patient's blood. B) The dialysate must contain electrolytes in a concentration lower than in the patient's blood. C) The dialysate must contain electrolytes in a concentration higher than in the patient's blood. D) The dialysate must not contain electrolytes. Answer: B Diff: 3 Page Ref: 1325 Standard: Medicine (Genitourinary/Renal) Objective: 3

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34) Which of these statements regarding a dialysis fistula is TRUE? A) A fistula is a surgical anastomosis of an artery and a vein. B) The fistula is the preferred site of venous access in an emergency situation. C) A fistula uses a dual lumen tube to connect an artery and a vein. D) The fistula is inserted peripherally, but the end of it is placed near the right atrium. Answer: A Diff: 2 Page Ref: 1325 Standard: Medicine (Genitourinary/Renal) Objective: 3 35) When assessing a fistula used for hemodialysis, which of these findings should concern you? A) Pulsation with each heartbeat B) A bruit on auscultation C) Bruising around the fistula D) Lack of a palpable vibration Answer: D Diff: 2 Page Ref: 1326 Standard: Medicine (Genitourinary/Renal) Objective: 4 36) A 40-year-old female presents with hemorrhage from her dialysis graft. She states that she just got back from dialysis when the bleeding started. There is a significant amount of blood on the chair and floor. To control the bleeding, you would immediately: A) place a tourniquet proximal to the graft. B) place a tourniquet distal to the graft. C) apply direct pressure over the graft. D) apply ice to the area and elevate the extremity. Answer: C Diff: 2 Page Ref: 1326 Standard: Medicine (Genitourinary/Renal) Objective: 6 37) Which of these is associated with CAPD? A) Catheter placed in the central circulation B) Catheter providing access to the abdominal cavity C) Dialysis shunt in either arm D) Dialysis fistula in either arm Answer: B Diff: 1 Page Ref: 1326 Standard: Medicine (Genitourinary/Renal) Objective: 1

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38) Which of these is a prerenal cause of acute renal failure? A) Pyelonephritis B) Embolism of the renal vein C) Urethral obstruction due to renal calculi D) Massive overdose of ibuprofen Answer: B Diff: 2 Page Ref: 1320 Standard: Medicine (Genitourinary/Renal) Objective: 1 39) Which of the following chemistry findings would suggest acute renal failure? A) Elevated blood urea nitrogen (BUN) B) Decreased creatinine C) Decreased potassium D) Elevated iron Answer: A Diff: 2 Page Ref: 1322 Standard: Medicine (Genitourinary/Renal) Objective: 4 40) Ammonia is converted into urea, to be excreted as urine, in which organ? A) Kidney B) Liver C) Spleen D) Bladder Answer: B Diff: 1 Page Ref: 1310 Standard: Medicine (Genitourinary/Renal) Objective: 2 41) The two main functions of the renal system are: A) maintaining pH balance and blood volume. B) maintaining blood glucose and clearing dead blood cells. C) maintaining blood volume with proper pH, and retaining glucose and excreting urea. D) maintaining hematocrit levels with the proper creatine balance, and activation of the RAAS. Answer: C Diff: 1 Page Ref: 1312 Standard: Medicine (Genitourinary/Renal) Objective: 2

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42) Glucose is excreted through the urea above which level? A) 250 mg/dL B) 500 mg/dL C) 150 mg/dL D) 180 mg/dL Answer: D Diff: 1 Page Ref: 1312 Standard: Medicine (Genitourinary/Renal) Objective: 2 43) When dealing with a possible renal emergency, it is imperative to ask: A) "How many times have you urinated today?" B) "How much do you weigh?" C) "Do you think you can walk?" D) "When was the last time you saw your nephrologist?" Answer: A Diff: 1 Page Ref: 1321 Standard: Medicine (Genitourinary/Renal) Objective: 4 44) You respond to a call of a patient experiencing back pain. Upon your arrival, the patient is curled into the fetal position and feels warm to the touch. You suspect: A) acute renal failure. B) acute renal calculi. C) acute pyelonephritis. D) acute urinary tract infection. Answer: C Diff: 2 Page Ref: 1329-1330 Standard: Medicine (Genitourinary/Renal) Objective: 3 45) You respond to a nursing home for an ill patient. Upon your arrival, the staff tells you that over the past few days the patient's urine output has been steadily declining. Today, the patient has voided only approximately 400 mL. You suspect: A) chronic renal failure. B) acute renal failure. C) renal calculi. D) pyelonephritis. Answer: B Diff: 2 Page Ref: 1319 Standard: Medicine (Genitourinary/Renal) Objective: 4

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46) Oliguria is defined as: A) urine output of less than 400-500 mL daily. B) urine output of less than 4000-5000 mL daily. C) urine output of less than 100-200 mL daily. D) urine output of less than 1000-2000 mL daily. Answer: A Diff: 1 Page Ref: 1319 Standard: Medicine (Genitourinary/Renal) Objective: 1 47) Acute renal failure occurs when a patient loses what percentage of the functioning nephrons? A) 80 percent B) 70 percent C) 60 percent D) 50 percent Answer: B Diff: 1 Page Ref: 1322 Standard: Medicine (Genitourinary/Renal) Objective: 5 48) You respond to an ill patient. You note that the patient appears jaundiced and has a white frosty dust on his skin. You suspect: A) eczema. B) scabies. C) uremic frost. D) renal frost. Answer: C Diff: 2 Page Ref: 1322 Standard: Medicine (Genitourinary/Renal) Objective: 4 49) You respond to a call of an ill male patient. Upon arrival, you see a patient in a chair, hooked into two large bags–one on an IV stand, one below his waist. The tubes are going into the patient's abdomen. You should suspect that this patient is undergoing: A) peritoneal dialysis. B) hemodialysis. C) gastric lavage. D) J tube feeding. Answer: A Diff: 2 Page Ref: 1326 Standard: Medicine (Genitourinary/Renal) Objective: 4 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine

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Chapter 39 Toxicology 1) A patient has accidentally ingested about 4 ounces of drain cleaner. Your primary concern should be: A) metabolic alkalosis. B) internal bleeding. C) potential airway compromise. D) decreased level of consciousness. Answer: C Diff: 3 Page Ref: 1336 Standard: Medicine (Toxicology) Objective: 7 2) Restoril and Ativan are examples of: A) benzodiazepines. B) barbiturates. C) opiates. D) narcotics. Answer: A Diff: 1 Page Ref: 1344 Standard: Medicine (Toxicology) Objective: 6 3) Your patient is a 27-year-old male who has possibly overdosed on heroin. He is unresponsive and bradypneic. What intervention is most appropriate? A) 25 mg diphenhydramine B) 2 mg of naloxone C) 1 mg of flumazenil D) 100 mg of thiamine Answer: B Diff: 2 Page Ref: 1342 Standard: Medicine (Toxicology) Objective: 8

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4) Your patient is a 40-year-old male who ingested 30 tablets of Lexapro and 24 tablets of Tylenol PM. Which of these is the most important question you should ask? A) "Why did you take these medications?" B) "Have you ever done this before?" C) "Do you have a history of depression?" D) "How long ago did you take these medications?" Answer: D Diff: 2 Page Ref: 1339 Standard: Medicine (Toxicology) Objective: 5 5) Which class of drug is commonly abused to produce hyperactivity and exhilaration? A) Amphetamines B) Barbiturates C) Alcohol D) Benzodiazepines Answer: A Diff: 1 Page Ref: 1352 Standard: Medicine (Toxicology) Objective: 6 6) A patient has overdosed on TCA antidepressants in an attempt to end his life. The blood pressure is low despite repeated fluid boluses. You contact medical direction for additional orders to help raise the blood pressure. What medication will you likely be told to administer? A) Atropine sulfate B) Norepinephrine C) Vasopressin D) Sodium nitroprusside Answer: B Diff: 2 Page Ref: 1345 Standard: Medicine (Toxicology) Objective: 66 7) Using a pharmaceutical agent for something other than its intended use is called: A) overdose. B) addiction. C) habituation. D) substance abuse. Answer: D Diff: 1 Page Ref: 1352 Standard: Medicine (Toxicology) Objective: 1

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8) A 54-year-old female is conscious and alert and in significant pain after a coral snake bite to her hand. You note two small puncture wounds surrounded by a swollen, red area. She states that she is nauseous and has chills. Your management of this patient should include immobilization of the affected arm and: A) placing it at the level of the heart. B) placing it below the level of the heart with a constricting band proximal to the wound. C) elevating it above the level of the heart. D) placing it at the level of the heart with ice packs to the affected area. Answer: A Diff: 3 Page Ref: 1359 Standard: Medicine (Toxicology) Objective: 7 9) Which of the following medication combinations is beneficial for a lithium overdose? A) Narcan and sodium bicarbonate B) Mannitol and sodium bicarbonate C) Flumazenil and naloxone D) Haloperidol and furosemide Answer: B Diff: 3 Page Ref: 1339 Standard: Medicine (Toxicology) Objective: 7 10) Your patient is a 45-year-old female who became hypertensive after eating some cheese and drinking wine. Which type of medication would most likely account for this reaction? A) Phenothiazines B) Tricyclic antidepressants C) Selective serotonin reuptake inhibitors D) Monoamine oxidase inhibitors Answer: D Diff: 2 Page Ref: 1344 Standard: Medicine (Toxicology) Objective: 6 11) When a substance enters the body through the gastrointestinal tract, it has accessed the body by: A) inhalation. B) surface absorption. C) injection. D) ingestion. Answer: D Diff: 1 Page Ref: 1335 Standard: Medicine (Toxicology) Objective: 4

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12) You have been called to a residence by the parents of a 14-year-old boy, whom they found sniffing paint fumes in an effort to get high. The patient is agitated, coughing, and complaining of dizziness and shortness of breath. His airway is patent, respirations adequate, and radial pulse easily palpable. Closer assessment of the patient reveals paint around his mouth and breath sounds that are clear and equal. Heart rate = 96, respirations = 20, blood pressure = 116/78, and SaO2 = 96 percent. Oxygen via a nonrebreather has been applied and an IV established. What intervention is the most important in the assessment and care of this patient? A) Benzodiazepines B) Antipyretics C) Cardiac monitoring D) Albuterol administration Answer: C Diff: 3 Page Ref: 1349-1350 Standard: Medicine (Toxicology) Objective: 8 13) Your patient is a 29-year-old male who is conscious, alert, and extremely hyperactive after using cocaine. HR = 134, BP = 148/102, RR = 20. Physical examination reveals warm, diaphoretic skin and dilated pupils bilaterally. Which of the following medications should be considered to manage this patient? A) Metoprolol B) Naloxone C) Propranolol D) Diazepam Answer: D Diff: 2 Page Ref: 1343 Standard: Medicine (Toxicology) Objective: 7 14) Your patient is a 56-year-old female who is sitting on a park bench. She is conscious, though lethargic, and complaining of faintness. She states she has had a "chest cold" for the past week so had decided to stop taking her "blood pressure pills" until she felt better. She states that this morning she ingested five tablets instead of her normal one tablet dose to "catch up" after the days off. You note cool, slightly diaphoretic skin; lungs clear bilaterally; PEARL; and no motor deficits. HR = 48, BP = 76/30, RR = 12, SaO2 = 97 percent. Which of the following is least likely to be the medication she overdosed on? A) Metoprolol B) Procardia C) Cardizem D) Verapamil Answer: A Diff: 3 Page Ref: 1345-1346 Standard: Medicine (Toxicology) Objective: 6

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15) Lithium is used to treat: A) bipolar disorder. B) schizophrenia. C) depression. D) personality disorders. Answer: A Diff: 1 Page Ref: 1344 Standard: Medicine (Toxicology) Objective: 6 16) Two 15-year-old boys have been hiking and camping and using a guide to native plants to determine which plants are edible. They drank a tea made from some plants that they picked. They are now complaining of abdominal cramping, watering eyes, vomiting, diarrhea, and sweating. Which of the following have they most likely ingested? A) Amanita B) Jimson weed C) Holly berries D) Poison sumac Answer: A Diff: 2 Page Ref: 1340 Standard: Medicine (Toxicology) Objective: 6 17) Your patient is a 22-year-old female who has increased her daily dose of lithium without her physician's knowledge. She is complaining of generalized weakness, vomiting, and diarrhea. You notice that her speech is slurred. Heart rate = 68 and irregular, respirations = 16, blood pressure = 104/70, SaO2 = 97 percent on room air, and the monitor shows a sinus rhythm with PACs and PJCs. Which of the following would be most beneficial to this patient? A) Oxygen B) Magnesium sulfate C) Calcium chloride D) Sodium bicarbonate Answer: D Diff: 3 Page Ref: 1339 Standard: Medicine (Toxicology) Objective: 7

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18) A patient is experiencing severe abdominal cramping, vomiting, diarrhea, and facial flushing after eating undercooked chicken. Management of this patient should include all of these EXCEPT: A) activated charcoal. B) IV of normal saline. C) oxygen. D) transport. Answer: A Diff: 2 Page Ref: 1339 Standard: Medicine (Toxicology) Objective: 8 19) Your patient has ingested cyanide in a suicide attempt. Which of these is the primary threat to life you should anticipate? A) Hypotension B) Pulmonary edema C) Cellular asphyxia D) Liver failure Answer: C Diff: 2 Page Ref: 1349-1350 Standard: Medicine (Toxicology) Objective: 5 20) Which of the following statements would make you suspicious that your patient has been exposed to cyanide? A) "I think I smoked some bad weed." B) "I inhaled some fumes when I was fueling my truck." C) "I think my car has an exhaust leak." D) "I have been burning carpets and old furniture all day." Answer: D Diff: 2 Page Ref: 1349-1350 Standard: Medicine (Toxicology) Objective: 5 21) LSD and PCP are examples of: A) amphetamines. B) hallucinogens. C) sedatives. D) narcotics. Answer: B Diff: 1 Page Ref: 1353 Standard: Medicine (Toxicology) Objective: 6

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22) Your patient is a 56-year-old female who is alert and sitting in a chair. She states that she accidentally took too many of her Cardizem tablets. Which sign or symptom would you least expect to find? A) Cool, dry skin and mild hypotension B) Warm, dry skin and tachycardia C) Cool, diaphoretic skin and profound hypotension D) Bradycardia and altered mental status Answer: B Diff: 3 Page Ref: 1346 Standard: Medicine (Toxicology) Objective: 6 23) Your patient is a 20-year-old female who is conscious and alert, though obviously hallucinating after ingesting LSD. Her friends state that she is having a "bad trip," and you note that she is vigorously scratching her arms to the point of drawing blood. Physical examination reveals warm, slightly diaphoretic skin and dilated pupils bilaterally. Which of the following medications should be considered to manage this patient? A) Haloperidol B) Thiamine C) Narcan D) Avapro Answer: A Diff: 2 Page Ref: 1344 Standard: Medicine (Toxicology) Objective: 7 24) All of the following are examples of one of the three "principles of decontamination" that are specific to toxicological emergencies EXCEPT: A) administration of N-acetylcysteine. B) administration of normal saline fluid challenge. C) administration of sorbitol. D) removing a patient from a structure that is filled with carbon monoxide. Answer: B Diff: 2 Page Ref: 1347 Standard: Medicine (Toxicology) Objective: 7

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25) The need to progressively increase the dose of a drug to reproduce the effect originally achieved at smaller doses is: A) addiction. B) tolerance. C) substance abuse. D) habituation. Answer: B Diff: 1 Page Ref: 1352 Standard: Medicine (Toxicology) Objective: 1 26) A couple has been experimenting with Ecstasy. They are both complaining of anxiety, nausea, and palpitations. You would also expect: A) dyspnea. B) seizures. C) elevated blood pressure. D) bradycardia. Answer: C Diff: 2 Page Ref: 1353 Standard: Medicine (Toxicology) Objective: 6 27) A 19-year-old male has ingested fifty 325 mg aspirin tablets 20 minutes before your arrival. He is alert and complaining of burning abdominal pain. Which of these is appropriate in the prehospital management of this patient? A) Syrup of ipecac B) Activated charcoal C) Sodium bicarbonate D) N-acetylcysteine Answer: B Diff: 2 Page Ref: 1338 Standard: Medicine (Toxicology) Objective: 7 28) Your patient was in the building when a fire started at a factory that manufactures plastics. He is complaining of a headache, palpitations, and a burning sensation in his throat. His airway, breathing, and circulation are intact. Heart rate = 128, respirations = 22, blood pressure = 148/84, SaO2 = 93 percent. You should immediately: A) administer amyl and sodium nitrate. B) initiate supportive measures. C) apply the cardiac monitor. D) prepare to intubate. Answer: B Diff: 2 Page Ref: 1348-1349 Standard: Medicine (Toxicology) Objective: 8 152 Copyright © 2023 Pearson Education, Inc.

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29) The order Hymenoptera includes: A) wasps. B) jellyfish. C) spiders. D) scorpions. Answer: A Diff: 1 Page Ref: 1360 Standard: Medicine (Toxicology) Objective: 7 30) Which poison injury cause(s) damage by inducing liquefaction necrosis? A) Caustics B) Alkalis C) Emulsifiers D) Acids Answer: B Diff: 2 Page Ref: 1346 Standard: Medicine (Toxicology) Objective: 7 31) The ingestion of which type of mushroom would result in findings consistent with excessive serotonergic effects such as tachycardia, increased bowel sounds, hyperreflexia, and clonus? A) Button B) Psilocybin C) Shiitake D) Galerina Answer: B Diff: 1 Page Ref: 1353 Standard: Medicine (Toxicology) Objective: 6 32) Your patient is a 24-year-old, 176-pound male who is alert and oriented 12 hours after ingesting thirty 500 mg tablets of Tylenol. What is the most likely complaints or findings? A) Confusion, lethargy, and hyperthermia B) Nausea, vomiting, weakness, and fatigue C) Abdominal pain and oliguria D) Signs and symptoms of liver failure Answer: B Diff: 3 Page Ref: 1344-1345 Standard: Medicine (Toxicology) Objective: 6

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33) Which of the following is NOT associated with chronic alcohol ingestion? A) Decreased sensation in hands and feet B) Thiamine deficiency C) Hyperactivity D) Esophageal varices Answer: C Diff: 1 Page Ref: 1355 Standard: Medicine (Toxicology) Objective: 6 34) Your patient is a 19-year-old male who ingested thirty 500 mg tablets of Tylenol 25 minutes ago. Police officers on the scene are requesting that you "check him out" before they transport him for psychiatric evaluation. The patient denies ingesting other drugs or alcohol and has no complaints. HR = 94, BP = 116/74, RR = 12, SaO2 = 98 percent. Which of the following would be most appropriate? A) Release the patient to law enforcement custody B) Transport to the emergency department and administer activated charcoal C) Transport to the emergency department and administer sodium bicarbonate D) Transport to the emergency department and start an IV of normal saline Answer: D Diff: 3 Page Ref: 1345 Standard: Medicine (Toxicology) Objective: 8 35) Drinking alcohol (ETOH) is classified as a(n): A) stimulant. B) anxiolytic. C) depressant. D) hallucinogen. Answer: C Diff: 1 Page Ref: 1354 Standard: Medicine (Toxicology) Objective: 6

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36) A 38-year-old male is conscious and alert after a black widow spider bite to his right hand. You note pain and swelling to the hand, and the patient states that he is dizzy and nauseous. HR = 117, BP = 128/78, RR = 20. During your physical examination, you note that he begins to experience severe, painful muscle spasms in his right arm. Which of the following is NOT appropriate? A) Sodium bicarbonate B) Calcium gluconate C) Diazepam D) Midazolam Answer: A Diff: 3 Page Ref: 1360 Standard: Medicine (Toxicology) Objective: 8 37) One of the treatment goals for a patient who has been bitten by a pit viper on the foot is to: A) induce diuresis. B) elevate the extremity. C) alkalinize the urine. D) remove the venom from the surrounding tissue. Answer: B Diff: 2 Page Ref: 1359 Standard: Medicine (Toxicology) Objective: 7 38) Which statement concerning Africanized honeybees is accurate? A) Envenomation by Africanized honeybees requires treatment with specific antivenin. B) The venom of Africanized honeybees causes acute renal failure. C) The venom of Africanized honeybees is more toxic than that of other types of bees. D) Patients stung by Africanized honeybees tend to have more stings than patients stung by other types of bees during an attack. Answer: D Diff: 2 Page Ref: 1362 Standard: Medicine (Toxicology) Objective: 7 39) Which of these substances is considered to be included with the sympathomimetic toxidrome? A) Cocaine B) Marijuana C) Heroin D) Morphine Answer: A Diff: 1 Page Ref: 1340 Standard: Medicine (Toxicology) Objective: 6

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40) A 32-year-old female is conscious and alert at a group home for recovering alcoholics and states, "I'm having rum fits." Counselors from the home tell you that she is a chronic alcoholic who entered their program three days ago and has not had a drink since. Physical examination reveals cool, diaphoretic skin; dilated pupils bilaterally that are responsive to light; and obvious anxiety. HR = 122, BP = 156/104, RR = 20, SaO2 = 99 percent, blood glucose = 62 mg/dL. Based on the clinical exam findings, all of the following should be part of your patient management EXCEPT: A) 25 g of D50W IV. B) metoprolol IV. C) IV of normal saline. D) thiamine 100 mg IM. Answer: B Diff: 2 Page Ref: 1354-1355 Standard: Medicine (Toxicology) Objective: 8 41) Your patient is an 18-year-old female college student who is supine in bed and responsive only to painful stimuli. Her roommate states that they went to a party last night. She says the patient only drank soda, but now she thinks a guy who had been following them around might have put something in the patient's drink. Physical examination reveals cool, dry skin and pupils sluggish to light bilaterally. HR = 72, BP = 112/64, RR = 10, SaO2 = 98 percent. Which of the following drugs was most likely slipped into her drink? A) Flunitrazepam B) LSD C) Amphetamines D) Opium Answer: A Diff: 2 Page Ref: 1353 Standard: Medicine (Toxicology) Objective: 7 42) Your patient is a two-year-old male who is alert and crying after ingesting bathroom cleaner. Physical examination reveals no obvious burns or irritation to his oropharynx, and his skin is cool and dry. HR = 112, BP = 108/60, RR = 24, SaO2 = 99 percent. Which of the following is most appropriate? A) Having the patient drink a glass of milk B) Administration of ipecac C) Transport D) Administration of activated charcoal Answer: C Diff: 2 Page Ref: 1346-1347 Standard: Medicine (Toxicology) Objective: 7

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43) Which of the following best describes the mechanism of action of activated charcoal? A) It absorbs toxins in the stomach. B) It neutralizes both acidic and alkaline substances in the stomach. C) It adsorbs toxins in the stomach. D) It prevents substances from ionizing in the small intestine. Answer: C Diff: 2 Page Ref: 1338 Standard: Medicine (Toxicology) Objective: 6 44) A 32-year-old is conscious and in mild distress, complaining of nausea and sweating. He states that his symptoms started two days ago when he stopped drinking "cold turkey." Physical examination reveals cool, diaphoretic skin; slightly dilated pupils bilaterally; and a general weakness to all extremities. Which of the following findings would also be likely? A) Delirium tremens, hallucinations, and anxiety B) Insomnia, hyperglycemia, and difficulty breathing C) Hypertension, bradycardia, and hyperglycemia D) Depression, hypotension, and polyuria Answer: A Diff: 2 Page Ref: 1354-1355 Standard: Medicine (Toxicology) Objective: 6 45) Your patient is an alcoholic who stopped drinking three days ago. Which of the following should concern you the most in the care of this patient? A) Abdominal cramps B) Command hallucinations C) Hypothermia D) Potential for seizures Answer: D Diff: 3 Page Ref: 1355-1356 Standard: Medicine (Toxicology) Objective: 6 46) Which of the following correctly pairs a toxin with its antidote? A) Benzodiazepine: naloxone B) Flunitrazepam: flumazenil C) Carbon monoxide: amyl nitrite D) Aspirin: magnesium citrate Answer: B Diff: 2 Page Ref: 1353 Standard: Medicine (Toxicology) Objective: 5

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47) Which of the following is NOT a possible source of cyanide poisoning? A) Fume inhalation from burning plastic, synthetic carpeting, or silk B) Ingestion of apricot, pear, and cherry pits C) Long-term sodium nitroprusside therapy D) Improperly vented heating systems Answer: D Diff: 2 Page Ref: 1349-1350 Standard: Medicine (Toxicology) Objective: 6 48) Which of the following does NOT typically enter the body through injection? A) Medication overdose B) Organophosphate C) Envenomation D) Illicit drug overdose Answer: B Diff: 1 Page Ref: 1335 Standard: Medicine (Toxicology) Objective: 4 49) Which of the following is a highly toxic, odorless, tasteless gas that is a by-product of incomplete combustion? A) Carbon dioxide B) Carbon monoxide C) Cyanide D) Methane Answer: B Diff: 1 Page Ref: 1348 Standard: Medicine (Toxicology) Objective: 6 50) You are presented with a 42-year-old male who is unconscious with snoring respirations and pinpoint pupils after a heroin overdose. HR = 64, BP = 98/50, RR = 6 and shallow, SaO2 = 91 percent. Which of the following is the most appropriate initial treatment? A) Intubate, ventilate with supplemental oxygen B) IV access, administer a 250 cc fluid bolus C) BLS airway management and ventilation with supplemental oxygen D) IV access, administer naloxone Answer: D Diff: 3 Page Ref: 1337 Standard: Medicine (Toxicology) Objective: 7

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51) Fluoxetine, paroxetine, and citalopram are all examples of: A) phenothiazines. B) monoamine oxidase inhibitors. C) selective serotonin reuptake inhibitors. D) tricyclic antidepressants. Answer: C Diff: 1 Page Ref: 1340 Standard: Medicine (Toxicology) Objective: 6 52) All of the following are roles of a poison control center EXCEPT: A) identifying the toxin or poison. B) determining the potential toxicity of the agent. C) providing information on the most current definitive treatment. D) notifying the receiving hospital and recommending treatment. Answer: A Diff: 2 Page Ref: 1338 Standard: Medicine (Toxicology) Objective: 3 53) Narcan acts as an antagonist to all of the following medications EXCEPT: A) midazolam. B) methadone. C) codeine. D) heroin. Answer: A Diff: 2 Page Ref: 1342 Standard: Medicine (Toxicology) Objective: 6 54) Naproxen, ibuprofen, and ketorolac are all examples of: A) MAOIs. B) SSRIs. C) NSAIDs. D) TCAs. Answer: C Diff: 1 Page Ref: 1344 Standard: Medicine (Toxicology) Objective: 6

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55) The pathophysiology of toxic inhalation includes: A) bronchodilation and destruction of cilia. B) irritation and pulmonary edema. C) pulmonary hypertension, alveolar atelectasis, and destruction of cilia. D) bronchoconstriction and dispersal of surfactant. Answer: B Diff: 2 Page Ref: 1335 Standard: Medicine (Toxicology) Objective: 4 56) Your patient is a 60-year-old male complaining of chills, fever, joint pain, and vomiting. He states he was bitten by a spider yesterday morning, and now he thinks the bite might be infected. The patient has an ulcerated wound on his left leg. The best treatment for this patient would include: A) diazepam 2.5 mg. B) magnesium sulfate 2 g. C) calcium gluconate 0.1 mg/kg. D) supportive management. Answer: D Diff: 2 Page Ref: 1361 Standard: Medicine (Toxicology) Objective: 8 57) Which of the following accounts for more than 90 percent of hospital admissions for toxic substance exposure? A) Pediatric overdoses B) Intentional poisoning by another person C) Pediatric accidental poisonings D) Adult poisonings and overdoses Answer: D Diff: 1 Page Ref: 1335 Standard: Medicine (Toxicology) Objective: 2

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58) You are presented with a 25-year-old male complaining of mouth and stomach pain after accidentally ingesting approximately 8 ounces of benzene. Physical examination reveals irritation to the oral mucosa, skin warm and slightly diaphoretic, and lungs clear and equal bilaterally. HR = 100, BP = 118/66, RR = 14, SaO2 = 89 percent. Based on the clinical exam findings, treatment would consist of all of the following EXCEPT: A) oxygen. B) rapid transportation to an ED for gastric decontamination. C) administration of activated charcoal. D) IV of NS KVO. Answer: C Diff: 2 Page Ref: 1338 Standard: Medicine (Toxicology) Objective: 4 59) Which of the following is commonly indicated in the management of cocaine overdose? A) Thiamine B) Flumazenil C) Diazepam D) Narcan Answer: C Diff: 2 Page Ref: 1344 Standard: Medicine (Toxicology) Objective: 6 60) Your patient is a 16-year-old female who has taken an overdose of phenobarbital. She is unresponsive. Her skin is cool and pale, BP = 92/60, HR = 60, RR = 6. You have intubated the patient and started an IV. Which of the following is appropriate? A) Contact poison control–may order bicarbonate. B) Sodium bicarbonate 100 mEq C) Naloxone 2 mg, 25 g dextrose, transport D) 50 g activated charcoal through an NG tube en route to the hospital Answer: A Diff: 3 Page Ref: 1343 Standard: Medicine (Toxicology) Objective: 3

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61) Your patient is a 24-year-old male complaining of a headache for the past two days. He states he has taken aspirin but cannot get rid of the headache. The patient lives in a basement apartment, which you observe is very chilly. The patient states his furnace hasn't been working and he had to use the oven to help heat the apartment. Which other findings and complaints are most likely? A) Nausea, vomiting, decreased hemoglobin saturation B) Rash, nausea, a metallic taste in the mouth C) Pale skin, sluggish pupils, tachycardia D) Nausea, vomiting, confusion, tachypnea Answer: D Diff: 2 Page Ref: 1348 Standard: Medicine (Toxicology) Objective: 5 62) Which of the following is a narcotic? A) Mescaline B) Crack C) Cocaine D) Heroin Answer: D Diff: 1 Page Ref: 1340 Standard: Medicine (Toxicology) Objective: 6 63) The continued use of the drug despite the fact that it may be harmful and serves no medical purpose is: A) substance abuse. B) withdrawal. C) addiction. D) habituation. Answer: C Diff: 1 Page Ref: 1352 Standard: Medicine (Toxicology) Objective: 1

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64) Your patient is a 48-year-old female who is unconscious with snoring respirations after ingesting an unknown substance. You note cold, peripherally cyanotic skin and a weak, rapid pulse. Her pupils are equal and reactive but constricted. She has no unusual odors, and her blood glucose level is 80 mg/dl. HR = 74, BP = 100/68, RR = 4, SaO2 = 91 percent. Which of the following is appropriate? A) Intubate, ventilate using supplemental oxygen, IV, 1 mEq/kg sodium bicarbonate B) Intubate, ventilate using supplemental oxygen, IV, 2 mg naloxone, 100 mg thiamine, 25 g dextrose C) Assist ventilations using supplemental oxygen, IV, 2 mg naloxone D) Assist ventilations using supplemental oxygen, IV, 2 mg naloxone, 100 mg thiamine, 25 g dextrose Answer: C Diff: 3 Page Ref: 1337 Standard: Medicine (Toxicology) Objective: 7 65) Fifty percent of accidental poisonings occur in: A) adults younger than 45. B) geriatric patients over the age of 65. C) pediatric patients under 6 years of age. D) dementia patients of any age. Answer: C Diff: 1 Page Ref: 1334 Standard: Medicine (Toxicology) Objective: 2 66) In addition to determining potential toxicity based on the type of agent, poison control centers are able to: A) refer the patient to a specialist. B) determine whether transport is needed. C) guide the paramedic in starting definitive treatment in the field. D) give the paramedic documentation advice. Answer: C Diff: 1 Page Ref: 1338 Standard: Medicine (Toxicology) Objective: 3 67) Some of the most immediate effects from ingesting a poison include: A) oral burns. B) localized skin reaction. C) absorption by the lower intestine. D) clotting disorders. Answer: A Diff: 1 Page Ref: 1335 Standard: Medicine (Toxicology) Objective: 4 163 Copyright © 2023 Pearson Education, Inc.

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68) Inhalation of a poison causes: A) absorption by the trachea. B) absorption through the alveolar-capillary membrane. C) increase in secretions. D) aspiration. Answer: B Diff: 1 Page Ref: 1335 Standard: Medicine (Toxicology) Objective: 4 69) Inhaled toxins: A) cause damage and edema in the lungs. B) are immediately absorbed into the bloodstream. C) are eliminated by first-round metabolism. D) permeate the blood-brain barrier more quickly. Answer: A Diff: 1 Page Ref: 1335 Standard: Medicine (Toxicology) Objective: 4 70) What would be a likely way for a hydrocarbon to be abused? A) Surface absorption B) Ingestion C) Injection D) Inhalation Answer: D Diff: 1 Page Ref: 1347 Standard: Medicine (Toxicology) Objective: 8 71) An antidote: A) neutralizes a specific toxin. B) enhances the toxin. C) is not indicated in the field. D) is universally oxygen. Answer: A Diff: 1 Page Ref: 1342 Standard: Medicine (Toxicology) Objective: 1

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72) Your first priority in the treatment of an inhaled toxin is to: A) decontaminate the patient. B) remove the patient from the source. C) flood with oxygen. D) deluge with water. Answer: B Diff: 2 Page Ref: 1336 Standard: Medicine (Toxicology) Objective: 7 73) You respond to an ill male patient. Upon arrival, you note a farmer who is complaining of not feeling well. The patient presents in a tripod position with copious secretions, lacrimation, vomiting, and evidence of urination and defecation. You suspect: A) anticholinergic exposure. B) cholinergic exposure. C) sympathomimetic exposure. D) extrapyramidal syndrome. Answer: B Diff: 2 Page Ref: 1343 Standard: Medicine (Toxicology) Objective: 6 74) The half-life of carboxyhemoglobin is reduced to approximately 30 minutes by using: A) 100 percent oxygen. B) 44 percent oxygen. C) hypobaric oxygen therapy. D) hyperbaric oxygen therapy. Answer: D Diff: 2 Page Ref: 1349 Standard: Medicine (Toxicology) Objective: 6 75) You respond to an ill patient experiencing flu-like symptoms. Upon your arrival, the patient states that she woke up not feeling well. The patient states that she has been heating her home with wood due to the electric bill being too high. You should suspect: A) carbon dioxide poisoning. B) carbon monoxide poisoning. C) hypercarbia. D) hypothermia. Answer: B Diff: 2 Page Ref: 1348 Standard: Medicine (Toxicology) Objective: 6 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine 165 Copyright © 2023 Pearson Education, Inc.

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Chapter 40 Hematology 1) Which of these statements about immunity is TRUE? A) T cells mature in the bone marrow. B) Lymphocytes are the primary cells involved in the immune response. C) Humoral immunity uses cytotoxic chemicals to destroy pathogens. D) Cell-mediated immunity uses antibody formation to combat pathogens. Answer: B Diff: 2 Page Ref: 1375 Standard: Medicine (Hematology) Objective: 3 2) Which of these would directly result in decreased fibrinolysis? A) Increased factor X B) Decreased plasminogen secretion C) Increased plasmin secretion D) Hypercalcemia Answer: B Diff: 2 Page Ref: 1386 Standard: Medicine (Hematology) Objective: 3 3) When a patient receives a laceration, the clotting process that occurs is primarily mediated by which pathway? A) Platelet B) Common C) Extrinsic D) Intrinsic Answer: C Diff: 2 Page Ref: 1373 Standard: Medicine (Hematology) Objective: 3 4) Of these, which would be the most likely dysfunction experienced by a patient with multiple myeloma? A) Increased T cell production B) Decreased T cell production C) Decreased blood cell production D) Increased blood cell production Answer: C Diff: 2 Page Ref: 1385 Standard: Medicine (Hematology) Objective: 4 5) A patient with hemophilia has suffered a large and deep laceration to the right forearm after cutting it on a mirror, which fell while he was hanging it. The wound is hemorrhaging a steady 166 Copyright © 2023 Pearson Education, Inc.

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amount of dark red blood. Given the history of hemophilia, your immediate action on reaching the patient's side and putting on gloves would be to: A) request that the ED have Factor VIII standing by on your arrival. B) start an IV and administer a 1 L NS bolus. C) apply a tourniquet proximal to the wound. D) apply direct pressure with a bulky dressing. Answer: B Diff: 3 Page Ref: 1384-1385 Standard: Medicine (Hematology) Objective: 6 6) Prehospital treatment for a hemophiliac patient who is bleeding is to: A) contact online medical control for factor VIII infusion. B) provide aggressive IV therapy with isotonic crystalloids. C) control bleeding with direct pressure. D) administer IV colloid solutions. Answer: C Diff: 2 Page Ref: 1384-1385 Standard: Medicine (Hematology) Objective: 6 7) A cat scratches a patient on the arm. Twenty-four hours later, the area is swollen and red. What additional signs or symptoms is the patient most likely to exhibit? A) Fever and hypotension B) Loss of appetite C) Pain and warmth at the injury site D) Urticaria Answer: C Diff: 1 Page Ref: 1375-1376 Standard: Medicine (Hematology) Objective: 4 8) Patients with lymphoma are most likely to experience abnormal function of: A) thrombocytes. B) stem cells from which malignancy arises. C) erythrocytes. D) neutrophils. Answer: B Diff: 2 Page Ref: 1383 Standard: Medicine (Hematology) Objective: 4

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9) Which of these statements about sickle cell disease is FALSE? A) Patients with chronic sickle cell disease have chronic hemolytic anemia. B) Sickled red blood cells have longer life spans than normal red blood cells. C) Sickle hemoglobin has a flawed chemical structure that results in erythrocyte deformity when oxygen levels are low. D) Splenomegaly is a common problem of sickle cell disease. Answer: B Diff: 2 Page Ref: 1385-1386 Standard: Medicine (Hematology) Objective: 4 10) Your patient is a 22-year-old male complaining of a two-day history of a sore throat. He denies difficulty breathing, nausea, vomiting, or chest pain. He has no medical history and takes no medications. HR = 72, BP = 120/78, RR = 12, SaO2 = 99 percent. Physical examination reveals cool, dry skin. Which of these findings would be most likely? A) Rhonchi upon auscultation of the lungs B) Swelling of the cervical lymph nodes C) Generalized erythema D) Positive Murphy's sign Answer: B Diff: 2 Page Ref: 1377 Standard: Medicine (Hematology) Objective: 4 11) In a patient with a hematological disease resulting in production of high numbers of abnormal red blood cells, which of these would you be most likely to find? A) Splenomegaly B) Fever C) Hepatomegaly D) Florid skin Answer: A Diff: 2 Page Ref: 1380 Standard: Medicine (Hematology) Objective: 4 12) Which of these situations would result in a right shift of the oxygen-hemoglobin dissociation curve? A) Hypothermia B) Hyperventilation C) Sepsis D) Increase in 2,3-BPG Answer: D Diff: 3 Page Ref: 1368 Standard: Medicine (Hematology) Objective: 3

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13) The more acidic the blood is, the more readily hemoglobin: A) binds carbon dioxide. B) releases oxygen. C) releases carbon dioxide. D) binds oxygen. Answer: B Diff: 2 Page Ref: 1368 Standard: Medicine (Hematology) Objective: 3 14) Dehydration is most likely to result in: A) thrombocytopenia. B) leukocytosis. C) increased number of white blood cells and platelets. D) increased prothrombin time. Answer: C Diff: 2 Page Ref: 1382 Standard: Medicine (Hematology) Objective: 4 15) Which of these is NOT a difference between cellular and humoral immunity? A) Humoral immunity uses memory cells, while cell-mediated immunity does not. B) T cells mature in the thymus gland, but B cells mature in lymph tissue. C) T cells use cytotoxins to destroy pathogens, while B cells use antibodies. D) Cellular immunity concerns itself with pathogens in cells and tissue; humoral concerns itself with pathogens in the lymph. Answer: A Diff: 1 Page Ref: 1371 Standard: Medicine (Hematology) Objective: 1 16) A smoker who also takes supplemental vitamin K would be expected to: A) have a higher incidence of polycythemia. B) have enhanced clotting ability. C) have a lower risk of developing pulmonary embolism. D) be unable to generate active forms of clotting factors II, VII, IX, and X. Answer: B Diff: 2 Page Ref: 1364 Standard: Medicine (Hematology) Objective: 4

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17) All of these are components of the inflammatory process EXCEPT: A) vasodilation. B) increased capillary permeability. C) increased blood flow. D) decreased chemotaxis. Answer: D Diff: 2 Page Ref: 1375-1376 Standard: Medicine (Hematology) Objective: 3 18) Your patient is a 23-year-old female who is 6 hours postpartum after a traumatic delivery resulting in a massive blood transfusion. She is to be transferred from a community hospital to a specialty hospital for further care. She is unconscious and intubated, with a number of intravenous lines. Your physical examination reveals a purpuric rash over the chest and abdomen and mottling of the fingers and toes and all of the venous access sites are oozing blood. In addition, auscultation of the lung fields reveals rales to the dependent regions. HR = 112, BP = 82/60, RR = 12 via ventilator. Which of these best describes the patient's condition and treatment needs, in addition to continued ventilation and fluid administration? A) DIC; type O negative blood B) Idiopathic hemophilia; corticosteroids C) DIC; fresh frozen plasma and platelet administration D) Idiopathic hemophilia; factor VIIa administration Answer: C Diff: 3 Page Ref: 1385 Standard: Medicine (Hematology) Objective: 7 19) Humoral and cell-mediated immunity differ in that cell-mediated immunity uses: A) B cells, which generate effector cells to combat such invaders as intracellular organisms, while cellular immunity uses T cells that reside in lymph tissue and produce antibodies to combat foreign invaders. B) T cells, which generate effector cells to combat such invaders as intracellular organisms, while humoral immunity uses B cells that reside in lymph tissue and produce antibodies to combat foreign invaders. C) B cells, which generate effector cells to combat such invaders as intracellular organisms, while humoral immunity uses T cells that reside in lymph tissue and produce antibodies to combat foreign invaders. D) T cells, which reside in lymph tissue and produce antibodies to combat foreign invaders, while humoral immunity uses B cells that generate effector cells to combat such invaders as intracellular organisms. Answer: B Diff: 2 Page Ref: 1371 Standard: Medicine (Hematology) Objective: 1

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20) Which of these statements about disseminated intravascular coagulation (DIC) is TRUE? A) The bleeding typical of DIC is a result of an increased fibrinogen level. B) DIC most commonly results from hemophilia, hypertension, and severe tissue injury. C) Causes of DIC include reduced fibrinogen levels, consumption of coagulation factors, and thrombocytopenia. D) Activated thrombin converts fibrinogen to fibrin in the circulating blood. Answer: D Diff: 2 Page Ref: 1385 Standard: Medicine (Hematology) Objective: 1 21) Which of these situations would result in erythropoietin secretion? A) CVA B) Hypoxia C) Alkalemia D) Hemophilia Answer: B Diff: 2 Page Ref: 1368 Standard: Medicine (Hematology) Objective: 4 22) Which of these situations would result in a more rapid response by the immune system to an infection? A) First-time exposure to an antigen with memory T cell activation B) First-time exposure to an antigen with memory B cell activation C) First-time exposure to an antigen D) Second exposure to an antigen with memory B cell activation Answer: D Diff: 1 Page Ref: 1371 Standard: Medicine (Hematology) Objective: 3 23) A patient has a hematocrit of 48 percent and a hemoglobin of 15 g/dl. Which of these statements is TRUE? A) His hemoglobin is high, but his hematocrit is normal. B) Both are within the normal range for an adult male or female. C) His hematocrit and hemoglobin are both low. D) Both are within the normal range for an adult male. Answer: D Diff: 2 Page Ref: 1369 Standard: Medicine (Hematology) Objective: 5

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24) Which of these statements about leukemia is TRUE? A) Infections secondary to low levels of circulating neutrophils are common. B) The pediatric mortality rate is greater than 50 percent. C) Leukemia is a disease of children and young adults, not older adults. D) Leukemias are cancers of erythrocytes. Answer: A Diff: 2 Page Ref: 1383 Standard: Medicine (Hematology) Objective: 5 25) In the presence of calcium, thrombin will encourage: A) fibrin clot formation. B) prothrombin activation. C) platelet aggregation. D) plasminogen release. Answer: C Diff: 2 Page Ref: 1373 Standard: Medicine (Hematology) Objective: 3 26) You are pruning a rosebush and puncture the skin on your thumb with a thorn. The next day you note that the area is swollen. Which of these best explains the swelling that has occurred? A) Humoral immunity activation results in localized tissue damage and edema of the tissue surrounding the injury site. B) Localized vasodilation and increased capillary permeability result in plasma leakage into the tissue surrounding the injury site. C) Cell-mediated immunity activation results in chemotaxis and increased capillary permeability. D) There is an infection, resulting in edema to the surrounding tissue. Answer: B Diff: 2 Page Ref: 1371 Standard: Medicine (Hematology) Objective: 5 27) Which of these statements about leukocytes is FALSE? A) Leukocytes follow chemical signals to an infection site. B) Leukocytes protect against foreign invaders. C) Leukocytes engulf and destroy foreign invaders via leukopoiesis. D) Leukocytes can travel through blood vessel walls into the surrounding tissues. Answer: C Diff: 1 Page Ref: 1369 Standard: Medicine (Hematology) Objective: 3

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28) Which of these circumstances would result in activation of the coagulation cascade via the intrinsic pathway? A) Development of a plaque in a coronary artery resulting in turbulent blood flow B) Administration of warfarin C) Blunt-force trauma D) Penetrating trauma resulting in soft-tissue damage Answer: A Diff: 2 Page Ref: 1373 Standard: Medicine (Hematology) Objective: 4 29) A male will express hemophilia if he acquires A) defective X and Y B) one defective X C) two defective X D) one defective Y Answer: B Diff: 2 Page Ref: 1372 Standard: Medicine (Hematology) Objective: 2

chromosome(s).

30) For a patient with hemophilia B, which of these statements is TRUE? A) The patient's father had hemophilia B, and the mother was a carrier of the defective gene. B) The patient's father had hemophilia B, and the mother was unaffected. C) The patient's father was a carrier for the defective gene, and her mother did not carry the defective gene. D) The patient's mother was a carrier for the defective gene, and her father did not carry the defective gene. Answer: D Diff: 3 Page Ref: 1384 Standard: Medicine (Hematology) Objective: 2 31) Which of these is NOT a goal of the inflammatory process? A) To produce antibodies to combat pathogens B) To ward off damage from microorganisms or trauma C) To facilitate repair of the tissues D) To localize the damage Answer: A Diff: 2 Page Ref: 1371 Standard: Medicine (Hematology) Objective: 3

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32) Which of these situations would NOT result in anemia? A) Blood loss B) Destruction of red blood cells C) Increased production of erythropoietin D) Iron deficiency Answer: C Diff: 2 Page Ref: 1380-1381 Standard: Medicine (Hematology) Objective: 5 33) Your patient is a 26-year-old African American male who is alert but in severe distress, complaining of pain in his hands and feet, as well as abdominal pain. The pain began this morning but has progressed from an initial rating of 5/10 to a 9/10 at the present time. The patient has a history of sickle cell anemia and denies any trauma. Physical examination reveals cool, diaphoretic skin; pain with palpation to all four abdominal quadrants; splenomegaly; and a priapism. HR = 132, BP = 140/90, RR = 16. Select the most appropriate acute diagnosis and treatment for this patient. A) Sickle cell vaso-occlusive crisis; administer high-concentration oxygen, IV therapy with isotonic crystalloids, and narcotics for pain control B) Sickle cell trait; administer oxygen according to pulse oximetry readings, and give a 500 mL bolus of isotonic crystalloid solution C) Sickle cell occlusive crisis; administer oxygen by nonrebreathing mask, isotonic crystalloids, and aspirin D) Sickle cell disease; administer oxygen according to pulse oximetry readings, start an IV of normal saline, and administer ketorolac for pain Answer: A Diff: 3 Page Ref: 1381 Standard: Medicine (Hematology) Objective: 7 34) Your patient is suffering from end-stage liver disease. In which of these ways would impairment of the hematologic system most likely be evident? A) Jaundice B) Polycythemia resulting in a florid appearance C) Vaso-occlusive crisis resulting in joint pain D) Leukocytosis Answer: A Diff: 3 Page Ref: 1379 Standard: Medicine (Hematology) Objective: 5

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35) Your patient is taking an immunosuppressant drug to prevent rejection of a transplanted kidney. As a consequence, the patient is more prone to: A) prolonged blood clotting time. B) aplastic anemia. C) infection. D) polycythemia. Answer: C Diff: 2 Page Ref: 1371 Standard: Medicine (Hematology) Objective: 4 36) Your patient is undergoing chemotherapy and is complaining of bleeding from the gums and blood in his stool. Which of these will best address the patient's problem? A) Stopping the chemotherapy B) Administering platelets C) Administering erythropoietin D) Administering vitamin K Answer: B Diff: 3 Page Ref: 1379 Standard: Medicine (Hematology) Objective: 6 37) In an emergency situation if you administer blood to a patient whose blood type is unknown, you should administer which type of blood? A) A positive B) O negative C) B positive D) A negative Answer: B Diff: 2 Page Ref: 1375 Standard: Medicine (Hematology) Objective: 6 38) Your patient has type A+ blood. Which of these statements about the patient's blood is TRUE? A) The patient produces anti-A antibodies. B) The blood cells lack Rh antigens. C) There are type A antigens on the surface of the red blood cells. D) The patient can only receive A+ blood if a transfusion is needed. Answer: C Diff: 3 Page Ref: 1375 Standard: Medicine (Hematology) Objective: 3

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39) In which of these situations is hemolytic disease of the newborn most likely to occur? A) An Rh positive mother delivers a first Rh negative newborn B) An Rh positive mother delivers a second Rh negative newborn C) An Rh negative mother delivers a first Rh positive newborn D) An Rh negative mother delivers a second Rh positive newborn Answer: D Diff: 3 Page Ref: 1376 Standard: Medicine (Hematology) Objective: 4 40) Which of these medications would be most useful in the event of a transfusion reaction? A) Aspirin B) Diphenhydramine C) Magnesium sulfate D) Furosemide Answer: B Diff: 2 Page Ref: 1376 Standard: Medicine (Hematology) Objective: 6 41) Your patient has a history of pernicious anemia. If not treated, your primary concern for this patient would be: A) hypovolemia. B) prolonged blood clotting time. C) hypoxia. D) infection. Answer: C Diff: 2 Page Ref: 1380 Standard: Medicine (Hematology) Objective: 5 42) Which of these is TRUE concerning sickle cell anemia? A) It is a hereditary disease involving abnormal hemoglobin. B) It is a hereditary disease involving lack of intrinsic factor. C) It is an autoimmune disease in which the body destroys its own hemoglobin. D) It is an acquired disease in which the body cannot absorb iron. Answer: A Diff: 2 Page Ref: 1381 Standard: Medicine (Hematology) Objective: 4

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43) Your patient is an 18-year-old female suffering from sickle cell crisis. Which of these is the best course of treatment for this patient? A) High-concentration oxygen, IV NS KVO, diphenhydramine B) High-concentration oxygen, IV bolus of NS C) High-concentration oxygen, IV bolus of NS, morphine sulfate D) High-concentration oxygen, IV NS KVO Answer: C Diff: 3 Page Ref: 1382 Standard: Medicine (Hematology) Objective: 6 44) Which of these statements regarding polycythemia is most accurate? A) It decreases the patient's risk of infection. B) It decreases the ability of blood to clot. C) It increases the patient's risk of infection. D) It increases the patient's risk of thrombosis and congestive heart failure. Answer: D Diff: 3 Page Ref: 1382 Standard: Medicine (Hematology) Objective: 1 45) Which of these statements regarding hemophilia is most accurate? A) Hemophilia is a hereditary abnormality of the platelets. B) Hemophilia is a hereditary lack of certain proteins needed in the clotting cascade. C) Hemophilia is a hereditary disease that causes fibrin clots to dissolve prematurely. D) Hemophilia is a hereditary disease in which the body is unable to produce vitamin K. Answer: B Diff: 2 Page Ref: 1384 Standard: Medicine (Hematology) Objective: 4 46) What ethnicity is most likely to suffer from sickle cell disease? A) Native American B) Asian C) African American D) Caucasian Answer: C Diff: 2 Page Ref: 1381 Standard: Medicine (Hematology) Objective: 2

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47) You are caring for a patient with a known history of sickle cell disease. The patient has severe abdominal and back pain. The patient is tachycardic and tachypneic. The blood pressure is normal. What should be one of the paramedic's first interventions? A) Administer oxygen B) Initiate an IV C) Give oral analgesics D) Put the patient in a supine position Answer: A Diff: 2 Page Ref: 1382 Standard: Medicine (Hematology) Objective: 6 48) The study of blood and blood-forming organs is called: A) oncology. B) hematology. C) homeostasis. D) palliative care. Answer: B Diff: 1 Page Ref: 1366 Standard: Medicine (Hematology) Objective: 1 49) Hemophilia A is an example of what type of disorder? A) Genetically acquired B) Environmentally acquired C) Intrinsically endued D) Extrinsically endued Answer: A Diff: 1 Page Ref: 1384 Standard: Medicine (Hematology) Objective: 2 50) The organ that is most responsible for producing erythropoietin is the: A) bone marrow. B) liver. C) kidney. D) spleen. Answer: C Diff: 1 Page Ref: 1366 Standard: Medicine (Hematology) Objective: 3

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51) A complete hemoglobin molecule can carry up to: A) three oxygen molecules. B) six oxygen molecules. C) four oxygen molecules. D) two oxygen molecules. Answer: C Diff: 2 Page Ref: 1367 Standard: Medicine (Hematology) Objective: 3 52) Causes of the inflammatory process include all of these EXCEPT: A) infection. B) chemical exposure. C) trauma. D) psychosocial factors. Answer: D Diff: 1 Page Ref: 1371 Standard: Medicine (Hematology) Objective: 3 53) Hemostasis is maintained by which three mechanisms? A) Vascular spasm, platelet plugs, fibrin clots B) Fibrin, platelets, hemoglobin C) Von Willebrand's factor, fibrin, platelets D) Factor VIII, factor VII, factor III Answer: A Diff: 1 Page Ref: 1372 Standard: Medicine (Hematology) Objective: 3 54) Fibrinolytics are effective against: A) any clot. B) clots containing fibrin. C) occlusions only in the heart. D) occlusions only in the brain. Answer: B Diff: 2 Page Ref: 1373 Standard: Medicine (Hematology) Objective: 1

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55) You are transporting a patient to a tertiary trauma center. The patient is receiving blood and has sustained trauma the local center cannot handle. You notice that the patient has begun to develop tachycardia, hives, and a fever. You suspect: A) hypovolemia. B) a normal response to a transfusion. C) transfusion reaction. D) anaphylaxis. Answer: C Diff: 2 Page Ref: 1376 Standard: Medicine (Hematology) Objective: 5 56) You suspect that your patient is having a transfusion reaction. The patient's care plan should include: A) dobutamine, diphenhydramine, albuterol. B) dopamine, diphenhydramine, IV fluid bolus. C) IV fluid. D) diphenhydramine alone. Answer: B Diff: 2 Page Ref: 1376-1377 Standard: Medicine (Hematology) Objective: 6 57) A patient complains of atraumatic bleeding of the gums. You suspect: A) halitosis. B) dentalgia. C) a hematologic disorder. D) gingivitis. Answer: C Diff: 2 Page Ref: 1379 Standard: Medicine (Hematology) Objective: 5 58) You are caring for a patient who is complaining of diffuse musculoskeletal pain, shortness of breath, and atraumatic priapism. You suspect: A) sickle cell vaso-occlusive crisis. B) sickle cell hematologic crisis. C) acute lymphocytic leukemia (ALL). D) AML. Answer: A Diff: 2 Page Ref: 1381 Standard: Medicine (Hematology) Objective: 1

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59) You respond to a patient complaining of shortness of breath. Upon your arrival, the patient tells you that she has been experiencing headaches, vertigo, and now itching. She says her doctor had called with a lab result of her latest test. Her hematocrit is reported as 60. You suspect: A) congestive heart failure (CHF). B) sickle cell disease. C) thrombocytopenia. D) polycythemia. Answer: D Diff: 2 Page Ref: 1382 Standard: Medicine (Hematology) Objective: 7 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 41 Infectious Diseases and Sepsis 1) After receiving the hepatitis B vaccine, the blood of a paramedic reveals no circulating antibodies for the disease. Which of these phases would the paramedic most likely be in regarding the immunization? A) Latent B) Window C) Incubation D) Seroconversion Answer: B Diff: 1 Page Ref: 1396 Standard: Medicine (Infectious Diseases) Objective: 5 2) Which of these agencies is the primary agency responsible for establishing guidelines and standards to regulate health care worker safety as it relates to communicable disease transmission? A) NFPA B) CDC C) FEMA D) OSHA Answer: D Diff: 1 Page Ref: 1392 Standard: Medicine (Infectious Diseases) Objective: 2 3) A paramedic within your service was treating an IV drug addict when the patient spit at her, hitting her in the eye. At the hospital, when asked for blood, the patient refused to consent for testing. In this case, which of these is TRUE? A) The patient can be placed under detention and be required to give a blood sample. B) A judge will issue a court order requiring the patient to allow his blood to be tested. 181 Copyright © 2023 Pearson Education, Inc.

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C) By law the patient is required to submit blood for testing. D) It is within the patient's right to refuse blood testing. Answer: D Diff: 2 Page Ref: 1406-1407 Standard: Medicine (Infectious Diseases) Objective: 6

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4) Which of these measures is most important in protecting EMS providers from infectious disease? A) Thorough disinfection of the ambulance after every call B) Tuberculosis vaccination C) Hand washing after all patient contact D) Glove use for all patient contact Answer: C Diff: 1 Page Ref: 1422 Standard: Medicine (Infectious Diseases) Objective: 6 5) For which of these diseases is there no vaccine? A) Measles B) Croup C) Mumps D) Rubella Answer: B Diff: 1 Page Ref: 1427 Standard: Medicine (Infectious Diseases) Objective: 8 6) Which of these statements about prions is TRUE? A) They are neither prokaryotes nor eukaryotes. B) Eastern equine encephalitis is the most common prion disease. C) Prions are easily destroyed by heat sterilization. D) Prions are single-celled animals capable of causing disease. Answer: A Diff: 2 Page Ref: 1393 Standard: Medicine (Infectious Diseases) Objective: 3 7) HIV attacks and destroys the: A) B lymphocytes. B) T lymphocytes. C) pluripotent stem cells. D) macrophages. Answer: B Diff: 1 Page Ref: 1409 Standard: Medicine (Infectious Diseases) Objective: 8

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8) Which of these statements about herpes simplex type 2 (HSV-2) is FALSE? A) There is a low risk of disease transmission via casual contact. B) HSV-2 is responsible for 70 to 90 percent of all genital herpes cases. C) In addition to painful lesions to the infected area, fever and enlarged lymph nodes can be present during the initial presentation of the infection. D) Treatment with acyclovir can eradicate the virus. Answer: D Diff: 2 Page Ref: 1426-1427 Standard: Medicine (Infectious Diseases) Objective: 8 9) Which of these statements about mumps is TRUE? A) Mumps are of no concern to the adult patient. B) There is no vaccine for the mumps virus. C) Mumps are characterized by enlargement of the salivary glands. D) Mumps are not highly communicable. Answer: C Diff: 2 Page Ref: 1424 Standard: Medicine (Infectious Diseases) Objective: 8 10) Which of these organisms causes mononucleosis? A) Epstein-Barr virus B) Pediculus humanus capitis C) Treponema D) Herpes zoster Answer: A Diff: 1 Page Ref: 1426 Standard: Medicine (Infectious Diseases) Objective: 3 11) All the following are common signs or symptoms of lice infestation EXCEPT: A) red macules or papules on the affected areas. B) white, oval-shaped nits on the hair shafts. C) itching. D) open lesions in the affected areas. Answer: D Diff: 1 Page Ref: 1436-1437 Standard: Medicine (Infectious Diseases) Objective: 7

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12) Your patient is a 40-year-old male. As a child he would have been least likely to have suffered from: A) RSV. B) pertussis. C) measles. D) mumps. Answer: B Diff: 1 Page Ref: 1425-1426 Standard: Medicine (Infectious Diseases) Objective: 7 13) Which of these agencies monitors national disease data and provides disease information to health care providers? A) DHHS B) CDC C) OSHA D) NIOSH Answer: B Diff: 1 Page Ref: 1392 Standard: Medicine (Infectious Diseases) Objective: 2 14) Which of these techniques destroys some, but not all, microorganisms? A) Cleaning B) Disinfection C) Decontamination D) Sterilization Answer: B Diff: 1 Page Ref: 1405-1406 Standard: Medicine (Infectious Diseases) Objective: 8 15) Which of these is NOT a known transmission route for hepatitis B? A) Blood transfusion B) Dialysis C) Tattooing D) Insect bites Answer: D Diff: 1 Page Ref: 1411-1412 Standard: Medicine (Infectious Diseases) Objective: 4

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16) Your patient was bitten on the hand by a wild raccoon he tried to capture. Which of these is the first step in management for this patient? A) Irrigate the wound with sterile saline, dry the area around the wound, and apply a thin layer of antibiotic ointment. B) Clean the area with a povidone-iodine swab. C) Clean the area with an isopropyl alcohol pad. D) Wash the wound with soap and running water. Answer: D Diff: 2 Page Ref: 1430 Standard: Medicine (Infectious Diseases) Objective: 8 17) Health care workers can best avoid hepatitis B infection by: A) using standard precautions for all patients. B) using an alcohol-based hand sanitizer after each patient contact. C) completing the hepatitis B vaccine series. D) receiving gamma globulin in the event of an exposure. Answer: C Diff: 2 Page Ref: 1398 Standard: Medicine (Infectious Diseases) Objective: 9 18) While working in the emergency department, you accidentally stick yourself with the stylet of an IV needle you just used to start an IV. What should you do immediately? A) Wash the area thoroughly with soap and running water. B) Stop the bleeding with a sterile gauze pad. C) Wipe the area with a povidone-iodine swab. D) Wipe the area with an alcohol prep. Answer: A Diff: 2 Page Ref: 1405 Standard: Medicine (Infectious Diseases) Objective: 9 19) Which of these is best described as a change from the absence of antibodies to detectable levels of antibodies in the blood after exposure to an infectious disease? A) Clinical horizon B) Virulence C) Chemotaxis D) Seroconversion Answer: D Diff: 1 Page Ref: 1396 Standard: Medicine (Infectious Diseases) Objective: 5

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20) Which of these cells play a functional role in the inflammatory response? A) Neutrophils B) T lymphocytes C) Stem cells D) B lymphocytes Answer: A Diff: 2 Page Ref: 1397 Standard: Medicine (Infectious Diseases) Objective: 5 21) Clostridium botulinum has its effect primarily by: A) altering cellular structure to create syncytia. B) releasing a toxin that results in muscular paralysis. C) creating gas through the fermentation of carbohydrates in muscle tissue. D) causing septicemia. Answer: B Diff: 2 Page Ref: 1429 Standard: Medicine (Infectious Diseases) Objective: 3 22) A memory or specific response of the immune system is considered what "type" of response? A) Cell-mediated B) Inflammatory C) Humoral D) Immune Answer: C Diff: 2 Page Ref: 1397 Standard: Medicine (Infectious Diseases) Objective: 1 23) Which of these types of agents acts specifically by inhibiting bacterial growth or reproduction? A) Bacteriostatic B) Antiseptic C) Pathological D) Aseptic Answer: A Diff: 1 Page Ref: 1393 Standard: Medicine (Infectious Diseases) Objective: 1

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24) Demographics are: A) statistics related to the morbidity and mortality of all illnesses and injuries. B) geographical distributions of illness and injury. C) statistics related to the incidence of infectious disease. D) characteristics of human populations. Answer: D Diff: 1 Page Ref: 1391 Standard: Medicine (Infectious Diseases) Objective: 2 25) Which of these statements about rubella and the rubella virus is FALSE? A) EMS providers should receive an MMR vaccination. B) The virus is spread via contact with infected blood and body fluids. C) Immunization via the MMR vaccination is 98 to 99 percent effective. D) Infection in the first trimester of pregnancy increases the risk of birth defects. Answer: B Diff: 1 Page Ref: 1425 Standard: Medicine (Infectious Diseases) Objective: 8 26) The alternate pathway that reacts quickly to foreign bodies and uses antibodies and inflammation to combat pathogens is which system? A) Complement B) Lymphatic C) Humoral D) Cell-mediated Answer: A Diff: 2 Page Ref: 1397-1398 Standard: Medicine (Infectious Diseases) Objective: 5 27) Which of these is a mobile, single-celled, parasitic organism? A) Fungus B) Virus C) Protozoan D) Bacterium Answer: C Diff: 1 Page Ref: 1435 Standard: Medicine (Infectious Diseases) Objective: 3

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28) The destructive substances released from some bacteria when they die are known as: A) endotoxins. B) syncytia. C) prions. D) exotoxins. Answer: A Diff: 1 Page Ref: 1393 Standard: Medicine (Infectious Diseases) Objective: 3 29) A 44-year-old male staying in a homeless shelter is alert and complaining of shortness of breath. He has a two-week history of cough with hemoptysis, fever, chills, and night sweats. Physical examination reveals skin to be warm and moist and lung sounds decreased in the right upper lobe with rhonchi. HR = 100, BP = 142/100, RR = 20, SaO2 = 95 percent. You should assume this patient has a high likelihood of having: A) hantavirus pulmonary syndrome. B) tuberculosis. C) pneumonia. D) RSV. Answer: B Diff: 2 Page Ref: 1413 Standard: Medicine (Infectious Diseases) Objective: 7 30) Your patient is a 21-year-old male who is alert and oriented, complaining of a rash that started about 36 hours ago, first appearing on his trunk. The rash has now spread to his face and extremities. You notice multiple small, fluid-filled vesicles on the patient's body. The patient is concerned that he will miss work as a second-grade student teacher. He has no medical history, including childhood diseases. The patient is most likely suffering from: A) rubella. B) Epstein-Barr virus. C) herpes simplex. D) varicella. Answer: D Diff: 2 Page Ref: 1419-1420 Standard: Medicine (Infectious Diseases) Objective: 7

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31) Mononucleosis presents with all the following signs and symptoms EXCEPT: A) enlarged and tender lymph nodes. B) fatigue. C) hepatomegaly. D) sore throat. Answer: C Diff: 1 Page Ref: 1426 Standard: Medicine (Infectious Diseases) Objective: 8 32) Which of these is classified as a helminth? A) Trichomonas B) Treponema C) Spirochete D) Fluke Answer: D Diff: 1 Page Ref: 1391, 1394 Standard: Medicine (Infectious Diseases) Objective: 3 33) Which of these statements about influenza and the influenza virus is FALSE? A) High-risk individuals include the elderly. B) An influenza vaccine confers immunity against only a few strains of the virus each year. C) Influenza is the leading cause of respiratory disease worldwide. D) The disease is characterized by nausea, vomiting, and diarrhea. Answer: D Diff: 2 Page Ref: 1422-1423 Standard: Medicine (Infectious Diseases) Objective: 8 34) You are suspicious that a patient is suffering from active tuberculosis. Which of these would be most appropriate? A) Neither you nor the patient should wear a HEPA respirator. B) Both you and the patient should wear a HEPA respirator. C) You should wear an N95 mask. D) The patient should wear a HEPA respirator. Answer: C Diff: 2 Page Ref: 1413-1415 Standard: Medicine (Infectious Diseases) Objective: 9

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35) Your patient is a 23-year-old male prisoner who is alert and oriented, complaining of general malaise. He describes a month-long history of weakness, joint pain, nausea and occasional vomiting, and anorexia. He has no medical history and takes no medications. Physical examination reveals clear lung sounds bilaterally; warm, dry skin; several prison tattoos; a firm liver; and jaundice to his sclera. Which of these is most likely? A) Fatty liver B) Cirrhosis of the liver C) HIV D) Hepatitis B Answer: D Diff: 3 Page Ref: 1411-1412 Standard: Medicine (Infectious Diseases) Objective: 11 36) Which of these statements about hepatitis A is TRUE? A) Hepatitis A is transmitted through direct contact with blood and body fluids. B) Many patients are asymptomatic with hepatitis A infection. C) Transmission via needle stick injury is common. D) The incubation period for hepatitis A is three to five days. Answer: B Diff: 1 Page Ref: 1411 Standard: Medicine (Infectious Diseases) Objective: 8 37) Which of these statements about measles and the measles virus is FALSE? A) Immunization is ineffective until age 15. B) Measles is highly communicable. C) Measles is transmitted by inhalation of infected droplets. D) Signs of measles infection include high fever and a maculopapular rash. Answer: A Diff: 2 Page Ref: 1423-1424 Standard: Medicine (Infectious Diseases) Objective: 8 38) Which hepatitis often presents with hepatitis D? A) A B) B C) C D) D Answer: B Diff: 1 Page Ref: 1412 Standard: Medicine (Infectious Diseases) Objective: 8

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39) Your patient is a 20-year-old female college student who lives in a dormitory. She complains of weakness, fever, chills, nausea, a rash on her chest, and neck pain. Physical examination reveals warm, moist skin; pain with flexion of her neck; and a petechial rash on her chest. HR = 92, BP = 108/68, RR = 14, SaO2 = 99 percent. Which of these is most appropriate? A) Place an N-95 respirator on the patient, transport BLS, notify the hospital before arrival B) Place a face mask on your patient and yourself, transport BLS, notify the hospital before arrival C) Administer oxygen by nonrebreather, BLS, and transport D) Administer O2 via nonrebreather mask, cardiac monitor, IV of normal saline, and transport Answer: B Diff: 2 Page Ref: 1420-1421 Standard: Medicine (Infectious Diseases) Objective: 11 40) From which of these incidents would infection with Clostridium tetani be most likely? A) Eating improperly prepared, home-canned food B) Receiving a puncture wound to the foot C) Drinking contaminated well water D) Being bitten by an infected animal Answer: B Diff: 2 Page Ref: 1430-1431 Standard: Medicine (Infectious Diseases) Objective: 8 41) Which of these statements about Streptococcus pneumoniae is TRUE? A) Vaccines are ineffective against Streptococcus pneumoniae. B) It is the second most common cause of pneumonia in adults. C) It is the leading cause of meningitis in children. D) It is an infrequent cause of otitis media in children. Answer: B Diff: 1 Page Ref: 1415-1416 Standard: Medicine (Infectious Diseases) Objective: 3 42) All the following pathogens typically cause meningitis in children EXCEPT: A) Haemophilus influenza type B. B) Streptococcus pneumoniae. C) Neisseria meningitidis. D) Paramyxovirus. Answer: D Diff: 1 Page Ref: 1415 Standard: Medicine (Infectious Diseases) Objective: 3

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43) Which of these statements about Neisseria meningitidis is TRUE? A) The vaccine is recommended for health care workers. B) It is the bacteria that most often cause serious cases of meningitis. C) It is responsible for 90 percent of patients with viral meningitis. D) Signs and symptoms of infection can take weeks to develop. Answer: B Diff: 1 Page Ref: 1420 Standard: Medicine (Infectious Diseases) Objective: 3 44) Hepatitis E is often associated with: A) HIV infection. B) tuberculosis infection. C) contaminated drinking water. D) HBV infection. Answer: C Diff: 1 Page Ref: 1412 Standard: Medicine (Infectious Diseases) Objective: 4 45) Mushrooms and yeasts are examples of: A) parasites. B) fungi. C) helminthes. D) protozoa. Answer: B Diff: 1 Page Ref: 1394 Standard: Medicine (Infectious Diseases) Objective: 3 46) To test for Brudzinski's sign you would: A) have the patient take a deep breath while you palpate under the right costal margin. B) check for periumbilical ecchymosis. C) place the patient in a supine position and flex the neck. D) stroke the bottom of the foot from heel to toe with a pen. Answer: C Diff: 1 Page Ref: 1421 Standard: Medicine (Infectious Diseases) Objective: 7

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47) Your patient is a 27-year-old male complaining of difficulty breathing. He states that he has just returned from a month-long backpacking trip across Arizona. He describes a two-week history of fatigue, fever, nausea, vomiting, diarrhea, and abdominal pain. He started experiencing difficulty breathing yesterday. He has no significant medical history and takes no medications. Physical examination reveals hot, moist skin; bilateral lower-lobe rales on auscultation of the lungs; and the abdomen is soft and nontender. Which of these is most likely? A) Legionnaire's disease B) Hantavirus infection C) Anthrax D) Scorpion bite Answer: B Diff: 3 Page Ref: 1428 Standard: Medicine (Infectious Diseases) Objective: 13 48) Which of these statements about Haemophilus influenzae type B is TRUE? A) It is the leading cause of conjunctivitis in adults. B) It was once the leading cause of meningitis in children aged 6 months to 3 years. C) Vaccines are ineffective against Haemophilus influenzae type B. D) It is a gram-positive rod. Answer: B Diff: 1 Page Ref: 1421 Standard: Medicine (Infectious Diseases) Objective: 8 49) Which of these findings would be most specific to mumps? A) Swelling and tenderness of the parotid glands B) Temperature of 103°F or higher C) Redness of the face that gives a "slapped cheeks" appearance D) Fluid-filled vesicles on the trunk Answer: A Diff: 2 Page Ref: 1424 Standard: Medicine (Infectious Diseases) Objective: 8

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50) Your patient is a 19-year-old female college student complaining of a low-grade fever, extremely sore throat, tenderness of the cervical lymph nodes, and extreme fatigue. Examination reveals warm, moist, flushed skin. Heart rate = 88, respirations = 12, and blood pressure = 118/78. There is tenderness to palpation of the left upper quadrant of the abdomen. Which of these is most likely? A) Bacterial meningitis B) Hantavirus pulmonary syndrome C) Mononucleosis D) Fifth disease Answer: C Diff: 2 Page Ref: 1426 Standard: Medicine (Infectious Diseases) Objective: 7 51) While on a call you receive a laceration to your thigh from a jagged piece of metal. Which of these is the correct recommendation for tetanus prophylaxis? A) You must receive a tetanus booster annually to be protected from tetanus. B) You should receive a tetanus booster if you have not had one in the past 10 years. C) If you are over the age of 60, you should receive tetanus immune globulin but not a tetanus booster. D) If you received the entire series of tetanus immunizations as a child, you do not need a tetanus booster. Answer: B Diff: 2 Page Ref: 1398 Standard: Medicine (Infectious Diseases) Objective: 9 52) A life-threatening medical condition that is caused by systemic inflammatory response syndrome (SIRS) is: A) hypoglycemia. B) thrombocytopenia. C) septicemia. D) pernicious anemia. Answer: C Diff: 2 Page Ref: 1439 Standard: Medicine (Infectious Diseases) Objective: 10

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53) Which of these is NOT a government organization involved with infectious diseases? A) CDC B) OSHA C) EPA D) FEMA Answer: C Diff: 1 Page Ref: 1392 Standard: Medicine (Infectious Diseases) Objective: 2 54) Poisonous proteins shed by bacteria growth are called: A) exotoxins. B) endotoxins. C) spores. D) fungi. Answer: A Diff: 1 Page Ref: 1393 Standard: Medicine (Infectious Diseases) Objective: 3 55) Which of these is NOT a common form of pathogen transmission? A) Cough B) Sneeze C) Sexual contact D) Organisms shed into the environment Answer: D Diff: 1 Page Ref: 1394 Standard: Medicine (Infectious Diseases) Objective: 4 56) The body will produce antibodies in response to: A) pathogens. B) antigens. C) T cells. D) phagocytes. Answer: B Diff: 1 Page Ref: 1396 Standard: Medicine (Infectious Diseases) Objective: 5

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57) Cell-mediated immunity generates: A) T lymphocytes. B) B lymphocytes. C) inflammation. D) histamine. Answer: A Diff: 1 Page Ref: 1397 Standard: Medicine (Infectious Diseases) Objective: 5 58) When the body produces antibodies against itself, this is known as: A) immunology. B) allergy. C) autoimmunity. D) immunocompromise. Answer: C Diff: 1 Page Ref: 1397 Standard: Medicine (Infectious Diseases) Objective: 1 59) The lymphatic system comprises all of these EXCEPT: A) spleen. B) lymph nodes. C) thymus. D) liver. Answer: D Diff: 1 Page Ref: 1398 Standard: Medicine (Infectious Diseases) Objective: 5 60) Contaminated sharps need to be placed in: A) properly labeled puncture-resistant containers. B) biohazard containers in the dirty-utility room. C) the decontamination room. D) They can be thrown in the trash if they are "self-containing." Answer: A Diff: 1 Page Ref: 1400 Standard: Medicine (Infectious Diseases) Objective: 9

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61) You respond to an ill patient. Upon arrival, you find out that the patient has just traveled from an area with active Ebola virus disease (EVD). You should initially: A) examine the patient like any other. B) examine the patient over the phone. C) wait for a hazmat tech who is also a paramedic. D) assess the patient from at least 3 feet away. Answer: D Diff: 2 Page Ref: 1402 Standard: Medicine (Infectious Diseases) Objective: 7 62) One of the most effective ways to prevent disease transmission is: A) use of gloves. B) sterilizing all equipment. C) washing your hands. D) using an alcohol-based sanitizer. Answer: C Diff: 1 Page Ref: 1422 Standard: Medicine (Infectious Diseases) Objective: 6 63) According to the 2009 extension of the Ryan White Care Act, an employee who has been exposed to an infectious disease has the right to: A) demand that the patient be tested for infectious disease. B) ask about the source patient's infection status. C) have the receiving ED draw a sample of the patient's blood for testing. D) nothing; HIPAA is in effect. Answer: B Diff: 1 Page Ref: 1406 Standard: Medicine (Infectious Diseases) Objective: 6 64) In response to fever, the patient's metabolic needs will: A) increase. B) decrease. C) remain the same. D) become anaerobic. Answer: A Diff: 1 Page Ref: 1407 Standard: Medicine (Infectious Diseases) Objective: 5

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65) HIV uses the host cell to copy itself by: A) carrying its genetic material in its RNA. B) replicating its genetic material in its DNA. C) infiltrating the mitochondria. D) glucogenolysis. Answer: A Diff: 1 Page Ref: 1408 Standard: Medicine (Infectious Diseases) Objective: 8 66) As hepatitis progresses, the patient may become: A) edematous. B) jaundiced. C) more infectious. D) less infectious. Answer: B Diff: 1 Page Ref: 1410 Standard: Medicine (Infectious Diseases) Objective: 8 67) Hepatitis A can exist on unwashed hands for: A) 5 days. B) 4 days. C) 6 hours. D) 4 hours. Answer: D Diff: 1 Page Ref: 1411 Standard: Medicine (Infectious Diseases) Objective: 4 68) Hepatitis B is stable on surfaces with dried visible blood for: A) 3 days. B) 3 hours. C) 8 hours. D) 8 days. Answer: D Diff: 1 Page Ref: 1411 Standard: Medicine (Infectious Diseases) Objective: 4

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69) You are caring for a patient who is complaining of chills, fever, night sweats, sudden weight loss, and hemoptysis. You suspect: A) AIDS. B) hepatitis B virus. C) tuberculosis. D) Ebola virus disease (EVD). Answer: C Diff: 2 Page Ref: 1413 Standard: Medicine (Infectious Diseases) Objective: 7 70) You are caring for a patient you suspect of having an active TB infection. Your personal protective equipment (PPE) should include: A) Tyvek suit. B) hazmat level B protection. C) powered air-purifying respirator (PAPR) mask. D) N-95 mask. Answer: D Diff: 2 Page Ref: 1414 Standard: Medicine (Infectious Diseases) Objective: 6 71) The most common complication in adults contracting the varicella virus is: A) chickenpox. B) pneumonia. C) respiratory syncytial virus (RSV). D) paranoia. Answer: B Diff: 1 Page Ref: 1419-1420 Standard: Medicine (Infectious Diseases) Objective: 8 72) You respond to an ill patient. Upon your arrival, the patient's caregivers state that the patient has been complaining of lethargy, vomiting, and nuchal rigidity. You suspect: A) pertussis. B) meningitis. C) varicella. D) pneumonia. Answer: B Diff: 2 Page Ref: 1421 Standard: Medicine (Infectious Diseases) Objective: 7

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73) While examining a patient, you note that he exhibits a positive Brudzinski's sign. You suspect: A) meningitis. B) pertussis. C) varicella. D) tuberculosis. Answer: A Diff: 2 Page Ref: 1421 Standard: Medicine (Infectious Diseases) Objective: 7 74) You and your partner have just been notified by the infection control officer that you have been exposed to an active meningitis case. You would expect to receive prophylactic: A) Cipro. B) Zithromax. C) penicillin. D) nothing, just self-monitor. Answer: A Diff: 2 Page Ref: 1421 Standard: Medicine (Infectious Diseases) Objective: 9 75) Whooping cough is also known as: A) meningococcus. B) pertussis. C) varicella. D) pneumonia. Answer: B Diff: 1 Page Ref: 1425 Standard: Medicine (Infectious Diseases) Objective: 1 76) You are called to evaluate an ill child. The mother states that the child was fine a few hours ago but now is exhibiting, dysphonia, drooling, dysphagia, and distress. You suspect: A) croup. B) epiglottitis. C) bronchitis. D) influenza A. Answer: B Diff: 2 Page Ref: 1427 Standard: Medicine (Infectious Diseases) Objective: 7

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77) You respond to a two-year-old child who has a seal-like cough and stridor. You suspect: A) laryngotracheobronchitis. B) influenza. C) pneumonia. D) pharyngitis. Answer: A Diff: 2 Page Ref: 1427 Standard: Medicine (Infectious Diseases) Objective: 7 78) One area in which paramedics have a chance to assume leadership is: A) public education and infectious disease prevention. B) FEMA studies. C) CDC studies. D) hospital advisory boards. Answer: A Diff: 2 Page Ref: 1438 Standard: Medicine (Infectious Diseases) Objective: 2 79) You respond to a patient who has been having trouble with his indwelling urinary catheter. Vital signs are: pulse, 110; respiration rate, 22; ETCO2, 28; temperature, 101.2°F. You suspect: A) sepsis. B) urinary tract infection (UTI). C) renal failure. D) rhabdomyolysis. Answer: A Diff: 2 Page Ref: 1439-1440 Standard: Medicine (Infectious Diseases) Objective: 10 80) You are treating a patient you suspect may be suffering from septic shock. You should consider fluid and pressor therapy to maintain a mean arterial pressure (MAP) of: A) above 90 mmHg. B) above 60 mmHg. C) below 120 mmHg. D) below 60 mmHg. Answer: B Diff: 1 Page Ref: 1440 Standard: Medicine (Infectious Diseases) Objective: 10 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 42 Psychiatric and Behavioral Disorders 202 Copyright © 2023 Pearson Education, Inc.

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1) Which of these is NOT a common pathophysiological cause of behavioral emergencies? A) Underlying psychiatric illness B) Psychosocial stressors C) The environment D) Use of recreational drugs and alcohol Answer: C Diff: 1 Page Ref: 1445-1446 Standard: Medicine (Psychiatric) Objective: 4 2) Your patient is a 50-year-old male who has been detained by mall security officers. The patient is distraught, stating that he needs to "get away from the terrorists." The security officers state the patient was found climbing into a trash dumpster behind the mall and became distressed when they took him away from it. Your physical exam is unremarkable except for noting neglect of hygiene and nutrition. His skin is warm and dry. HR = 98, BP = 114/78, RR = 12, SaO2 = 99 percent, blood glucose = 80 mg/dL. You offer him transport to the ED, which he accepts. Which of these is most appropriate during transport of this patient? A) Apply a cardiac monitor, initiate IV B) Restrain the patient with four-point restraints, no ALS interventions C) Start an IV, and request orders for haloperidol D) Make the patient comfortable on the stretcher, no ALS interventions Answer: D Diff: 2 Page Ref: 1459 Standard: Medicine (Psychiatric) Objective: 10 3) A 19-year-old female states that she is addicted to Vicodin because it makes her feel good, and she cannot stop taking the pills. She states that she craves them all the time, and when she runs out she does not feel sick but becomes preoccupied with how she can get more. Assessment reveals no abnormalities, and vital signs are within acceptable limits. This patient's condition is most consistent with: A) physical dependence. B) habituation. C) psychological dependence. D) tolerance. Answer: C Diff: 2 Page Ref: 1453 Standard: Medicine (Psychiatric) Objective: 1

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4) Your patient is a 27-year-old female who is distraught and crying after having her children taken by child protective services. Her sister called EMS because the patient threatened to cut her wrists. On your arrival you find that she has not attempted to harm herself and has no weapons within reach. However, she does not wish to speak with you. Which of these actions is most likely to be effective when communicating with this patient? A) Maintain a distance of 3 to 5 feet from the patient. B) Sit down so that you are at eye level with the patient. C) Tell the patient that you cannot help her unless she talks to you. D) Tell the patient that you want to help her, but you can't unless she calms down. Answer: B Diff: 2 Page Ref: 1446-1447 Standard: Medicine (Psychiatric) Objective: 3 5) Which of these helps assess a patient's potential for violence? A) Gender B) Body language C) Ethnicity D) Age Answer: B Diff: 1 Page Ref: 1446 Standard: Medicine (Psychiatric) Objective: 3 6) Which of these is described as the visible indication of mood? A) Mental status B) Behavior C) Affect D) Level of consciousness Answer: C Diff: 1 Page Ref: 1446-1447 Standard: Medicine (Psychiatric) Objective: 1 7) Which of these statements about patient restraint is TRUE? A) Restraints can be released once the patient is in control of himself. B) Roller bandages for restraint do not cause neurovascular damage to the extremities, but leather restraints do. C) Handcuffs are an acceptable choice for prehospital care. D) Four-point restraints should be used. Answer: D Diff: 2 Page Ref: 1460-1462 Standard: Medicine (Psychiatric) Objective: 9

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8) Which of these is most likely to effectively gain the cooperation of a psychologically disturbed patient for physical examinations? A) Telling the patient you cannot help him unless you do a thorough physical examination B) Standing closer to and using more physical contact with the patient than usual C) Asking the patient's permission to examine him D) Telling the patient you must examine him Answer: C Diff: 1 Page Ref: 1446-1447 Standard: Medicine (Psychiatric) Objective: 3 9) Which of these is the best method of communicating with an emotionally disturbed patient? A) Ignore statements that are irrelevant to the situation. B) Tell the patient you understand how he feels. C) Explain that you are concerned with the patient's welfare. D) Agree with everything the patient says. Answer: C Diff: 2 Page Ref: 1459-1460 Standard: Medicine (Psychiatric) Objective: 5 10) Which of these is most relevant to your decisions about how to handle a potentially violent patient? A) The fact that you have transported this patient many times and he has never become violent B) The family's reassurances that the patient never harmed anyone C) The patient's current behavior D) Whether or not the patient is taking antipsychotic medications Answer: C Diff: 1 Page Ref: 1447-1448 Standard: Medicine (Psychiatric) Objective: 9 11) Which of these statements about consent is accurate? A) Competent people may not be transported against their will. B) People cannot be transported against their will unless there is a court order to do so. C) People who are alert and oriented to person, place, and time may not be transported against their will. D) People cannot be transported against their will unless a first-degree relative (spouse, adult child, parent, or sibling) agrees. Answer: A Diff: 2 Page Ref: 1470 Standard: Medicine (Psychiatric) Objective: 5

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12) Your patient is a 34-year-old female, eight weeks postpartum. She is alert and oriented but crying and extremely depressed. She states she "just can't go on like this." Her husband called EMS because she is distraught and cannot care for herself or the baby. Which of these statements about this situation is TRUE? A) Postpartum depression is common, but it is not linked to suicide. B) The patient requires medical treatment. C) Suicide is not likely as long as the husband remains supportive. D) She should be advised not to have additional children. Answer: B Diff: 1 Page Ref: 1452 Standard: Medicine (Psychiatric) Objective: 5 13) Which of these best describes perceived loss of physical functioning without medical or traumatic cause? A) Somatization disorder B) Conversion disorder C) Catatonia D) Body dysmorphic disorder Answer: B Diff: 1 Page Ref: 1453 Standard: Medicine (Psychiatric) Objective: 4 14) Your patient is a 32-year-old male who has been successfully treated for depression with a selective serotonin reuptake inhibitor. The patient's wife is concerned, because over the past few days her husband has not slept and has been spending most of his time trading stocks online and making extravagant purchases. He has been talking about taking a trip to Spain to run with the bulls in Pamplona. She states that he is talking incessantly and seems "wired." The patient had a similar episode about a month ago that came on suddenly but resolved when the patient "crashed" and slept for several days. Which of these is most consistent with this situation? A) Cocaine use B) Schizoaffective disorder C) Methamphetamine use D) Bipolar disorder Answer: D Diff: 2 Page Ref: 1452-1453 Standard: Medicine (Psychiatric) Objective: 2

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15) Your patient is a 32-year-old female who is depressed and tearful after a fight with her exhusband. Which of these would NOT increase the risk of or indicate an increased risk of the patient committing suicide? A) The patient has access to a method of suicide. B) The paramedic is using direct questioning about suicidal intentions. C) The patient has called her sister to come and get her dog. D) The patient has had three glasses of wine since the fight. Answer: B Diff: 2 Page Ref: 1456 Standard: Medicine (Psychiatric) Objective: 5 16) Which of these best describes a feeling of alarm at the expectation of danger? A) Fear B) Rage C) Phobia D) Stress Answer: A Diff: 1 Page Ref: 1450 Standard: Medicine (Psychiatric) Objective: 1 17) Which of these statements about patient restraint is FALSE? A) Patients should be transported in a prone position. B) Restraining the thighs just above the knees can be more effective at preventing kicking than restraining at the ankles. C) Verbal methods of deescalation should be tried before considering physical restraint. D) Neuromuscular blocking agents should never be used to restrain a patient. Answer: A Diff: 2 Page Ref: 1460-1461 Standard: Medicine (Psychiatric) Objective: 9 18) Which of these best describes the position or bearing of the body? A) Stature B) Facies C) Affect D) Posture Answer: D Diff: 1 Page Ref: 1446 Standard: Medicine (Psychiatric) Objective: 1

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19) Your patient is a 34-year-old male who is threatening to kill himself. Which of these does NOT indicate an increased risk for suicide? A) The patient having ingested a substantial amount of alcohol B) The patient having a father who committed suicide when the patient was a teenager C) A previous nonlethal attempt at suicide D) The patient being married Answer: D Diff: 2 Page Ref: 1456 Standard: Medicine (Psychiatric) Objective: 5 20) Which of these is NOT associated with anorexia nervosa? A) Intense fear of obesity B) Cessation of menstruation C) Excessive fasting D) Intentionally inducing vomiting after eating Answer: D Diff: 1 Page Ref: 1454 Standard: Medicine (Psychiatric) Objective: 4 21) Which of these best describes an emotional reaction characterized by rage? A) Emotional lability B) Anger C) Dread D) Irrationality Answer: B Diff: 1 Page Ref: 1446 Standard: Medicine (Psychiatric) Objective: 1

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22) Your patient is a 45-year-old male with a history of bipolar disorder. He is sitting at the kitchen table, conscious, alert, and oriented. He is pleasant and greets you as you walk in. The patient's wife called EMS because he has refused to take his lithium and is "driving her crazy with his hyperactive attitude." She insists that you transport him to the hospital. The patient admits to voluntary noncompliance with his lithium, stating, "I didn't like the way it made me feel." He denies any suicidal thoughts and states that he has not felt "this good for a long time." He is curious about your job and wants to know how he could get into a paramedic class. He states that he's also thinking about going to law school but wants to finish his Ph.D. first. The physical examination is unremarkable. HR = 82, BP = 122/80, RR = 10, SaO2 = 99 percent. He says, "See, I told you I'm fine. I don't need to go to the hospital." Which of these is the best course of action? A) Contact medical direction. B) Explain to the patient that he has no choice; if he is unwilling to take his medication, you must take him to the hospital for evaluation. C) Restrain the patient if necessary and transport. D) Request law enforcement assistance for legal detention of the patient for transport to the ED. Answer: A Diff: 2 Page Ref: 1453 Standard: Medicine (Psychiatric) Objective: 5 23) Your patient is a 76-year-old male who is alert and oriented. The patient's neighbor called EMS because of general concern about the patient's health. He states that the patient hasn't been himself since his wife's death six months ago. He hasn't taken care of his usually meticulous lawn and house, and he has lost a lot of weight. The patient says he misses his wife but doesn't need medical care. Which of these is the best course of action? A) Tell the patient you cannot leave him and that if he refuses to go to the hospital, you will have to call the police and have him placed under immediate detention for psychiatric treatment. B) Explain to the neighbor that the patient is behaving as expected and the only treatment is time. C) Have the patient sign a refusal of service form, but let him know he can call you back if he changes his mind. D) Explain to the patient that it is common for people in his situation to feel depressed, and you would like to help him by transporting him to the hospital. Answer: D Diff: 2 Page Ref: 1452 Standard: Medicine (Psychiatric) Objective: 6

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24) Which of these is NOT considered an appropriate method of controlling a combative patient in the prehospital setting? A) Droperidol B) Leather restraints C) Pepper spray D) Verbal deescalation Answer: C Diff: 1 Page Ref: 1462 Standard: Medicine (Psychiatric) Objective: 9 25) Which of these best describes a profound melancholy characterized by a diminished interest in daily pleasures, hypersomnia, feelings of worthlessness, inability to concentrate, and agitation? A) Bipolar disorder B) Schizoaffective disorder C) Dysthymia D) Depression Answer: D Diff: 1 Page Ref: 1452 Standard: Medicine (Psychiatric) Objective: 4 26) You are on the scene of an agitated male patient with a history of alcohol abuse. He is threatening to "knock your head off" if you get close to him. While you are getting a history from the patient's wife, she states that, "He had something wrong with his EKG. A long QR…something, something like that." Which of these should you avoid in the treatment of this patient? A) Lorazepam B) Diazepam C) Droperidol D) Physical restraint Answer: C Diff: 2 Page Ref: 1462 Standard: Medicine (Psychiatric) Objective: 5

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27) Which of these is NOT likely to negatively impact the emotional or behavioral status of a patient with a psychiatric disorder? A) Medical illness B) Following the same routine daily C) Stressful situations D) Taking recreational drugs and using alcohol Answer: B Diff: 1 Page Ref: 1445-1446 Standard: Medicine (Psychiatric) Objective: 2 28) Which of these best describes a state of uneasiness, discomfort, apprehension, or restlessness? A) Depression B) Paranoia C) Anxiety D) Mania Answer: C Diff: 1 Page Ref: 1449 Standard: Medicine (Psychiatric) Objective: 2 29) Which of these is NOT an organic cause of a behavioral emergency? A) Tumor B) Hypoglycemia C) Alcoholic encephalopathy D) Dementia Answer: B Diff: 1 Page Ref: 1445 Standard: Medicine (Psychiatric) Objective: 4

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30) You have been called to a college dormitory where campus police are talking to a 20-yearold male who was threatening to jump from his eighteenth-floor window. The patient admits that he was upset because he is failing most of his courses and his girlfriend broke up with him but says he was just "psyching out" his roommate and had no intention of jumping. Campus police tell you that the patient was sitting on the balcony railing with his feet over the edge when they arrived. The patient was cooperative when they asked him to come back inside the room. Which of these is the best course of action? A) Consider it a police matter, and mark in service. B) Have the police place the patient under immediate detention, and transport the patient in restraints. C) Tell the patient you must take his suicide threat seriously and transport him for evaluation. D) Have the patient sign a refusal form as long as the roommate will take responsibility for staying with him. Answer: C Diff: 2 Page Ref: 1455-1456 Standard: Medicine (Psychiatric) Objective: 10 31) Your patient is a 28-year-old male with a history of panic attacks. He states that symptoms began about 20 minutes ago and that he has been unable to get them under control. He complains of shortness of breath, chest pain, dizziness, and a feeling that he is going to die. His skin is warm and moist. HR = 132, BP = 138/98, RR = 26 and shallow. You spend 15 minutes on-scene with him attempting to "talk him down" without success. Which of these is most appropriate? A) Oxygen, IV, nitroglycerin, aspirin, morphine B) IV, diazepam C) Oxygen D) IV, haloperidol Answer: B Diff: 2 Page Ref: 1450 Standard: Medicine (Psychiatric) Objective: 10 32) Which of these best describes a state of disorientation or disorganized thought? A) Delusion B) Confabulation C) Neurosis D) Delirium Answer: D Diff: 1 Page Ref: 1449 Standard: Medicine (Psychiatric) Objective: 1

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33) Which of these is the most frequent cause of deterioration in a patient with a psychiatric disorder? A) Failure to keep counseling appointments B) Situational stresses C) Being released from an institution back into the public D) Noncompliance with medications Answer: D Diff: 1 Page Ref: 1445, 1448 Standard: Medicine (Psychiatric) Objective: 4 34) Which of these best describes a person's state of cerebral functioning? A) Mental status B) Affect C) Level of consciousness D) Intelligence Answer: A Diff: 1 Page Ref: 1446 Standard: Medicine (Psychiatric) Objective: 2 35) Your patient is a 28-year-old male who tells you his hands and arms are turning green. He states that he was held captive by some people for a month and forced to make movies. While the patient is undoubtedly convinced he is turning green, you cannot see it. The patient's brother tells you that he has not been missing for the past month but that he has stopped taking his medication. Which of these is most consistent with this situation? A) Schizotypal personality disorder B) Bipolar disorder C) Acute dystonic reaction D) Schizophrenia Answer: D Diff: 2 Page Ref: 1449 Standard: Medicine (Psychiatric) Objective: 4 36) Which of these best describes four-point restraints? A) Straps restraining the patient across the chest, hips, thighs, and legs B) A separate restraint on each of the four extremities C) A commercially manufactured restraint device D) Restraint of the head, torso, arms, and legs Answer: B Diff: 1 Page Ref: 1461 Standard: Medicine (Psychiatric) Objective: 9

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37) Which of these best describes the correct positioning of a restrained patient? A) Prone, sandwiched between the cot and a long backboard to prevent movement B) Prone, ensuring the restraints are not loose enough to allow patient movement C) Left lateral recumbent, ensuring the restraints are not tight enough to affect breathing or circulation D) Supine on the cot, ensuring the restraints are not loose but do not restrict circulation or breathing Answer: D Diff: 1 Page Ref: 1461-1462 Standard: Medicine (Psychiatric) Objective: 9 38) Your patient is in four-point restraints and starts to spit at you during transport. You should: A) put a nonrebreather mask on the patient but do not administer oxygen. B) place the patient prone, with his face turned away from you. C) place a surgical mask over the patient's mouth and nose. D) wear a HEPA respirator or an N-95 mask. Answer: C Diff: 2 Page Ref: 1461 Standard: Medicine (Psychiatric) Objective: 9 39) An example of a direct injury that may be sustained by a behavioral patient who has been TASERed would be: A) the muscle contractions that occur as a result of the electrical impulse. B) the damage caused by the impact of the probe. C) the ignition of the combustible gases that are present after firing the TASER. D) the resultant blunt force trauma caused by the fall that ensues after the electrical impulse. Answer: B Diff: 2 Page Ref: 1458 Standard: Medicine (Psychiatric) Objective: 8 40) You are caring for a patient that was TASERed by the police for being physically aggressive. This type of restraint works by what mechanism? A) It temporarily stuns the cerebral hemispheres. B) It paralyses the lower extremities. C) It renders the patient unconscious. D) It disrupts voluntary control of skeletal muscles. Answer: D Diff: 2 Page Ref: 1458 Standard: Medicine (Psychiatric) Objective: 8

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41) A patient has been stunned with a TASER, and as a result you note superficial skin damage from the probe. This type of injury is classified as: A) direct injury. B) primary injury. C) secondary injury. D) tertiary injury. Answer: A Diff: 1 Page Ref: 1458 Standard: Medicine (Psychiatric) Objective: 8 42) Which of these patients that have been TASERed do NOT meet the acceptable criteria to remove the TASER darts? A) A patient with a heart rate of 105/min B) A patient with a room SpO2 of 96 percent C) A patient with the TASER dart embedded in the URQ of the abdomen D) A patient with the TASER dart embedded in the neck Answer: D Diff: 2 Page Ref: 1458 Standard: Medicine (Psychiatric) Objective: 8 43) An emergency in which the patient's behavior is unusual, bizarre, threatening, or dangerous is referred to as a: A) psychiatric emergency. B) code green. C) behavioral emergency. D) personal assist. Answer: C Diff: 1 Page Ref: 1444 Standard: Medicine (Psychiatric) Objective: 1 44) Behavioral disorders NOT related to substance abuse or medical conditions are known as: A) sociocultural disorders. B) psychosocial disorders. C) nature behavior. D) nurture behavior. Answer: B Diff: 1 Page Ref: 1445-1446 Standard: Medicine (Psychiatric) Objective: 2

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45) Behavior disorders related to a patient's socioeconomic status, social habits, skills, and values are said to be: A) sociocultural disorders. B) psychosocial disorders. C) nature behavior. D) nurture behavior. Answer: A Diff: 1 Page Ref: 1446 Standard: Medicine (Psychiatric) Objective: 2 46) A clue that the scene may NOT be safe to enter would be: A) a messy house. B) broken-down cars. C) an overgrown lawn. D) broken glass and furniture. Answer: D Diff: 1 Page Ref: 1446 Standard: Medicine (Psychiatric) Objective: 3 47) Observing the patient for clues of violence should include the patient's: A) appearance and clothing. B) appearance and financial background. C) posture and hand gestures. D) ability to answer your questions. Answer: C Diff: 1 Page Ref: 1446-1447 Standard: Medicine (Psychiatric) Objective: 3 48) A mental status exam on a behavioral emergency should include all of these EXCEPT: A) orientation. B) sensorium. C) mood and affect. D) time since diagnosis. Answer: D Diff: 1 Page Ref: 1446 Standard: Medicine (Psychiatric) Objective: 3

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49) A behavior disorder characterized by relatively rapid onset of widely disorganized thought is: A) dementia. B) delirium. C) delusions. D) disassociation. Answer: B Diff: 1 Page Ref: 1449 Standard: Medicine (Psychiatric) Objective: 1 50) The second leading cause of death for 10-to-34-year-olds is: A) trauma. B) drug abuse. C) suicide. D) accidents. Answer: C Diff: 1 Page Ref: 1445 Standard: Medicine (Psychiatric) Objective: 2 51) Which of these is NOT a known risk factor for attempting suicide? A) Previous attempts B) Isolation C) Loss of independence D) Delirium Answer: D Diff: 1 Page Ref: 1456 Standard: Medicine (Psychiatric) Objective: 5 52) When dealing with a geriatric behavior crisis, you should: A) chemically restrain the patient. B) medicate the patient as soon as possible. C) be sure to call the patient by a nickname to establish a rapport. D) avoid administering any medication. Answer: D Diff: 2 Page Ref: 1456 Standard: Medicine (Psychiatric) Objective: 6

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53) When dealing with the pediatric patient in a behavioral crisis, you should: A) give the child some time alone to think. B) alter the truth to persuade the child. C) talk to the child like an adult. D) allow the child to keep a favorite toy or blanket. Answer: D Diff: 2 Page Ref: 1456-1457 Standard: Medicine (Psychiatric) Objective: 6 54) You respond to a local restaurant for a behavioral emergency. You arrive on the scene with law enforcement to find a patient who is sweating, severely agitated, and wearing inappropriate clothing. You should suspect: A) excited delirium. B) dissociative disorder. C) multiple personality disorder. D) psychosis. Answer: A Diff: 2 Page Ref: 1457 Standard: Medicine (Psychiatric) Objective: 7 55) You respond to a patient acting "extremely belligerent" at a nightclub. Law enforcement on the scene informs you that the club is known for MDMA abuse. You should consider: A) excited delirium and the need for chemical restraint. B) excited delirium and TASER removal. C) excited delirium and physical restraints. D) letting law enforcement transport. Answer: A Diff: 2 Page Ref: 1457 Standard: Medicine (Psychiatric) Objective: 7 56) When caring for a patient who has been TASERed, you should be aware that the primary TASER injury occurs from: A) the electricity. B) the darts. C) falling. D) There are no primary injuries. Answer: B Diff: 1 Page Ref: 1458 Standard: Medicine (Psychiatric) Objective: 8

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57) Which of these should be present to release the TASERed patient to police without EMS transport? A) Glasgow Coma Scale score of 15 B) Systolic blood pressure above 100 mmHg C) Pulse below 110 D) All of the above Answer: D Diff: 1 Page Ref: 1458 Standard: Medicine (Psychiatric) Objective: 8 58) Physical restraints deployed by EMS should be: A) hard restraints. B) handcuffs. C) soft restraints. D) EMS should never restrain a patient. Answer: C Diff: 1 Page Ref: 1461 Standard: Medicine (Psychiatric) Objective: 9 59) Ideally, a minimum of how many people should be used to restrain a patient? A) 3 B) 4 C) 5 D) 2 Answer: C Diff: 1 Page Ref: 1461 Standard: Medicine (Psychiatric) Objective: 9 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 43 Diseases of Ear, Nose, and Throat 1) All of these findings are symptoms of otitis media EXCEPT: A) pain. B) pressure. C) sinus infection. D) fever. Answer: C Diff: 2 Page Ref: 1473 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 3

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2) A chronic disease of the inner ear marked by a recurring syndrome of vertigo, dizziness, and progressive hearing loss is called: A) cholesteatoma. B) Ménière's disease. C) otosclerosis. D) mastoiditis. Answer: B Diff: 2 Page Ref: 1474 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 3 3) An inflammation of the membrane covering and protecting the exposed surface of the eye results in: A) cornea abrasion. B) lens distortion. C) choroiditis. D) conjunctivitis. Answer: D Diff: 1 Page Ref: 1468 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 3

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4) A patient complaining of eye pain informs you that he was diagnosed with a corneal abrasion three days ago. He called 911 today because the discomfort has not yet gone away and he desires medical attention. Based on this information, which statement is TRUE? A) Fluid is leaking from the posterior chamber. B) The transparent structure that covers the pupil has been damaged. C) The sclera must be infected. D) The lens of the eye has been abraded. Answer: B Diff: 2 Page Ref: 1467 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 4 5) Which portion of the eye controls the size of the pupil? A) Lens B) Iris C) Eyelid D) Cornea Answer: B Diff: 2 Page Ref: 1467 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2 6) Light passes to the eye through what opening? A) Iris B) Eyeball C) Cornea D) Lens Answer: C Diff: 1 Page Ref: 1467 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2 7) Which of these structures is NOT associated with the retina? A) Lens B) Photopigments C) Rods D) Cones Answer: A Diff: 2 Page Ref: 1467 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2

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8) A defect in what eye structure results in difficulty in visual detection of color and bright light? A) Lens B) Cones and rods C) Rods D) Cones Answer: D Diff: 2 Page Ref: 1467 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2 9) The sensor receptive cells in the retina that function best in dim light and do not perceive color is/are the: A) iris. B) cones. C) pupil. D) rods. Answer: D Diff: 2 Page Ref: 1467 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2 10) If left untreated, glaucoma can lead to what? A) Presbyopia B) Hyperopia C) Myopia D) Blindness Answer: D Diff: 1 Page Ref: 1470 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 3 11) A frantic mother dialed 911 for her three-year-old daughter, who stuck a small dried bean into her ear. Assessment shows the bean to be lodged firmly in the ear canal. When treating this patient, the paramedic would: A) reassure the mother the bean will eventually fall out. B) tap lightly on the other side of her head to dislodge the bean from the canal. C) have the patient follow up with her family physician. D) gently flush the ear canal with sterile water until the bean is dislodged. Answer: D Diff: 2 Page Ref: 1473 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 5

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12) The medial portion of the external ear ends at the: A) auricle. B) external auditory canal. C) tympanic membrane. D) tragus. Answer: C Diff: 2 Page Ref: 1471-1472 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2 13) What are the three tiny bones located in the middle ear called? A) Pinnas B) Cerumen C) Cochleae D) Ossicles Answer: D Diff: 1 Page Ref: 1471 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2 14) Which structure contains sensors that detect rotation of the head? A) Vestibule B) Semicircular canals C) Incus D) Cochlea Answer: B Diff: 1 Page Ref: 1472 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2 15) The "bony labyrinth" protects the: A) outer ear. B) auditory nerve. C) middle ear. D) inner ear. Answer: D Diff: 1 Page Ref: 1472 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2

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16) Which of these structures is NOT a bone of the middle ear? A) Malleus B) Stapes C) Cochlea D) Incus Answer: C Diff: 1 Page Ref: 1471-1472 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2 17) Which of the following structures in the inner ear is the organ of hearing? A) Semicircular canal B) Cochlea C) Vestibule D) Bony labyrinth Answer: B Diff: 2 Page Ref: 1472 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2 18) Swimmer's ear is also known as: A) otitis media. B) otitis externa. C) otitis interna. D) none of the above. Answer: B Diff: 1 Page Ref: 1473 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 4 19) A feeling of dizziness or an illusion of rotary motion is called: A) purulence. B) vertigo. C) eczema. D) tinnitus. Answer: B Diff: 2 Page Ref: 1474 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 3

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20) A three-year-old has stuck a crayon in his nose. Assessment reveals the crayon to be deeply embedded in the right nostril with some irritation and swelling noted. His vital signs are pulse124, respiration 20, and SpO2100 percent. Which of the following would be most appropriate when caring for this child? A) Nonemergent transport to the hospital B) Place a warm pack to the bridge of the nose C) Attempt removal of the crayon with forceps D) Oxygen via a nonrebreather at 5 liters/minute Answer: C Diff: 3 Page Ref: 1473 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 4 21) Oral candidiasis, commonly called thrush, is caused by what type of infection of the mouth? A) Bacterial B) Viral C) Fungal D) Protozoan Answer: C Diff: 1 Page Ref: 1480 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 3 22) The structures that protect the eyes are known as: A) sockets. B) ocular orbits. C) zygomatic bones. D) maxilla. Answer: B Diff: 1 Page Ref: 1466 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2 23) Vitreous humor is: A) a clear, jellylike fluid that fills the vitreous cavity. B) the sclera. C) behind the cones. D) behind the rods. Answer: A Diff: 1 Page Ref: 1466-1467 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 1

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24) You are called to a patient complaining of drainage and erythema from the right eye. You suspect: A) iritis. B) pterygium. C) conjunctivitis. D) herpes zoster ophthalmicus. Answer: C Diff: 1 Page Ref: 1468 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 4 25) You are caring for a patient with known sickle cell disease. You would also examine this patient for the presence of: A) glaucoma. B) hyphema. C) cataract. D) papilledema. Answer: B Diff: 1 Page Ref: 1470 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 1 26) In a patient experiencing otitis media, you should expect to find: A) tympanic membrane redness and distention. B) perforated membrane. C) cochlear fluid. D) infection at the base of the ear. Answer: A Diff: 1 Page Ref: 1473 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 4 27) Ménière's disease affects: A) balance and hearing. B) balance and depth perception. C) olfactory senses. D) the tympanic membrane. Answer: A Diff: 1 Page Ref: 1474 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 3

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28) Posterior epistaxis can arise from conditions such as: A) intracranial pressure. B) diabetic ketoacidosis. C) hypertension. D) insulin-dependent diabetes mellitus. Answer: C Diff: 1 Page Ref: 1476 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 3 29) You respond to a patient with a report of a mouth infection. Upon arrival, you find a thin man with a prominent fungal infection in his mouth. He denies any history of diabetes mellitus. You should strongly suspect: A) thrush commonly seen in AIDS patients. B) thrush commonly seen in patients who overdose. C) dentalgia. D) temporomandibular joint disorder. Answer: A Diff: 2 Page Ref: 1480-1482 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 6 30) You are treating a patient that was struck in the face by a baseball during a family picnic. The injury is located above his left eye where you note a contusion with swelling. The patient lost consciousness briefly. While doing your pupil assessment, you note a raised, wedge-shaped growth of conjunctiva that extends from the corner of the eye to almost the pupil on his left eye. This is likely from: A) pterygium. B) frontal lobe hematoma from the ball strike. C) allergic conjunctivitis. D) congenital defect. Answer: A Diff: 2 Page Ref: 1468 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 1 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 44 Nontraumatic Musculoskeletal Disorders 1) A finding that develops in patients who are on SMR precautions for long periods can be: A) decubitus ulcers. B) cellulitis. C) gangrene. D) fasciitis. 227 Copyright © 2023 Pearson Education, Inc.

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Answer: A Diff: 2 Page Ref: 1494 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 3 2) In which of these patients should you suspect pathological fractures? A) A young boy who fell off his bicycle, landing after hitting the curb B) A little girl who broke her arm from pulling her shirt over her head C) An older man who was struck by a car while crossing the street D) A woman who tripped and fell down a stairwell Answer: B Diff: 3 Page Ref: 1497 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4 3) You are called for a 48-year-old male who is complaining of back and leg pain. Your assessment shows that he has pain and tenderness in his lower back with tingling through his left buttock and down his left leg. He tells you that he has been moving furniture. You should suspect: A) decubitus. B) kyphosis. C) sciatica. D) osteoarthritis. Answer: C Diff: 2 Page Ref: 1490 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 6

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4) All of these would be appropriate care for a patient with nontraumatic back pain EXCEPT: A) administration of analgesia prior to moving the patient. B) application of an ice pack to the affected area. C) spinal immobilization with careful padding of voids. D) administration of anti-inflammatory medications. Answer: C Diff: 2 Page Ref: 1490 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 6 5) Inflammation of the skin, including the dermis and subcutaneous layers, usually caused by bacterial infection would be identified as: A) an abscess. B) cellulitis. C) necrotizing fasciitis. D) rhabdomyolysis. Answer: B Diff: 1 Page Ref: 1495 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 1 6) Your 56-year-old female patient is complaining of chronic fatigue, muscle stiffness, and tender areas on each elbow. Based on your assessment and the patient's history, you should suspect: A) reflex sympathetic dystrophy. B) osteoporosis. C) osteoarthritis. D) fibromyalgia. Answer: D Diff: 2 Page Ref: 1498 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 1 7) The current treatment for fibromyalgia is: A) exercise and stress management. B) allopurinol. C) sulfonamide antibiotics. D) anti-inflammatory drugs. Answer: A Diff: 1 Page Ref: 1498 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 5

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8) A patient with a soft tissue infection can develop gangrene. Which of these complications of infection can lead to gangrene? A) Decubitus ulcers B) Necrotizing fasciitis C) Interrupted blood supply D) Metabolic acidosis Answer: C Diff: 1 Page Ref: 1495 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4 9) Your patient is complaining about severe pain from a minor scratch on his arm. His medical history includes type II diabetes and hypertension. He is agonizing over the pain in his arm. You should suspect: A) gangrene. B) necrotizing fasciitis. C) infectious cellulitis. D) ankylosing spondylosis. Answer: B Diff: 2 Page Ref: 1495 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4 10) A patient has an advanced infection in his foot. There is discoloration of the skin, foul smelling discharge, and loss of sensation. These signs are typically seen in: A) ankylosing spondylosis. B) cellulitis. C) necrotizing fasciitis. D) gangrene. Answer: D Diff: 1 Page Ref: 1495 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 3 11) A degenerative joint disease in which the articular cartilage is damaged and breaks down is known as: A) osteoarthritis. B) osteoporosis. C) septic arthritis. D) bursitis. Answer: A Diff: 1 Page Ref: 1499-1500 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4

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12) Which of these is a form of arthritis that occurs from uric acid crystals being deposited in a joint? A) Bursitis B) Gout C) Osteopenia D) Rickets Answer: B Diff: 1 Page Ref: 1494 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4 13) Gangrene, so called because the infected area oozes foul smelling liquid, occurs as a result of: A) group A hemolytic streptococci. B) pressure ischemia. C) Stevens-Johnson syndrome. D) an untreated infection. Answer: D Diff: 1 Page Ref: 1495 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4 14) The form of arthritis that causes the bones that form the joints to become fused is: A) osteoarthritis. B) ankylosing spondylitis. C) osteopenia. D) septic arthritis. Answer: B Diff: 1 Page Ref: 1493-1494 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4 15) Which of these is NOT a repetitive motion injury? A) Tennis elbow B) Tenosynovitis C) Carpal tunnel syndrome D) Osteoarthritis Answer: D Diff: 2 Page Ref: 1491 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4

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16) The most common form of bone disease is: A) osteoporosis. B) osteomyelitis. C) rheumatoid arthritis. D) osteoarthritis. Answer: A Diff: 1 Page Ref: 1492 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4 17) This is a chronic disease that leads to inflammation and injury to the joints and the surrounding tissues. It is also considered an autoimmune disease. A) Septic arthritis B) Degenerative joint disease C) Rheumatoid arthritis D) Ankylosing spondylitis Answer: C Diff: 1 Page Ref: 1493 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 3 18) What is referred to as an infection of the bone, most commonly caused by a bacterial infection? A) Osteomyelitis B) Gout C) Septic arthritis D) Neoplastic infection Answer: A Diff: 1 Page Ref: 1496 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 1 19) You are caring for a patient with nontraumatic musculoskeletal pain. During your assessment you believe the patient is suffering from Osgood-Schlatter disease as this is a painful swelling of what structure of the body, seen primarily in children? A) Medial humeral epicondyle B) Femoral synovial bursae C) Anterior tibial tubercle D) Carpal tunnel sheath Answer: C Diff: 2 Page Ref: 1498 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 3

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20) All of these are malignant bone tumors EXCEPT: A) chondrosarcoma. B) osteosarcoma. C) rhabdomyosarcoma. D) fibrosarcoma. Answer: C Diff: 2 Page Ref: 1499 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4 21) The knee is classified as which type of joint? A) Saddle B) Gliding C) Hinge D) Ellipsoidal Answer: C Diff: 1 Page Ref: 1486 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 2 22) Another name for tennis elbow is: A) tenosynovitis. B) medial epicondylitis. C) bursitis. D) lateral epicondylitis. Answer: D Diff: 2 Page Ref: 1491 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4 23) The human skeleton consists of approximately how many bones? A) 210 B) 200 C) 202 D) 206 Answer: D Diff: 1 Page Ref: 1486 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 2

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24) The strongest and most rigid cartilage in the body is: A) elastic cartilage. B) hyaline cartilage. C) fibrocartilage. D) All cartilage is equally rigid. Answer: C Diff: 1 Page Ref: 1488 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 2 25) There are approximately how many skeletal muscles in the human body? A) Approximately 400 B) 400 to 500 C) 500 to 600 D) Approximately 700 Answer: D Diff: 1 Page Ref: 1488 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 2 26) You are called for an ill person. Upon your arrival, the patient is complaining of numbness to the perineum and back pain, and has evidence of urinary incontinence. You suspect: A) urinary tract infection. B) lumbago. C) systemic lupus erythematosus. D) cauda equina syndrome. Answer: D Diff: 2 Page Ref: 1490 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 5 27) You are evaluating a patient complaining of severe pain in the elbow after a game of tennis. You suspect: A) epicondylitis. B) tenosynovitis. C) bursitis. D) tendonitis. Answer: A Diff: 2 Page Ref: 1491 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 5

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28) You are questioning a patient about her pain when the patient jokingly says, "I used to be three inches taller." You suspect what underlying disease? A) Lupus erythematosus B) DDD C) Osteoporosis D) Cushing's syndrome Answer: C Diff: 2 Page Ref: 1498 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 5 29) Your patient is complaining of a low-grade fever and increasing joint pain and swelling, but has normal lymph nodes. You suspect? A) DDD B) Osteoporosis C) Rheumatoid arthritis D) Lupus erythematosus Answer: C Diff: 2 Page Ref: 1493 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4 30) You are evaluating a patient with swollen lymph nodes, fever, swelling, and painful joints. You suspect? A) DDD B) Osteoporosis C) Rheumatoid arthritis D) Systemic lupus erythematosus Answer: D Diff: 2 Page Ref: 1494 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4 31) You are evaluating a patient complaining of swollen and exudative legs. The patient has a history of diabetes mellitus. You suspect? A) Lupus erythematosus B) Rheumatoid arthritis C) Fasciitis D) Cellulitis Answer: D Diff: 2 Page Ref: 1495 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4

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32) A patient presents with a history of an infected pustule. The patient states that he has been self-treating with homeopathic remedies. He called today because he noticed that the tissue has become black and blue. You suspect: A) contusion. B) gangrene. C) tenosynovitis. D) osteomyelitis. Answer: B Diff: 2 Page Ref: 1495 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 5 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 45 Obstetrics and Gynecology 1) The paramedic accurately describes the difference between endometritis and endometriosis when she states: A) "Endometriosis is an infection of the uterine lining, while endometritis occurs when endometrial tissue is found outside the uterus." B) "Endometriosis occurs in women under age 40, while endometritis more common in women who are older." C) "Endometritis is an infection of the uterine lining, while endometriosis occurs when endometrial tissue is found outside the uterus." D) "Endometritis patients can be transported code 2, while those with endometriosis should always go code 3." Answer: C Diff: 2 Page Ref: 1512 Standard: Medicine (Gynecology) Objective: 1 2) Your patient tells you that she is being treated for cystitis. You recognize that she is being treated for: A) ovarian cysts. B) pelvic inflammatory disease. C) a urinary tract infection. D) an ectopic pregnancy. Answer: C Diff: 1 Page Ref: 1511-1512 Standard: Medicine (Gynecology) Objective: 3 3) Which of the following is TRUE of mittelschmerz? A) It is typically located unilaterally in one of the upper abdominal quadrants. B) It is usually accompanied by heavy vaginal bleeding. 236 Copyright © 2023 Pearson Education, Inc.

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C) It is associated with ovulation. D) It is a sign of ectopic pregnancy. Answer: C Diff: 1 Page Ref: 1512 Standard: Medicine (Gynecology) Objective: 1

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4) Menorrhagia is: A) irregular cycles of menstruation. B) painful menstruation. C) absence of menstruation. D) excessive menstrual flow. Answer: D Diff: 1 Page Ref: 1513 Standard: Medicine (Gynecology) Objective: 1 5) Mittelschmerz refers to which of the following? A) Purulent vaginal discharge B) False labor pains C) Midcycle abdominal pain D) Painful urination Answer: C Diff: 1 Page Ref: 1512 Standard: Medicine (Gynecology) Objective: 1 6) Which of the following occurs during the proliferative phase of the menstrual cycle? A) Ovulation B) An increase in uterine vascularity C) Endometrial thickening D) A drop in estrogen levels Answer: C Diff: 1 Page Ref: 1505-1506 Standard: Medicine (Gynecology) Objective: 2 7) The innermost lining of the uterus is called the: A) myometrium. B) perimetrium. C) endometrium D) vasometrium. Answer: C Diff: 1 Page Ref: 1505 Standard: Medicine (Gynecology) Objective: 2

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8) A 22-year-old woman presents in moderate distress, complaining of diffuse lower abdominal pain. She states that the pain has become progressively worse for the past two weeks and she is now unable to walk without an increase in pain. Your physical exam reveals severe pain with palpation of the lower abdomen and the following vital signs: heart rate 102, blood pressure 118/74 mmHg, and respirations 20/min. Which of the following statements made by the patient would most indicate the presence of pelvic inflammatory disease? A) "My boyfriend was just diagnosed with chlamydia." B) "I just had an IUD inserted." C) "My last menstrual cycle was normal." D) "I have chronic urinary tract infections." Answer: A Diff: 2 Page Ref: 1510-1511 Standard: Medicine (Gynecology) Objective: 3 9) A 20-year-old sexually active woman presents with severe right-side abdominal pain that radiates to her back. She states that the pain came on sharply during intercourse about 15 minutes earlier, and she reports a small amount of vaginal bleeding. She states that her menstrual cycles have been irregular for the past three months. The most likely clinical diagnosis would be: A) ruptured ectopic pregnancy. B) ruptured ovarian cyst. C) spontaneous abortion. D) pelvic inflammatory disease. Answer: B Diff: 2 Page Ref: 1511 Standard: Medicine (Gynecology) Objective: 3 10) A 33-year-old woman presents with a low-grade fever and abdominal pain. She reports that she noticed blood in her urine this morning. Which of the following questions would be most helpful when trying to identify the underlying cause of this patient's symptoms? A) "Have you noticed any foul-smelling discharge?" B) "Do you have any pain or burning with urination?" C) "Do you take birth control?" D) "Have you vomited today?" Answer: B Diff: 3 Page Ref: 1511 Standard: Medicine (Gynecology) Objective: 3

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11) A 19-year-old woman presents with severe lower abdominal pain, an oral temperature of 102.4°F, and skin that is pale and sweaty. She reports that she had an elective abortion 72 hours earlier and has had bloody vaginal discharge ever since. Appropriate treatment for this patient would include which of the following? A) IV fluids, oxygen, and transport B) Position of comfort, pain medication, and delayed transport C) Detailed secondary exam and 12-lead ECG D) Knee-chest position and rapid transport Answer: A Diff: 2 Page Ref: 1513 Standard: Medicine (Gynecology) Objective: 4 12) A 22-year-old woman presents with severe unilateral abdominal pain and vaginal bleeding with signs of shock. When asked whether she is pregnant, she states, "There's no way I'm pregnant, I have an IUD." Which of the following is the most likely cause of her signs and symptoms? A) Endometriosis B) Pelvis inflammatory disease C) Miscarriage D) Ectopic pregnancy Answer: D Diff: 2 Page Ref: 1512 Standard: Medicine (Gynecology) Objective: 3 13) All of the following are associated with spontaneous abortion EXCEPT: A) nontraumatic vaginal bleeding. B) the passage of clots and tissue. C) hypotension and fever. D) cramping abdominal pain. Answer: C Diff: 2 Page Ref: 1513, 1525 Standard: Medicine (Gynecology) Objective: 4

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14) Your patient is a 42-year-old woman who is alert and upset, complaining of vaginal bleeding. She states that the bleeding began 10 hours ago and is heavier than her normal menstrual flow. Her last menstrual period was three months ago, G3P3, and there is no other significant gynecologic history. Which of the following is the most likely cause of her signs and symptoms? A) Ectopic pregnancy B) Pelvic inflammatory disease C) Menopause-related dysfunctional uterine bleeding D) Spontaneous abortion Answer: D Diff: 2 Page Ref: 1513, 1525 Standard: Medicine (Gynecology) Objective: 4 15) A 34-year-old woman presents with complaints of vaginal bleeding and pain during intercourse. Her last menstrual period was two weeks ago and was reportedly heavier than normal. She reports that she had saturated two menstrual pads in the past two hours. You should: A) assess vital signs and transport. B) apply oxygen and start a large-bore IV. C) advise her to insert a tampon to control the bleeding. D) ask her if she has a family history of uterine cancer. Answer: A Diff: 2 Page Ref: 1513 Standard: Medicine (Gynecology) Objective: 3 16) A 16-year-old female patient presents with complaints of abdominal pain and dizziness. She is pale and clammy, and reluctant to answer your questions regarding her sexual activity. Vital signs are: blood pressure 92/62 mmHg, heart rate 102, and respirations 20. You should: A) make it clear that she must be honest about her sexual history. B) start a large-bore IV and transport emergently. C) ask the mother if the patient might be pregnant. D) transport in a position of comfort. Answer: B Diff: 2 Page Ref: 1512 Standard: Medicine (Gynecology) Objective: 4

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17) Your patient is a 35-year-old woman who is complaining of severe abdominal pain in both lower quadrants. She states that she had a tubal ligation two years ago. Which of the following questions is appropriate to ask during your care of this patient? A) "Have you ever had a sexually transmitted disease?" B) "Do you have more than one sexual partner?" C) "Have you ever had pelvic inflammatory disease (PID)?" D) "When was your last menstrual period?" Answer: D Diff: 1 Page Ref: 1513 Standard: Medicine (Gynecology) Objective: 3 18) Risk factors for ectopic pregnancy include all of the following EXCEPT: A) use of an intrauterine device for birth control. B) pelvic inflammatory disease. C) previous ectopic pregnancies. D) IV drug usage. Answer: D Diff: 2 Page Ref: 1525 Standard: Medicine (Gynecology) Objective: 3 19) You are called to the scene of a sexual assault. The patient is a 17-year-old female who is crying inconsolably and withdraws when you attempt to touch her. Which of the following is the most appropriate response? A) Explain to the patient that she must allow you to examine her for injuries. B) Ask the patient to describe how she was assaulted so you know where she is injured. C) Tell the patient that you cannot help her if she won't allow you to touch her. D) Explain to the patient that you will not touch her if she does not want you to. Answer: D Diff: 1 Page Ref: 1514 Standard: Medicine (Gynecology) Objective: 4 20) A 35-year-old woman has been raped. She states repeatedly that she wants to change her clothes before going to the hospital, and becomes hysterical when you advise her that she should remain dressed to preserve evidence. You should: A) allow her to change and carefully bag each item of clothing. B) refuse to let her change her clothing, as it will destroy evidence. C) allow her to change only her shirt, not her pants or undergarments. D) promise to let her change as soon as you get to the hospital. Answer: A Diff: 2 Page Ref: 1514 Standard: Medicine (Gynecology) Objective: 4

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21) Which of the following is NOT an appropriate adaptation to make in the assessment and care of a sexual assault victim? A) Allow a friend to accompany the victim in the back of the ambulance. B) Ask simple, closed-ended questions about the nature of the assault. C) Keep the back of the ambulance well lit and warm. D) Do not touch the patient unless it is necessary to obtain vital signs or examine injuries. Answer: B Diff: 2 Page Ref: 1514 Standard: Medicine (Gynecology) Objective: 4 22) A 35-year-old woman presents with abdominal pain that she describes as "cramping and dull." She reports having multiple sexual partners in the past six months, and states that she has an IUD. Vital signs are: blood pressure, 118/76 mmHg, heart rate, 88, and respirations, 18. Appropriate care of this patient includes: A) cardiac monitoring and transport. B) examining the genitalia for hemorrhage. C) elevating the legs during transport. D) position of comfort and routine ALS care. Answer: D Diff: 2 Page Ref: 1513 Standard: Medicine (Gynecology) Objective: 4 23) A 22-year-old woman presents with left-sided lower abdominal pain. She reports that her last menstrual cycle ended approximately 10 days ago. Her blood pressure is normal and she rates the pain as 6 on a scale of 10. You should: A) palpate the abdomen. B) administer oxygen. C) withhold pain medication. D) look for vaginal bleeding. Answer: A Diff: 2 Page Ref: 1510 Standard: Medicine (Gynecology) Objective: 4

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24) Your patient is an 18-year-old woman who is alert and in moderate distress, complaining of abdominal pain and lightheadedness. She describes a four-week history of worsening unilateral lower quadrant abdominal pain with onset of malaise, nausea, and vomiting this week. Today, she is experiencing faintness and near-syncope with exertion. She denies pain or difficulty with urination. Her last menstrual period was two weeks ago. She is sexually active and uses oral contraceptives. Physical examination reveals marked tenderness and guarding with palpation of her abdomen. Her skin is cool and diaphoretic. Her vital signs are: heart rate 121, blood pressure 90/58 mmHg, respirations 18. The patient's presentation is most consistent with: A) ectopic pregnancy. B) pelvic inflammatory disease. C) spontaneous abortion. D) pyelonephritis. Answer: A Diff: 3 Page Ref: 1512 Standard: Medicine (Gynecology) Objective: 4 25) A 30-year-old woman presents with a fever of 103.5°F, pale skin, and an altered mental status. She cries out and withdraws when you palpate her abdomen. Her husband reports that she had a cervical biopsy three days earlier, and has been "feeling sick" ever since. Vital signs are: blood pressure 88/60 mmHg, heart rate 110, and respirations 22. You suspect: A) sepsis secondary to endometritis. B) hypovolemia secondary to miscarriage. C) infection of fibroid tumors. D) shock due to pelvic inflammatory disease. Answer: A Diff: 3 Page Ref: 1512 Standard: Medicine (Gynecology) Objective: 4 26) A 26-year-old woman is complaining of severe abdominal pain and heavy vaginal bleeding. She has used five sanitary napkins in the past hour. Her last menstrual period was six weeks ago, and she describes a history of irregular periods, but never to this extent. Management of this patient should include: A) IV dextrose. B) oral antiemetic. C) IM epinephrine. D) IV fluids. Answer: D Diff: 2 Page Ref: 1513 Standard: Medicine (Gynecology) Objective: 4

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27) Your patient is a 44-year-old woman who is alert and in mild distress. She states that she had an acute onset of sharp, right lower quadrant abdominal pain last evening while having intercourse and that the pain has not subsided. Physical examination reveals tenderness with palpation to the lower right abdominal quadrant. Vital signs are: heart rate 98, respirations 16, blood pressure 116/78 mmHg. She reports she had a tubal ligation 10 years ago and that she has several small fibroid tumors. Which of the following is the most likely diagnosis for this patient? A) Ectopic pregnancy B) Pelvic inflammatory disease C) Mittelschmerz D) Ruptured ovarian cyst Answer: D Diff: 2 Page Ref: 1511 Standard: Medicine (Gynecology) Objective: 3 28) Your patient is a transgender man complaining of severe lower abdominal pain. He states that he is in the process of transitioning from female to male, and that he takes hormone supplements. When evaluating this patient, which of the following questions is most appropriate? A) "Are you planning to have gender reassignment surgery?" B) "When was your last menstrual cycle?" C) "How often do you use illegal drugs?" D) "Are you usually sexually active with men, or with women?" Answer: B Diff: 3 Page Ref: 1513 Standard: Medicine (Gynecology) Objective: 3 29) A 27-year-old woman reports significant vaginal bleeding. She states that she is 11 weeks pregnant and awoke this morning to heavy bleeding including the passage of clots. She is crying and very upset, stating, "I can't lose this baby–I can't live with that." When caring for this patient, you should: A) ask her if she has ever had a miscarriage. B) perform a vaginal exam to determine if she is still bleeding. C) transport the patient in a position of comfort and provide emotional support. D) inform the patient's husband that she may be having a miscarriage. Answer: C Diff: 2 Page Ref: 1513 Standard: Medicine (Gynecology) Objective: 4

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30) A 30-year-old woman has right-sided abdominal pain and is hypotensive. You suspect she may have a ruptured ectopic pregnancy. You recognize: A) life-threatening hemorrhagic shock and the need for fluid resuscitation. B) potentially dangerous obstructive shock that requires rapid transport. C) a common medical condition that affects many women each year. D) a very rare disease process that requires immediate surgery to save the pregnancy. Answer: A Diff: 3 Page Ref: 1513 Standard: Medicine (Gynecology) Objective: 4 31) Which of the following is NOT an appropriate way to control vaginal bleeding in the prehospital setting? A) Placing sterile gauze over the opening of the vagina B) Using a tampon C) Using a sanitary napkin D) Placing an absorbent pad under the patient Answer: B Diff: 1 Page Ref: 1513 Standard: Medicine (Gynecology) Objective: 4 32) Your patient is a 36-year-old woman who is alert and complaining of abdominal pain. She states that she is having her period and that this pain is "much different than the cramps I usually get." She describes the pain as achy throughout her pelvis and lower abdomen. She says that this has occurred during the past three menstrual cycles and that she has experienced dyspareunia and spotting over the same period. She is G2P2 and has no other significant gynecologic history. Physical examination reveals pain with palpation over her entire abdomen; her skin is warm and dry. Vital signs are: heart rate 84, blood pressure 124/76 mmHg, respiration 12, SpO2 99 percent. Which of the following is the most likely diagnosis for this patient? A) Uterine fibroids B) Endometriosis C) Primary dysmenorrhea D) Polycystic ovary disease Answer: B Diff: 2 Page Ref: 1512 Standard: Medicine (Gynecology) Objective: 3

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33) Just before an infant is delivered, the fetal scalp can be seen at the vaginal opening during each contraction. This is referred to as: A) effacement. B) crowning. C) dilation. D) presentation. Answer: B Diff: 1 Page Ref: 1513 Standard: Special Patient Populations (Obstetrics) Objective: 1 34) The blood-rich structure that serves as a lifeline for the developing fetus is called the: A) uterus. B) cervix. C) placenta. D) amniotic sac. Answer: C Diff: 1 Page Ref: 1516 Standard: Special Patient Populations (Obstetrics) Objective: 1 35) The medically appropriate term for the projected birth date of a baby is: A) probable date of delivery. B) expected date of labor. C) predicted delivery date. D) estimated date of confinement. Answer: D Diff: 1 Page Ref: 1519 Standard: Special Patient Populations (Obstetrics) Objective: 1 36) The term "puerperium" refers to: A) the delivery of the afterbirth. B) a specific fertility treatment. C) the time surrounding delivery. D) a technique used to delay contractions. Answer: C Diff: 1 Page Ref: 1532 Standard: Special Patient Populations (Obstetrics) Objective: 1

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37) You are caring for a woman who is 32 weeks pregnant. While assessing her breathing, you notice that her rib cage expands visibly with each breath and that her tidal volume appears to be deep. You recognize: A) signs of a severe respiratory condition requiring immediate intervention. B) an increase in tidal volume that is normal during pregnancy. C) signs of obstructive shock. D) an increase in oxygen demand due to an obstetrical emergency. Answer: B Diff: 2 Page Ref: 1517 Standard: Special Patient Populations (Obstetrics) Objective: 5 38) A 27-year-old pregnant woman was the restrained driver of a vehicle that hit the guardrail at a high rate of speed. She sustained a large laceration to the upper thigh and has lost a significant amount of blood. Vital signs are: heart rate 102, blood pressure 118/78 mmHg, respirations 18, and her skin is pale and clammy. Which of the following BEST explains this patient's presentation? A) Maternal blood volume increases during pregnancy, allowing vital signs to remain normal despite significant blood loss. B) Fetal oxygen demand increases after trauma, causing maternal blood pressure and heart rate to increase immediately after injury. C) Maternal blood volume decreases during pregnancy, amplifying the effects of epinephrine and allowing for the maintenance of blood pressure. D) Maternal vital signs remain normal following trauma to ensure the survival of the developing fetus. Answer: A Diff: 2 Page Ref: 1517-1518 Standard: Special Patient Populations (Obstetrics) Objective: 5 39) A 30-year-old woman complains of swelling in both her legs. She is 32 weeks pregnant, and states that she has also developed varicose veins over the past few weeks. Which of the following BEST explains the cause of this patient's signs and symptoms? A) The gravid uterus compresses the superior vena cava, decreasing venous return to the heart. B) Changes in the endocrine system cause peripheral edema during the late stages of pregnancy. C) The gravid uterus compresses the pelvic and femoral vessels, decreasing venous return and causing venous stasis. D) Changes in kidney function alter the normal electrolyte balance, causing tissue edema in the legs and feet. Answer: C Diff: 2 Page Ref: 1518 Standard: Special Patient Populations (Obstetrics) Objective: 5

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40) During which period of development is the fetus most susceptible to damage from maternal exposure to toxins, such as alcohol and tobacco? A) 1-8 weeks B) 16-20 weeks C) 8-12 weeks D) 20-40 weeks Answer: C Diff: 2 Page Ref: 1520 Standard: Special Patient Populations (Obstetrics) Objective: 5 41) Which structure allows oxygenated maternal blood to bypass the uninflated lungs of the developing fetus? A) Ductus venosus B) Foramen ovale C) Umbilical artery D) Ductus arteriosus Answer: A Diff: 2 Page Ref: 1521 Standard: Special Patient Populations (Obstetrics) Objective: 5 42) A 38-year-old pregnant woman called 911 after she developed a "splitting headache" unrelieved by over-the-counter analgesics. She states that she has a previous diagnosis of diabetes that is typically well controlled with insulin injections. This patient's history of diabetes makes her more likely to develop which of the following pregnancy-related conditions? A) Preeclampsia B) Cerebral aneurysm C) Congestive heart failure D) Stroke Answer: A Diff: 2 Page Ref: 1522 Standard: Special Patient Populations (Obstetrics) Objective: 6

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43) A 29-year-old woman is 28 weeks pregnant. She complains of nausea, abdominal pain, and right shoulder pain. She states she vomited once, which caused temporary relief; however, the pain returned shortly afterward. She has no pertinent medical history or allergies, has stable vital signs, and states that she ate a cheeseburger about 20 minutes prior to the start of her pain. The most likely cause of this patient's presentation is: A) food poisoning. B) cholecystitis. C) hyperemesis gravidarum. D) appendicitis. Answer: B Diff: 2 Page Ref: 1524-1525 Standard: Special Patient Populations (Obstetrics) Objective: 6 44) You are caring for a 42-year-old woman who is 32 weeks pregnant with twins. She is complaining of a severe headache and blurred vision, and lives in a rural area approximately 30 miles from the nearest ED. Your physical exam reveals significant peripheral edema and the following vital signs: heart rate 98, blood pressure 156/98 mmHg, respirations 18. The patient states she has a history of hypertension, but has not taken her prescribed medications because "they aren't safe for the babies." Appropriate treatment for this patient includes: A) administration of nitroglycerine and delayed transport. B) intravenous calcium chloride and 12-lead ECG. C) administration of aspirin and a prehospital stroke assessment. D) intravenous magnesium sulfate and rapid transport. Answer: D Diff: 3 Page Ref: 1529 Standard: Special Patient Populations (Obstetrics) Objective: 7 45) A 24-year-old pregnant woman is actively seizing. Her partner reports that she complained of abdominal pain approximately 10 minutes ago, and then began seizing. He reports that the seizure activity has been consistent for the past 10 minutes, and that she has no significant medical history. You should: A) apply a nasal cannula, assess blood glucose level, and transport in the left lateral position. B) insert a nasal airway, administer midazolam, and obtain vital signs. C) apply high-flow oxygen, administer magnesium sulfate, and transport emergently. D) suction the airway, obtain IV access, and assess blood pressure. Answer: C Diff: 2 Page Ref: 1529 Standard: Special Patient Populations (Obstetrics) Objective: 6

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46) A 25-year-old woman presents complaining of heavy vaginal bleeding accompanied by cramping abdominal pain and backache. She can't stop crying and reports that she is 11 weeks pregnant with her first child. Your physical exam reveals what appears to be the fetus and umbilical cord passing through the vaginal opening; however, the placenta has not been passed. Appropriate care for this patient includes: A) clamping and cutting the umbilical cord, wrapping fetal material in linen, and providing emotional support for the patient. B) leaving the fetus untouched and transporting the patient in a position of comfort. C) oxygen, 1000 mL fluid bolus, and rapid transport. D) disposing of the fetal material in a biohazard bag, left lateral position, and providing emotional support for the patient. Answer: A Diff: 3 Page Ref: 1525 Standard: Special Patient Populations (Obstetrics) Objective: 6 47) You are caring for a patient who is 36 weeks pregnant. She states that she has been experiencing vaginal bleeding after intercourse, and denies any associated pain. Vital signs are: heart rate 84, respirations 18, blood pressure 102/72 mmHg, and warm, dry skin. The most likely cause of this patient's vaginal bleeding is: A) spontaneous abortion. B) placenta previa. C) abruptio placentae. D) false labor. Answer: B Diff: 2 Page Ref: 1526-1527 Standard: Special Patient Populations (Obstetrics) Objective: 6 48) A 37-year-old, obviously pregnant woman complains of sharp, tearing abdominal pain. She reports that she is pregnant with her fifth child, but states she cannot remember the exact due date. The patient has a history of drug use and states that she last smoked crack cocaine approximately 30 minutes ago. You suspect: A) spontaneous abortion. B) placenta previa. C) abruptio placentae. D) false labor. Answer: C Diff: 2 Page Ref: 1527 Standard: Special Patient Populations (Obstetrics) Objective: 6

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49) A pregnant woman is complaining of a severe headache and "feeling ill." Her vital signs are: heart rate 92, blood pressure 120/82 mmHg, and respirations 16. Which of the following questions would be most helpful in identifying a possible pregnancy-related emergency? A) "Do you have a history of migraine headaches?" B) "Have you been experiencing morning sickness or excessive vomiting today?" C) "When was the last time you saw your doctor?" D) "What has been a typical blood pressure for you during this pregnancy?" Answer: D Diff: 2 Page Ref: 1529 Standard: Special Patient Populations (Obstetrics) Objective: 6 50) Which of the following techniques is an appropriate method of estimating the gestational age? A) Measuring the circumference of the woman's abdomen; each inch corresponds to one week of pregnancy. B) Palpate the abdomen and estimate gestational age based on the size of the developing fetus. C) Measure the height of the fundus; each centimeter corresponds to one week of pregnancy. D) Palpate the abdomen; if fetal movement is felt then the pregnancy is at least 14 weeks. Answer: C Diff: 2 Page Ref: 1543 Standard: Special Patient Populations (Obstetrics) Objective: 6 51) When assessing the vital signs of a pregnant patient, it is generally most appropriate to have the patient in which position? A) Supine B) Left lateral recumbent C) Semi-Fowler's D) Standing Answer: B Diff: 1 Page Ref: 1523 Standard: Special Patient Populations (Obstetrics) Objective: 6 52) You are caring for a 19-year-old woman who states that she is 32 weeks pregnant. She is experiencing cramping abdominal pain every six to seven minutes and reports a brief period of fluid discharge from her vagina approximately 15 minutes ago. You should: A) provide routine BLS care and transport. B) begin a fluid bolus and transport code 3. C) administer ondansetron and reassess vital signs. D) apply oxygen and perform a physical exam. Answer: B Diff: 2 Page Ref: 1531 Standard: Special Patient Populations (Obstetrics) Objective: 7 252 Copyright © 2023 Pearson Education, Inc.

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53) The second stage of labor begins: A) with the complete dilation of the cervix. B) at the onset of contractions. C) when the baby is delivered. D) at the rupture of membranes. Answer: A Diff: 2 Page Ref: 1533 Standard: Special Patient Populations (Obstetrics) Objective: 8 54) You are caring for a woman in labor. She has had three previous deliveries and states that her contractions are approximately three minutes apart. Physical exam reveals a bulging of tissue at the vaginal opening with each contraction; however, the baby's head is not yet visible. You should: A) encourage the mother to breathe and ready her for transport. B) prepare for imminent delivery. C) place the mother in the knee-chest position. D) perform an internal exam to see how much the cervix is dilated. Answer: B Diff: 2 Page Ref: 1533 Standard: Special Patient Populations (Obstetrics) Objective: 8 55) What is the appropriate sequence of care for a newborn following a normal delivery? A) Suction the nose, dry the infant, and cut the cord. B) Dry the infant, cut the cord, and place infant on mother's stomach. C) Suction the mouth, deliver the placenta, and cut the cord. D) Apply oxygen, dry the infant, and give the infant to the mother. Answer: B Diff: 2 Page Ref: 1535 Standard: Special Patient Populations (Obstetrics) Objective: 8 56) A newborn has just been delivered. He is centrally pink with pale extremities, has a heart rate of 110, and is actively crying and moving. The appropriate APGAR score for this infant is: A) 6. B) 7. C) 8. D) 9. Answer: D Diff: 2 Page Ref: 1537 Standard: Special Patient Populations (Obstetrics) Objective: 9

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57) A newborn is listless and has a heart rate of 50 beats per minute after 30 seconds of stimulation. You should FIRST: A) initiate positive pressure ventilation. B) begin chest compressions. C) obtain IV access. D) apply the AED. Answer: A Diff: 2 Page Ref: 1537 Standard: Special Patient Populations (Obstetrics) Objective: 9 58) A 42-year-old woman is 38 weeks pregnant and in active labor. While assessing for crowning, you notice that although the top of the baby's head is visible, a loop of the umbilical cord is protruding from the vagina. You should: A) gently attempt to reinsert the cord into the vaginal canal. B) encourage the mother to push while gently pulling traction. C) clamp and cut the presenting section of the umbilical cord. D) insert two fingers to raise the head of the baby off the cord. Answer: D Diff: 2 Page Ref: 1539 Standard: Special Patient Populations (Obstetrics) Objective: 10 59) You are assisting a mother with an out-of-hospital delivery. After the head delivers, it immediately retracts back into the perineum. You should: A) transport in the knee-chest position. B) instruct the mother to drop her buttocks off the end of the bed. C) gently pull downward on the infant's head. D) instruct the mother to avoid pushing if possible. Answer: B Diff: 2 Page Ref: 1539 Standard: Special Patient Populations (Obstetrics) Objective: 10 60) During delivery, you notice a yellowish-green fluid on the baby's head and face. You recognize: A) a normal side effect of delivery. B) that emergency transport is required. C) a sign of fetal hypoxia. D) that the infant will require resuscitation. Answer: C Diff: 2 Page Ref: 1541 Standard: Special Patient Populations (Obstetrics) Objective: 10

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61) You have just delivered a healthy newborn to a 35-year-old woman. There is a steady flow of blood from the vagina and her uterus feels soft upon palpation. Her vital signs are: heart rate 122, respirations 20, blood pressure 90/60 mmHg. Appropriate management of this patient includes: A) sanitary pads placed over the vagina and continued monitoring. B) two large-bore IVs and oxytocin administration. C) Trendelenburg position and administration of magnesium sulfate. D) low-flow oxygen and position of comfort. Answer: B Diff: 2 Page Ref: 1532 Standard: Special Patient Populations (Obstetrics) Objective: 10 62) A 32-year-old woman was the restrained passenger of a vehicle that hit a tree at a high rate of speed. She is 34 weeks pregnant and complains of excruciating abdominal pain. She is cool and diaphoretic and has a faint and rapid radial pulse. You suspect: A) traumatic onset of labor. B) uterine inversion. C) uterine rupture. D) premature rupture of membranes. Answer: C Diff: 2 Page Ref: 1533 Standard: Special Patient Populations (Obstetrics) Objective: 10 63) A woman late in her pregnancy is in cardiac arrest. When resuscitating this patient, it is appropriate to: A) compress at a rate of at least 120 per minute. B) use a mechanical compression device. C) lift and push the gravid uterus to the left. D) assess for imminent delivery. Answer: C Diff: 2 Page Ref: 1534 Standard: Special Patient Populations (Obstetrics) Objective: 10 64) You have just delivered an infant at 33 weeks gestation. The infant is blue and limp and has a brachial pulse of 70 beats per minute. What is the appropriate sequence of care for this infant? A) Keep warm and dry, chest compressions, clamp and cut the cord. B) Keep warm and dry, clamp and cut the cord, positive pressure ventilations. C) Clamp and cut the cord, positive pressure ventilations, keep warm and dry. D) Clamp and cut the cord, chest compressions, positive pressure ventilations. Answer: B Diff: 2 Page Ref: 1537 Standard: Special Patient Populations (Obstetrics) Objective: 7

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65) A 21-year-old woman is complaining of abdominal pain. She says she is 25 weeks pregnant and has been actively trying to stop using methamphetamines, but slipped and used earlier today. Her abdominal pain comes every 8 to 10 minutes and is described as sharp and cramping. You suspect: A) hypertensive disorder of pregnancy. B) abruptio placentae. C) toxic shock syndrome. D) preterm labor. Answer: D Diff: 2 Page Ref: 1531 Standard: Special Patient Populations (Obstetrics) Objective: 7 66) When is the ideal time to assess a neonate for the APGAR score? A) 2 to 3 minutes after delivery B) 1 minute and 5 minutes after delivery C) 5 to 10 minutes after delivery D) 2 minutes and 10 minutes after delivery Answer: B Diff: 2 Page Ref: 1536-1537 Standard: Special Patient Populations (Obstetrics) Objective: 9 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 46 Neonatology 1) In some cases, the spinal cord and associated structures of a newborn may be exposed. This abnormality is called a(n): A) Tetralogy of Fallot. B) meningomyelocele. C) omphalocele. D) choanal atresia. Answer: B Diff: 2 Page Ref: 1552 Standard: Special Patient Populations (Neonatal Care) Objective: 1 2) Which of these best describes Pierre Robin syndrome? A) A congenital condition characterized by a small jaw and large tongue in conjunction with a cleft palate B) A condition in which the ductus arteriosus fails to close completely C) Repeat febrile seizures within the first 6 months of life D) Persistent pneumonia following meconium aspiration Answer: A 256 Copyright © 2023 Pearson Education, Inc.

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Diff: 2 Page Ref: 1553 Standard: Special Patient Populations (Neonatal Care) Objective: 1 3) Which of these is TRUE regarding vaginal delivery? A) Infants delivered vaginally are at greater risk of post-delivery complications. B) The compression of the infant's chest during vaginal delivery aids in the removal of fluid from the fetal lungs. C) Vaginal delivery stimulates the production of insulin in the newborn. D) The foramen ovale close more successfully in newborns delivered vaginally. Answer: B Diff: 2 Page Ref: 1549 Standard: Special Patient Populations (Neonatal Care) Objective: 3

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4) Factors that stimulate the newborn to take the first breath include all of the following EXCEPT: A) hypothermia. B) hypoxia. C) hyperglycemia. D) acidosis. Answer: C Diff: 2 Page Ref: 1549 Standard: Special Patient Populations (Neonatal Care) Objective: 3 5) You are caring for a newborn who had prolonged respiratory distress and hypoxia following birth. You recognize that continued hypoxia and subsequent severe acidosis can cause: A) refractory hypotension. B) rapid development of fetal alveoli to compensate for hypoxia. C) persistent fetal circulation. D) the formation of congenital heart defects. Answer: C Diff: 3 Page Ref: 1549 Standard: Special Patient Populations (Neonatal Care) Objective: 2 6) You have been called to the residence of a five-day-old infant. His parents are concerned because he sleeps about 18 hours a day. They took a rectal temperature and got a reading of 100°F. Which of these is the best course of action? A) Administer a 10 mL/kg fluid bolus. B) Undress the infant to his diaper and sponge him with tepid water. C) Reassure the parents that the infant's sleep patterns and temperature are normal. D) Contact medical control to order acetaminophen. Answer: C Diff: 2 Page Ref: 1557 Standard: Special Patient Populations (Neonatal Care) Objective: 3 7) You have just assisted in the delivery of a full-term infant in the back of the ambulance. Ten minutes after delivery, you obtain vital signs on the newborn and find the following: heart rate 120, respirations 54, and SpO2 of 90 percent. You recognize: A) the need for immediate supplemental oxygen. B) appropriate vital signs for this infant. C) tachycardia and the possibility of shock. D) tachypnea and possible respiratory distress. Answer: B Diff: 2 Page Ref: 1553 Standard: Special Patient Populations (Neonatal Care) Objective: 5

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8) Which of the following is NOT an option for prehospital vascular access in the newborn? A) Cannulation of a peripheral vein in an extremity B) Intraosseous needle placed in the proximal tibia C) Femoral vein cannulation D) Umbilical vein cannulation Answer: C Diff: 2 Page Ref: 1563 Standard: Special Patient Populations (Neonatal Care) Objective: 7 9) Which of these is NOT a recommended method for assessing the heart rate of a newborn? A) Palpating the carotid pulse B) Palpate the umbilical pulse C) Auscultate heart sounds D) Palpate a femoral pulse Answer: A Diff: 2 Page Ref: 1558 Standard: Special Patient Populations (Neonatal Care) Objective: 5 10) Which of these statements is TRUE regarding the cardiac output of a neonate? A) Cardiac output doubles within the first few hours of life. B) The cardiac output of a neonate is strongly influenced by body temperature. C) Neonates do not readily alter their pulse rate; cardiac output depends mainly on stroke volume. D) Newborns have a fixed stroke volume, thus cardiac output depends mostly on heart rate. Answer: D Diff: 2 Page Ref: 1557 Standard: Special Patient Populations (Neonatal Care) Objective: 3 11) A newborn has just been delivered. You notice a greenish-brown substance on the infant, and observe a vigorous cry and active movement. What is the appropriate way to manage this patient? A) Prepare to suction the trachea with an endotracheal tube and meconium aspirator. B) Using a bulb syringe, suction the nose and then the mouth. C) Rub/dry the infant with a dry towel and place on the mother's chest. D) Lay the infant supine and place padding behind the shoulders. Answer: C Diff: 2 Page Ref: 1556 Standard: Special Patient Populations (Neonatal Care) Objective: 3

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12) At 90 seconds after birth, based on these findings, which newborn does NOT require resuscitative efforts beyond routine care? A) HR = 100, RR = 30, peripheral cyanosis, APGAR = 8 B) HR = 158, RR = 40, central cyanosis, APGAR = 6 C) HR = 75, RR = 25, central cyanosis, APGAR = 5 D) HR = 98, RR = 27, peripheral cyanosis, APGAR = 6 Answer: A Diff: 2 Page Ref: 1553 Standard: Special Patient Populations (Neonatal Care) Objective: 3 13) You have just assisted in the delivery of a 34-week-gestation infant in the office of a methadone clinic. After 30 seconds of drying and stimulation, the infant remains limp and cyanotic, with a pulse of 50. Which of these actions is the most appropriate to perform FIRST for this patient? A) Begin CPR. B) Intubate the trachea. C) Begin bag-valve-mask ventilations. D) Continue to warm and dry the infant for an additional 30 seconds. Answer: A Diff: 3 Page Ref: 1562 Standard: Special Patient Populations (Neonatal Care) Objective: 5 14) Immediately after delivery, a neonate is crying and moving his arms and legs, but has peripheral cyanosis. You recognize: A) the need for supplemental oxygen. B) signs of a normal, healthy infant. C) the need to prevent further heat loss. D) signs of a congenital heart abnormality. Answer: B Diff: 2 Page Ref: 1559 Standard: Special Patient Populations (Neonatal Care) Objective: 3 15) All of the following are accurate methods for obtaining the heart rate of a newborn EXCEPT: A) a pulse oximeter. B) 3-lead ECG. C) palpating a brachial pulse. D) auscultating heart tones. Answer: C Diff: 2 Page Ref: 1558 Standard: Special Patient Populations (Neonatal Care) Objective: 5

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16) You are resuscitating a 15-day-old infant who was found pulseless and apneic in her crib. Which of the following questions would be most helpful when obtaining a history from the parents? A) "Does your daughter have any congenital heart abnormalities?" B) "Was your baby sleeping face up?" C) "Is there a family history of heart disease?" D) "Have any of your other children died from SIDS?" Answer: A Diff: 3 Page Ref: 1548 Standard: Special Patient Populations (Neonatal Care) Objective: 2 17) You are called to the home of a 72-hour-old infant whose mother is concerned because the infant has been "vomiting after she eats." Based on this information, which assessment parameter should you include in your history and physical assessment? A) End-tidal CO2 monitoring B) Auscultation of gastric sounds C) Asking if the baby could have ingested any toxins D) Assessing the fontanels Answer: D Diff: 3 Page Ref: 1568-1569 Standard: Special Patient Populations (Neonatal Care) Objective: 5 18) You have just assisted in the delivery of an approximately 4 kg newborn whose mother is a rather petite primipara. On assessment, you note that there is no spontaneous movement of the infant's right arm at the shoulder, but he moves the elbow and wrist. He otherwise exhibits vigorous movement and has a 1-minute APGAR score of 9. What should you suspect? A) Neonatal abstinence syndrome B) Spinal cord damage C) Fractured clavicle D) Caput succedaneum Answer: C Diff: 2 Page Ref: 1569 Standard: Special Patient Populations (Neonatal Care) Objective: 2

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19) You are assessing a 1-minute APGAR score on a patient who has peripheral cyanosis and a heart rate of 98, who cried spontaneously after delivery, is actively moving his extremities, and has a strong cry. What is the APGAR score of this patient? A) 9 B) 7 C) 8 D) 10 Answer: C Diff: 2 Page Ref: 1553-1554 Standard: Special Patient Populations (Neonatal Care) Objective: 6 20) A newborn was found pulseless and apneic in his crib. After lengthy attempts at resuscitation, medical control has advised you to stop resuscitation. When you inform the parents, they become hysterical and the mother cries, "Give me my baby! I don't want you touching him!" You should: A) gently tell the mother that, unfortunately, she cannot hold the baby until the coroner arrives. B) hand the child to the mother and allow the parents time alone with the child. C) request that a law enforcement officer remain with the mother. D) move the infant to the ambulance and transport. Answer: B Diff: 2 Page Ref: 1570 Standard: Special Patient Populations (Neonatal Care) Objective: 8 21) You are called to a residence to care for a three-hour-old infant in respiratory distress, delivered at their home by a midwife. Your physical exam reveals retractions, grunting, and tachypnea, along with rhonchi and crackles in the lungs. The midwife reports that the amniotic fluid had "some meconium." Which condition is the most likely cause of this infant's signs and symptoms? A) Tetralogy of Fallot B) Cardiac compromise C) Persistent fetal circulation D) Meconium aspiration Answer: D Diff: 2 Page Ref: 1564 Standard: Special Patient Populations (Neonatal Care) Objective: 7

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22) You respond to an apartment for a "sick child." You arrive to find a two-week-old infant in her mother's arms, wrapped in a thick blanket. The mother reports that the baby has been coughing, and suddenly "went stiff" 10 minutes ago. The infant is listless and not rousable. You should FIRST: A) unwrap the child and assess skin temperature. B) apply oxygen and assess blood glucose. C) obtain a blood pressure and medical history. D) package the infant in a car seat and transport emergently. Answer: A Diff: 2 Page Ref: 1567 Standard: Special Patient Populations (Neonatal Care) Objective: 7 23) Which of the following is NOT a consequence of respiratory insufficiency in the newborn? A) Hypoxia B) Hyperglycemia C) Bradycardia D) Acidosis Answer: B Diff: 2 Page Ref: 1556 Standard: Special Patient Populations (Neonatal Care) Objective: 7 24) A first-time mother has called 911 because her five-day-old son is "acting sick." Your assessment reveals a lethargic infant with a patent airway, adequate respirations, and a pulse rate of 100 beats per minute. His skin is cold to the touch and mottled. The mother reports she was giving the child a bath just prior to calling EMS. You suspect: A) hypoxia. B) hyperglycemia. C) hypothermia. D) hypercarbia. Answer: C Diff: 2 Page Ref: 1567-1568 Standard: Special Patient Populations (Neonatal Care) Objective: 8

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25) A four-hour-old infant is inconsolable with a weak cry. His hands and feet are trembling. The mother reports a history of gestational diabetes and hypertension, and states she delivered at home without complication. What is the MOST likely cause of this infant's signs and symptoms? A) Type 1 diabetes mellitus B) Meconium aspiration C) Hypoglycemia D) Febrile seizures Answer: C Diff: 2 Page Ref: 1558 Standard: Special Patient Populations (Neonatal Care) Objective: 7 26) Which medication/intervention is used for refractory bradycardia in a newborn? A) Transcutaneous pacing B) Epinephrine C) Atropine D) Dopamine Answer: B Diff: 2 Page Ref: 1548 Standard: Special Patient Populations (Neonatal Care) Objective: 7 27) Which statement is TRUE of prehospital newborn care? A) It is impossible to anticipate which deliveries may result in the need for newborn resuscitation. B) Newborns weighing over 2,500 grams are at higher risk of respiratory compromise. C) Sixty percent of newborns delivered outside a hospital require some form of resuscitation. D) Low-birth-weight babies are much more likely to require immediate assistance after delivery. Answer: D Diff: 2 Page Ref: 1556 Standard: Special Patient Populations (Neonatal Care) Objective: 2 28) Which statement BEST describes the relationship between primary and secondary apnea in newborns? A) Primary apnea is due to respiratory failure, whereas secondary apnea is due to cardiac arrhythmia. B) Primary apnea occurs only at birth, whereas secondary apnea occurs anytime during the first month of life. C) Secondary apnea results from primary apnea. D) Secondary apnea is a less serious condition and responds well to tactile stimulation and an oxygen-enriched atmosphere. Answer: C Diff: 2 Page Ref: 1549 Standard: Special Patient Populations (Neonatal Care) Objective: 7 264 Copyright © 2023 Pearson Education, Inc.

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29) The appearance of your newborn patient leads you to suspect that he has Pierre Robin syndrome. What should be your most immediate concern? A) Upper airway obstruction B) Lower airway obstruction C) Compression of the lungs by the abdominal contents D) Shunting of blood through a patent foramen ovale Answer: A Diff: 2 Page Ref: 1553 Standard: Special Patient Populations (Neonatal Care) Objective: 7 30) You suspect that a newborn has choanal atresia. Which finding would lead you to this diagnosis? A) The infant develops cyanosis when crying. B) The baby cannot nurse and breathe at the same time. C) The baby has unequal brachial pulses. D) The infant has a persistently low SpO2. Answer: B Diff: 2 Page Ref: 1553 Standard: Special Patient Populations (Neonatal Care) Objective: 7 31) Which condition may result in persistent fetal circulation? A) Failure to cut the umbilical cord B) Down syndrome C) Hypoxia D) Overaggressive administration of blow-by oxygen Answer: C Diff: 2 Page Ref: 1549 Standard: Special Patient Populations (Neonatal Care) Objective: 7 32) Which events are likely to occur when suctioning a newborn's airway? A) Hypoxia, tachycardia B) Hypoxia, bradycardia C) Hypoxia, ventricular fibrillation D) Vagal stimulation, tachycardia Answer: B Diff: 2 Page Ref: 1555 Standard: Special Patient Populations (Neonatal Care) Objective: 5

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33) Which statement describes the appropriate administration of intravenous fluids in a newborn? A) Normal saline or lactated Ringer's solution 40 mL/kg using a pressure infuser B) Normal saline, 10 mL/kg, slow IV push C) 10 percent dextrose in water, 20 mL/kg, slow IV push D) 5 percent dextrose in 0.45 percent saline solution, 30 mL/kg Answer: B Diff: 2 Page Ref: 1567 Standard: Special Patient Populations (Neonatal Care) Objective: 7 34) Which rationale BEST describes why hypoglycemia after delivery is common in infants born to mothers with gestational diabetes? A) The fetus develops compensatory insulin production in utero due to maternal hyperglycemia, which causes hypoglycemia after delivery. B) The genetic nature of diabetes mellitus makes infants born to mothers with gestational diabetes more likely to have diabetes themselves. C) The fetus is no longer receiving insulin via the umbilical cord, and therefore becomes hypoglycemic after birth. D) Gestational diabetes may cause fetal pancreatic abnormalities that cause hypoglycemia after birth. Answer: A Diff: 3 Page Ref: 1568 Standard: Special Patient Populations (Neonatal Care) Objective: 8 35) Which of these statements is the appropriate way to document a premature infant's gestational age? A) "Infant was born 3 weeks early." B) "Infant's gestational age is 4 weeks premature." C) "Infant was born 3 weeks prior to due date." D) "Infant was born at 33 weeks and 4 days gestation." Answer: D Diff: 2 Page Ref: 1562 Standard: Special Patient Populations (Neonatal Care) Objective: 8 36) In which of the congenital anomalies of the heart does the ductus arteriosus fail to close? A) Transposition of the great vessels B) Patent ductus arteriosus C) Ventricular septal defect D) Tetralogy of Fallot Answer: B Diff: 1 Page Ref: 1549 Standard: Special Patient Populations (Neonatal Care) Objective: 4 266 Copyright © 2023 Pearson Education, Inc.

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37) In which of the congenital anomalies of the heart is there a narrowing in the arch of the aorta, obstructing blood flow? A) Coarctation of the aorta B) Hypoplastic left heart syndrome C) Aortic stenosis D) Mitral stenosis Answer: A Diff: 1 Page Ref: 1552 Standard: Special Patient Populations (Neonatal Care) Objective: 4 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 47 Pediatrics 1) Funding for a significant amount of prehospital pediatric education comes largely from a program known as: A) Emergency Medical Pediatric Association. B) Emergency Medical Services for Children. C) Pediatric Advanced Medical Care. D) Pediatric Emergency Care Program. Answer: B Diff: 2 Page Ref: 1573 Standard: Special Patient Populations (Pediatrics) Objective: 1 2) Which of these statements regarding prehospital care of pediatric patients is TRUE? A) Up to 85 percent of children treated by EMS need nothing more than basic life support skills. B) The majority of pediatric calls are for allergic reactions. C) More than 50 percent of pediatric patients require advanced life support. D) Most pediatric patients seen by EMS personnel are from low-income families. Answer: A Diff: 2 Page Ref: 1573 Standard: Special Patient Populations (Pediatrics) Objective: 2 3) Your patient is a 16-year-old female cheerleader who fell while attempting a pyramid formation and struck her forehead on the back of another girl's head. She has a 2-cm laceration just above her right eyebrow. She is tearful and asks you if you think she is going to have a scar. Which of these is the best response? A) "It's a small cut. The emergency department will do everything they can to minimize scarring." B) "I really can't say. You should probably see a plastic surgeon." C) "A doctor can provide a prognosis when the cut has healed." D) "It's likely, but it's not something to get upset about." 267 Copyright © 2023 Pearson Education, Inc.

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Answer: A Diff: 2 Page Ref: 1574 Standard: Special Patient Populations (Pediatrics) Objective: 3

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4) Your patient is an eight-year-old girl. As you approach her, you note that she is holding her right arm against her body, cradling it with the left arm. To find out what happened, which of the following is the best approach? A) Ask the parents to tell you what happened while you examine the child. B) Sit next to the patient and ask her what happened. C) Take the parents aside and ask them what happened. D) Ask the parents to leave the room so you can talk to the patient. Answer: B Diff: 2 Page Ref: 1574 Standard: Special Patient Populations (Pediatrics) Objective: 3 5) Your patient is a five-year-old boy who appears to be dehydrated after having the flu. Which of the following is the best way to communicate with the patient regarding the need for obtaining IV access? A) Just before placing the IV, tell him you must put a needle in his arm. Tell him it will hurt, but only for a second. B) Tell him you are going to "start an IV in his arm" but that it won't hurt a big boy like him. C) Tell him you need to give him fluids to help him feel better and that it might hurt a little when you start the IV. D) Have a parent distract him while you place the IV. Answer: C Diff: 2 Page Ref: 1574 Standard: Special Patient Populations (Pediatrics) Objective: 3 6) At what age does the risk of foreign body airway obstruction become a significant concern in the normally developing infant? A) 3 months B) 18 months C) 1 month D) 6 months Answer: D Diff: 2 Page Ref: 1575 Standard: Special Patient Populations (Pediatrics) Objective: 6

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7) You are in the home of a 28-month-old boy whose mother called EMS because he fell while running and struck his forehead on the corner of a table. The patient has a hematoma on his forehead but seems to have forgotten about the injury and is entertaining himself with some building blocks. What is the best way to begin assessing the child? A) To avoid upsetting him, observe him from a distance and make no physical contact with him. B) Make him feel comfortable by calling him by a nickname. C) Sit next to him and ask if you can play with some of his toys. D) Ask his mother to pick him up and hold him on her lap. Answer: D Diff: 2 Page Ref: 1575-1576 Standard: Special Patient Populations (Pediatrics) Objective: 12 8) You are in the home of a 17-year-old female patient who is complaining of abdominal pain. Her mother and father are hovering near her and answering most of the questions you ask her. You sense that the patient is uncomfortable answering questions in front of her parents. Which of the following is the best way to handle this situation? A) Tell the patient you know she might be embarrassed but that it is imperative that she give you the whole story, so you know what to do for her. B) Defer the history to the triage nurse at the emergency department so as not to cause undue discomfort to the patient. C) Ask the parents to go to the kitchen with your partner so he can get some information for your paperwork. D) Tell the parents the daughter probably doesn't want to talk about her problems in front of them. Answer: C Diff: 2 Page Ref: 1577 Standard: Special Patient Populations (Pediatrics) Objective: 3 9) Your patient is a conscious eight-month-old infant who has a severe airway obstruction as a result of choking on a slice of canned peach. Which of these is your FIRST intervention? A) A portable suction device, using a rigid tonsil tip and no more than 100 mmHg of vacuum B) The use of a manually triggered, flow-restricted, oxygen-powered ventilation device C) Abdominal thrusts interspersed with attempts to ventilate D) An alternating series of back blows and chest thrusts Answer: D Diff: 1 Page Ref: 1591 Standard: Special Patient Populations (Pediatrics) Objective: 7

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10) Your patient is a nine-month-old boy who was a restrained passenger in a motor vehicle collision. Prior to your arrival, his mother took him out of the seat and is now holding him. Which of these is the best way to transport this patient? A) Place him back in the car seat and transport with the car seat on the gurney. B) Allow the mother to hold the child during transport. C) Secure the child to your gurney as you would an adult. D) Place the child on a long backboard with a folded towel under his shoulders, then place the backboard on the gurney. Answer: A Diff: 2 Page Ref: 1600,1602 Standard: Special Patient Populations (Pediatrics) Objective: 8 11) Your patient is a 13 year-old male drowning victim. He was initially in cardiac arrest with a pulseless, wide-complex bradycardia. He is intubated and being ventilated with supplemental oxygen. After CPR and intubation, the patient is now in ventricular tachycardia with a weak radial pulse. Which of these would be an appropriate treatment for this patient? A) Amiodarone, 5 mg/kg IV push B) Lidocaine, 3 mg/kg IV bolus, followed by a 3 mg/minute drip C) Procainamide, 20 mg per minute, up to 800 mg D) Synchronized cardioversion starting at 0.5-1.0 joules/kg Answer: D Diff: 3 Page Ref: 1614 Standard: Special Patient Populations (Pediatrics) Objective: 6 12) Which of these is NOT an acceptable estimate of the correct size of endotracheal tube for a pediatric patient? A) The patient's age in years plus 16, divided by 4 B) The diameter of the little finger C) A length-based resuscitation tape D) Twice the width of the naris Answer: D Diff: 1 Page Ref: 1596 Standard: Special Patient Populations (Pediatrics) Objective: 6

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13) Your patient is a seven-month-old boy whose mother called because he suddenly became lethargic and pale. Your assessment reveals that he is in a supraventricular tachycardia at a rate of 244 per minute. The patient's extremities are mottled and his capillary refill time is 4 seconds. Which of these is the best treatment plan for this patient? A) Adenosine, 0.1 mg/kg rapid IV push, repeated at 0.2 mg/kg if unsuccessful B) Verapamil, 0.3 mg/kg over 3 to 5 minutes C) Diltiazem, 0.25 mg/kg over 2 minutes D) Synchronized cardioversion beginning at 0.5-1.0 joules/kg Answer: D Diff: 2 Page Ref: 1613 Standard: Special Patient Populations (Pediatrics) Objective: 6 14) Your patient is a four-year-old boy with a history of asthma. He ran out of his inhaled bronchodilator while visiting his grandparents' farm. The patient has pale, cool, moist skin with cyanosis of his nail beds. He has audible wheezing with a respiratory rate of 18, accessory muscle use, and a heart rate of 130. He appears fatigued, he is unable to speak more than one or two words at a time, and his head bobs with each breath. Which of these best describes this patient's respiratory status? A) Because of decreased respiratory, cardiovascular, and stored energy reserves, the child's muscles have fatigued and he is now in respiratory failure. B) The child is in the early stages of his asthma attack, and is showing signs of respiratory distress. C) The patient is having some respiratory difficulty; however, a nebulizer treatment will likely correct all issues. D) The child's asthma was exacerbated by exercise and he is therefore tired. Rest will ease his respiratory distress. Answer: A Diff: 3 Page Ref: 1603 Standard: Special Patient Populations (Pediatrics) Objective: 7 15) As the pediatric patient progresses from respiratory distress to respiratory failure, which of these occurs? A) Hyperactivity B) Increased arterial carbon dioxide tension C) Peripheral cyanosis D) Muscular rigidity Answer: B Diff: 2 Page Ref: 1603 Standard: Special Patient Populations (Pediatrics) Objective: 7

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16) Which of the following is NOT a sign of respiratory distress in the pediatric patient? A) Grunting B) Tachypnea C) Tachycardia D) Central cyanosis Answer: D Diff: 1 Page Ref: 1603 Standard: Special Patient Populations (Pediatrics) Objective: 8 17) Which of the following affects the lower airway? A) Epiglottitis B) Pneumonia C) Croup D) Pharyngitis Answer: B Diff: 1 Page Ref: 1607-1609 Standard: Special Patient Populations (Pediatrics) Objective: 6 18) Your patient is a toddler who was burned when he accidentally pulled the cord of a deep fryer sitting on a countertop and spilled hot oil on his head and back. He has burns to the back half of his head, as well as his entire back. What percentage of total body surface area does this account for? A) 36 percent B) 40 percent C) 27 percent D) 18 percent Answer: C Diff: 2 Page Ref: 1628 Standard: Special Patient Populations (Pediatrics) Objective: 12 19) Your 12-month-old patient has burns covering the full length of both lower extremities circumferentially. Which of these is the most accurate estimate of the percentage of total body surface area involved? A) 20 percent B) 36 percent C) 14 percent D) 28 percent Answer: D Diff: 2 Page Ref: 1628 Standard: Special Patient Populations (Pediatrics) Objective: 12

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20) Your patient is a nine-month-old infant in respiratory distress with grunting respirations of 50 per minute, nasal flaring, and intercostal retractions. He is pale, and you note scattered bilateral wheezing on auscultation of the lungs. The mother states that the child is healthy and up to date on all his immunizations. Which of the following conditions is most likely, based on this information? A) New-onset asthma B) Bacterial tracheitis C) Bronchiolitis due to respiratory syncytial virus D) Epiglottitis due to Haemophilus influenzae type B Answer: C Diff: 3 Page Ref: 1608 Standard: Special Patient Populations (Pediatrics) Objective: 7 21) Which of these is TRUE of asthma in the pediatric patient? A) Bronchodilators are more effective in pediatric patients than in adults, and steroids are rarely indicated. B) Oxygen and nebulized beta agonists are indicated in the initial phase of an asthma attack. C) Bronchodilators are effective primarily when treating the second phase of an asthma attack. D) The primary therapeutic goal in the initial phase of an asthma attack is to rehydrate the patient and administer mucolytic and anti-inflammatory agents. Answer: B Diff: 2 Page Ref: 1608 Standard: Special Patient Populations (Pediatrics) Objective: 8 22) Which of these is the most common result of blunt chest trauma in children? A) Anterior flail segment B) Intrathoracic injury without external bruising of the thorax C) Associated spinal cord injury D) Fractured ribs with a high incidence of hemothorax Answer: B Diff: 2 Page Ref: 1626 Standard: Special Patient Populations (Pediatrics) Objective: 8

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23) Your 15-year-old male patient has a stab wound along the right sternal border at the fourth intercostal space. The patient responds to painful stimuli and shows little evidence of external bleeding. His respirations are 30, his breath sounds are clear and equal, and his radial pulse is weak and disappears on inspiration. The patient has distended jugular veins and is dyspneic. This patient is most likely suffering from shock due to . A) obstructive; cardiac tamponade B) hypovolemic; hemothorax C) distributive; loss of sympathetic nervous tone D) hypoxic; tension pneumothorax Answer: A Diff: 3 Page Ref: 1611 Standard: Special Patient Populations (Pediatrics) Objective: 8 24) Which of these conditions does NOT cause an upper airway obstruction? A) Epiglottitis B) Croup C) Bacterial tracheitis D) Asthma Answer: D Diff: 1 Page Ref: 1604-1606 Standard: Special Patient Populations (Pediatrics) Objective: 6 25) Your patient is a 12-year-old boy who was accidentally shot with a handgun by a playmate. You note one gunshot wound to the right upper quadrant of the abdomen, but no exit wound. The patient is pale, with cool, mottled extremities. He is lethargic, has a heart rate of 140, a respiratory rate of 30, and a blood pressure of 92/60 mmHg. Which of these can be said for certain about this patient? A) He is in compensated shock. B) He is in irreversible shock. C) He is in decompensated shock. D) It is not possible to say anything for certain about this patient. Answer: C Diff: 3 Page Ref: 1610 Standard: Special Patient Populations (Pediatrics) Objective: 12

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26) All of these are associated with an increased incidence of SIDS, EXCEPT: A) female infant. B) age between two and four months. C) low birth weight. D) fall and winter months. Answer: A Diff: 1 Page Ref: 1628 Standard: Special Patient Populations (Pediatrics) Objective: 9 27) Which of these best explains the cause of sudden infant death syndrome (SIDS)? A) Congenital absence of the Hering-Breuer reflex B) SIDS, by definition, has no identifiable cause. C) Diffuse axonal injury occurring due to "shaken baby syndrome" D) Aspiration of vomited formula or breast milk Answer: B Diff: 2 Page Ref: 1628 Standard: Special Patient Populations (Pediatrics) Objective: 9 28) Your four-year-old female patient has injuries suspicious of abuse. Statistically, who is most likely the abuser? A) Her mother, who is a stay-at-home mom B) Her father, who works in a local steel mill C) Her seven-year-old brother, with whom she shares a bedroom D) Her teenaged aunt, who babysits her two evenings a week Answer: A Diff: 2 Page Ref: 1629 Standard: Special Patient Populations (Pediatrics) Objective: 9 29) Your patient is an 11-year-old male quadriplegic who depends on a mechanical ventilator to breathe. You are called to the home during a thunderstorm that has caused a power outage. Which of these is the best course of action? A) Advise dispatch that you will be on the scene indefinitely and ask them to notify the power company that restoring power to this residence is a priority. B) Teach the patient's family members how to use the bag-valve-mask device and tell them to contact the department with questions or difficulties. C) Request a generator from the fire department tactical support division. D) Assist his breathing with a bag-valve-mask device, and transport. Answer: D Diff: 2 Page Ref: 1633 Standard: Special Patient Populations (Pediatrics) Objective: 10

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30) What is NOT one of the objectives of JumpSTART? A) To optimize the primary triage of injured children in the MCI setting B) To reduce the emotional burden on triage personnel who may have to make rapid life-ordeath decisions about the injured C) To allow responders to "think with their hearts" when treating the injured children D) To enhance the effectiveness of resource allocation of all MCI victims Answer: C Diff: 1 Page Ref: 1634-1636 Standard: Special Patient Populations (Pediatrics) Objective: 11 31) You arrive at an MCI. You see a nonambulatory child who has been evaluated using the JumpSTART algorithm with a yellow tag. What does this represent? A) Provide immediate attention to this patient. B) Move on and look at other patients; this patient does not have a significant external injury. C) The patient is dead. D) Delayed response; check to see if there are significant external signs of injury. Answer: D Diff: 1 Page Ref: 1636 Standard: Special Patient Populations (Pediatrics) Objective: 11 32) You are at the scene of a collision involving a school bus carrying elementary school-age children. You are concerned that some of the children may have spinal injuries. Which of these is TRUE of cervical spine injuries in children? A) They are more often due to penetrating trauma than in adults. B) The heavier head of the child increases the incidence of cervical distraction injuries. C) Pediatric patients do not require cervical spine immobilization, as their bodies will self-splint the injury. D) The pediatric cervical spine should be immobilized in a position of moderate hyperextension. Answer: B Diff: 2 Page Ref: 1600, 1626 Standard: Special Patient Populations (Pediatrics) Objective: 4 33) Your patient is a three-year-old girl who has had vomiting and diarrhea for 24 hours. Which of these is the best way to gain her cooperation when assessing her vital signs? A) Avoid explanations and finish the assessment quickly. B) Ask if you can check her doll to "see how the doll is feeling" before repeating the same procedures on the child. C) Say, "I'm going to take your blood pressure." D) Explain that you want to give her arm a hug. Answer: B Diff: 2 Page Ref: 1576 Standard: Special Patient Populations (Pediatrics) Objective: 13 277 Copyright © 2023 Pearson Education, Inc.

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34) Your patient is a five-year-old girl who awoke with a harsh cough, sore throat, drooling, and high fever. She has shallow respirations of 40 and inspiratory stridor. She is completely focused on breathing, leaning forward on her outstretched arms. Which of these is the best course of action? A) Start an IV for administration of succinylcholine and midazolam for RSI, intubate the trachea, and ventilate at a rate of 24 to 28 per minute. B) Provide high-concentration oxygen by nonrebreather mask, start an IV, and repeat a full set of vital signs every 5 minutes en route to the emergency department. C) Inspect the hypopharynx for edema and be prepared for immediate surgical cricothyrotomy if airway obstruction is imminent. D) Provide blow-by oxygen, humidified if possible; transport without delay and avoid procedures that might upset her. Answer: D Diff: 3 Page Ref: 1605-1606 Standard: Special Patient Populations (Pediatrics) Objective: 12 35) Your patient is a 14 month-old girl who has been taking an antibiotic for three days for an ear infection. Her parents have called EMS because the patient has not been eating or drinking, is irritable, has a fever, and generally appears very sick. Which of these should you most highly suspect? A) Herpes zoster B) Bacterial meningitis C) Fifth disease D) An allergic reaction to the antibiotic Answer: B Diff: 3 Page Ref: 1616 Standard: Special Patient Populations (Pediatrics) Objective: 8 36) You have just arrived on the scene where an infant stopped breathing. You find a threemonth-old child being held tightly by his mother, who is sobbing uncontrollably. On examination, you find that the child is apneic and pulseless and has dependent lividity and early rigor mortis. There are no obvious signs of injury. Which of these is the best course of action? A) Begin limited resuscitative measures, then contact medical control for orders to terminate resuscitation in the field. B) Gently tell the mother that the baby is dead and that there is nothing that can be done for him; allow her to hold him. C) Tell the mother that the baby is dead but that you cannot allow her to hold him until the police verify that no crime has been committed. D) Begin CPR and continue BLS measures until you are inside the ambulance; notify the hospital that you are transporting a deceased SIDS infant. Answer: B Diff: 2 Page Ref: 1629 Standard: Special Patient Populations (Pediatrics) Objective: 9 278 Copyright © 2023 Pearson Education, Inc.

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37) Your patient is a seven-year-old girl with a history of bee-sting anaphylaxis. She was stung by a bee and nearly immediately began having difficulty swallowing and breathing. Her father administered her prescribed 0.15 mg epinephrine auto-injector without result. On your arrival, the patient responds to painful stimuli; has labored, rapid, wheezing respirations; a heart rate of 60; and a blood pressure of 92/60 mmHg; a pulse oximeter reading of 88 percent; and a shark fin waveform on the capnograpy. Which of these is the best sequence of treatment for this patient? A) Administer only epinephrine 1:1,000 IM B) Administer only diphenhydramine IM C) Administer diphenhydramine IM and epinephrine 1:1,000 IV D) Administer both epinephrine 1:10,000 and diphenhydramine intravenously Answer: D Diff: 3 Page Ref: 1612 Standard: Special Patient Populations (Pediatrics) Objective: 5 38) Your 15-year-old male patient was kicked in the scrotum while playing with some friends. He is complaining of excruciating pain in his testicles. Which of the following guidelines applies to the examination of this patient? A) Make sure the procedure takes place in a medical office. B) Make sure another paramedic is present during the exam. C) Make sure a paramedic of the same sex performs the exam. D) Make sure a paramedic of the opposite sex performs the exam. Answer: C Diff: 2 Page Ref: 1577 Standard: Special Patient Populations (Pediatrics) Objective: 5 39) You have been called for a one-week-old infant who is sick. Assessment reveals him to have a fever and rhonchi in the left lower lobe. Which of these assessment findings would be most concerning to you, given the age of this patient? A) Respiratory rate of 33 breaths per minute B) Skin that is pink and warm C) Continual moaning and crying D) Nasal passages occluded by mucus Answer: D Diff: 3 Page Ref: 1609 Standard: Special Patient Populations (Pediatrics) Objective: 12

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40) You are delayed getting to a residence where a 16-month-old boy is actively seizing. The mother reports that he has had a fever for the past two days. A firefighter on scene informs you that the child has been seizing since their arrival approximately 15 minutes ago. You should: A) apply oxygen, administer intranasal midazolam, and transport. B) apply oxygen, administer fluids, and transport. C) actively cool the child with ice packs to the groin and axilla. D) actively warm the child with blankets. Answer: A Diff: 3 Page Ref: 1616 Standard: Special Patient Populations (Pediatrics) Objective: 12 41) A woman has called 911 after not being able to wake her eight-year-old son. Upon arrival, the mother tells you that her son is a diabetic, and that his diabetic alert dog awoke her in the night indicating the child's blood sugar was low. You perform a blood glucose check and find that your glucometer reads 28 mg/dL. You should: A) administer IV dextrose at 30 percent concentration. B) administer 1 mg of IV glucagon. C) administer 1 mg of IM glucagon. D) administer IV dextrose at 25 percent concentration. Answer: D Diff: 3 Page Ref: 1619 Standard: Special Patient Populations (Pediatrics) Objective: 5 42) A 16-year-old girl has been complaining of abdominal pain, nausea, polyuria, and polydipsia for the past four days. She has no significant medical history. You suspect she may be suffering from: A) ovarian cysts. B) diabetic ketoacidosis. C) meningitis. D) ectopic pregnancy. Answer: B Diff: 3 Page Ref: 1620 Standard: Special Patient Populations (Pediatrics) Objective: 12

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43) You are caring for a seven-year-old in ventricular fibrillation. The child weighs 19 kg. You have just delivered your first shock, and another paramedic reports that she has obtained IO access. You should direct the paramedic to administer what dose of epinephrine? A) 1.019 mg of 1:10,000 B) 1.9 mg of 1:1,000 C) 0.19 mg of 1:10,000 D) 0.019 mg of 1:1,000 Answer: C Diff: 3 Page Ref: 1601 Standard: Special Patient Populations (Pediatrics) Objective: 6 44) A nine-year-old weighing 28 kg is in supraventricular tachycardia. Which of the following is the appropriate dose of adenosine for this patient? A) 0.28 mg B) 2.8 mg C) 0.75 mg D) 6 mg Answer: B Diff: 3 Page Ref: 1601 Standard: Special Patient Populations (Pediatrics) Objective: 12 45) Which of these is not a component of the airway examination in the primary assessment? A) Is the airway patent? B) Is the airway maintainable with head positioning, suctioning, or airway adjuncts? C) Is the airway not maintainable? D) Is the airway a likely cause of cardiac arrest? Answer: D Diff: 1 Page Ref: 1584 Standard: Special Patient Populations (Pediatrics) Objective: 5 46) Which of these is not a typical condition to evaluate in assessment of the child's circulation? A) Heart rate B) Peripheral circulation C) Blood oxygenation D) End-organ perfusion Answer: C Diff: 1 Page Ref: 1585 Standard: Special Patient Populations (Pediatrics) Objective: 5

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47) Accidents of all types are the leading cause of injury deaths in pediatric patients in which age group? A) Birth to 1 year B) 1 to 2 years C) 1 to 3 years D) 2 to 4 years Answer: C Diff: 1 Page Ref: 1576 Standard: Special Patient Populations (Pediatrics) Objective: 2 48) A 5-year-old male has fallen off his outside jungle gym. He is now complaining of right forearm pain, and you note slight deviation along the long axis of the arm. The type of fracture he likely sustained is a(n): A) greenstick fracture. B) comminuted fracture. C) spiral fracture. D) impacted fracture. Answer: A Diff: 2 Page Ref: 1627 Standard: Special Patient Populations (Pediatrics) Objective: 2 49) At the scene of a cardiac arrest of a 2-year-old male following trauma, your paramedic student provides the endotracheal intubation, however you determine that he as placed the tube too deep. If this is the case, where is the tip of the ET tube most likely? A) In the right main stem bronchi B) In either the right or left main stem bronchi C) In the esophagus D) In the left main stem bronchi Answer: B Diff: 2 Page Ref: 1627 Standard: Special Patient Populations (Pediatrics) Objective: 2 50) You are at the scene of an infant with a gastrostomy tube. The first-time parents are very nervous and ask you what some of the complications they should look out for. Which of these is NOT an expected complication of this medical device? A) Tube dislodgement B) Bleeding at the insertion site C) Infection at the insertion site D) Seizures secondary to the tube feedings Answer: D Diff: 2 Page Ref: 1627 Standard: Special Patient Populations (Pediatrics) Objective: 10 282 Copyright © 2023 Pearson Education, Inc.

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51) While using the JumpSTART pediatric MCI triage algorithm, your 2-year-old patient has an intact airway, spontaneous breathing rate of 55/minute, and peripheral pulses. The patient also responds appropriately to pain. Given the algorithm, this patient should be tagged? A) Green B) Yellow C) Red D) Black Answer: C Diff: 2 Page Ref: 1635 Standard: Special Patient Populations (Pediatrics) Objective: 11 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 48 Geriatrics 1) Your 78-year-old patient gives a history of congestive heart failure, renal insufficiency, and type 2 diabetes. Together, these conditions are called: A) comorbid conditions. B) confounding conditions. C) functional impairments. D) polypathophysiology. Answer: A Diff: 1 Page Ref: 1645 Standard: Special Patient Populations (Geriatrics) Objective: 1 2) The study of the effects of aging and age-related diseases in human beings is called: A) dementiology. B) geriatrics. C) gerontology. D) senescence. Answer: C Diff: 1 Page Ref: 1639 Standard: Special Patient Populations (Geriatrics) Objective: 1 3) The term elderly applies to a person beginning at age: A) 70. B) 55. C) 80. D) 65. Answer: D Diff: 1 Page Ref: 1638 Standard: Special Patient Populations (Geriatrics) 283 Copyright © 2023 Pearson Education, Inc.

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Objective: 2 4) Elderly people who live alone are more likely to be: A) male, under age 80. B) female, age 85 or older. C) female, under age 80. D) male, age 85 or older. Answer: B Diff: 1 Page Ref: 1639 Standard: Special Patient Populations (Geriatrics) Objective: 2 5) You have been asked to deliver a talk about the geriatric population. Which of the following points would you emphasize in your presentation? A) Assessment can be difficult because most persons older than 70 have some degree of dementia. B) Many of the elderly have a combination of different diseases in various stages. C) Geriatric patients actually comprise a smaller number of EMS calls and transports than generally thought. D) Dementia and chronic disease are both an inevitable part of the aging process. Answer: B Diff: 1 Page Ref: 1639 Standard: Special Patient Populations (Geriatrics) Objective: 2 6) Which of the following statements regarding EMS consideration of psychosocial issues in elderly patients is TRUE? A) Successful medical treatment of elderly patients involves an understanding of the broader social situation in which they live. B) Most elderly patients are lonely and isolated, and may not be able to care for themselves. C) Elderly patients usually have limited income, and are likely to be unable to afford expensive medication. D) It is unlikely that an elderly patient in a nursing facility will be as well cared for as one who lives at home. Answer: A Diff: 2 Page Ref: 1678 Standard: Special Patient Populations (Geriatrics) Objective: 2 7) Which of the following is an appropriate question to ask of an elderly patient who lives alone? A) "Are you sure you are capable of taking care of yourself?" B) "Isn't there anyone who could move in with you to help you?" C) "Is there someone you can call if you have trouble with your medications tonight?" D) "Don't you know living alone is dangerous at your age?" Answer: C Diff: 2 Page Ref: 1639 284 Copyright © 2023 Pearson Education, Inc.

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Standard: Special Patient Populations (Geriatrics) Objective: 2

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8) While you are off-duty, a friend, who knows you are a paramedic, expresses concern about her elderly parents. She knows that their health needs are changing, but does not know what to do to help. Which of the following would NOT be an appropriate resource for her to use? A) AARP B) Department of Health and Human Services C) The local community senior center D) OSHA Answer: D Diff: 1 Page Ref: 1644-1645 Standard: Special Patient Populations (Geriatrics) Objective: 2 9) Which of these is NOT a factor in altered pharmacokinetics in the elderly? A) Decreased hepatic function B) Slowed drug absorption from the gastrointestinal tract C) Increased total body water D) Decreased renal function Answer: C Diff: 2 Page Ref: 1673 Standard: Special Patient Populations (Geriatrics) Objective: 4 10) An 84-year-old man complains of generalized weakness and an ache in his left shoulder. He also reports mild shortness of breath and has clear lung sounds and an SpO2 of 96 percent. When asked, he claims that the discomfort started after getting out of bed two hours ago. He denies any known injury to his shoulder or back. He has a history of coronary artery disease, hypertension, TIA, and dementia. Your differential diagnosis for this patient should include: A) aortic dissection, pulmonary embolism, and myocardial infarction. B) myocardial infarction, stroke, and musculoskeletal trauma. C) trauma, pulmonary embolism, and pneumonia. D) COPD, stroke, and medication overdose. Answer: B Diff: 2 Page Ref: 1661 Standard: Special Patient Populations (Geriatrics) Objective: 5

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11) A 97-year-old man became dizzy and fell onto the floor. You find him sitting on the floor with his wife next to him. His wife states that he did not lose consciousness and that this has happened several times over the past two days. Currently, the patient is alert and oriented and complaining of dizziness and a headache. He has a history of coronary artery disease, emphysema, and hypertension, and states that he saw his doctor two days ago. Which one of the following questions would be most helpful in identifying the cause of this patient's signs and symptoms? A) "Have you ever had a stroke?" B) "Did the doctor prescribe any new medications?" C) "When was the last time you ate or drank anything?" D) "Why didn't you call 911 when he fell before?" Answer: B Diff: 2 Page Ref: 1645-1646 Standard: Special Patient Populations (Geriatrics) Objective: 6 12) You are called to a residence for an unresponsive patient. The patient, an 86-year-old man, has reportedly been depressed recently. An empty bottle of Inderal is next to the patient, who is bradycardic and hypotensive. To best care for this patient, you should: A) apply pacer pads and pace at a rate of 80 per minute. B) administer 1 mg of epinephrine 1:10,000. C) administer glucagon. D) apply pads and perform synchronized cardioversion. Answer: C Diff: 1 Page Ref: 1674 Standard: Special Patient Populations (Geriatrics) Objective: 6 13) A 78-year-old woman complains of dizziness, visual disturbances, fatigue, and loss of appetite. Which medication would be most likely to cause these symptoms? A) Coumadin B) Enalapril C) Pradaxa D) Digitalis Answer: D Diff: 2 Page Ref: 1674-1675 Standard: Special Patient Populations (Geriatrics) Objective: 7

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14) Which statement regarding pharmacokinetics and the aging process is TRUE? A) Aging causes the kidneys to filter out more waste products, enhancing the absorption of many medications. B) Functional changes in the kidneys, liver, and gastrointestinal system slow the absorption and elimination of many medications. C) Cardiac cells become more sensitive to medication as they age, meaning that lower doses of cardiac medications are necessary. D) The GI tract of an elderly patient quickly processes medications, meaning that medications have a shorter half-life than in younger patients. Answer: B Diff: 3 Page Ref: 1673 Standard: Special Patient Populations (Geriatrics) Objective: 7 15) You are at the home of a 92-year-old male patient. He is alert and oriented and in good spirits and, although mildly hearing impaired, can hear you if you speak clearly and face him as you speak. He has no teeth and is not wearing dentures. His speech is indistinct and difficult to understand. What is the best course of action to improve communication? A) See if he can write down what he wants to say. His speech may be impaired from a stroke rather than a lack of dentition. B) Tell him to respond to your questions with simple hand gestures. C) Ask him to put in his dentures if he has them. Locate them for him if necessary. D) Ask a family member to "translate," because the family is probably able to understand him better. Answer: C Diff: 2 Page Ref: 1648 Standard: Special Patient Populations (Geriatrics) Objective: 5 16) Which statement is TRUE of falls in the elderly? A) Falls in the elderly are not preventable. B) Falls are the leading cause of accidental death in the elderly. C) The elderly have the highest incidence of falls. D) Falls typically do not result in significant injury for the geriatric patient. Answer: B Diff: 2 Page Ref: 1646 Standard: Special Patient Populations (Geriatrics) Objective: 3

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17) Your patient is a 75-year-old woman complaining of constipation and abdominal pain for two days. Your physical examination reveals a moderately distended abdomen. What is the best course of action? A) Advise the patient to use an enema. B) Suggest that the patient see her primary care physician. C) Transport the patient, because she has a potentially serious medical problem. D) Advise the patient to use a laxative. Answer: C Diff: 2 Page Ref: 1668 Standard: Special Patient Populations (Geriatrics) Objective: 9 18) Which of these is NOT a complication caused by incontinence? A) Skin ulcer B) Urinary tract infection C) Diverticulosis D) Sepsis Answer: C Diff: 2 Page Ref: 1647-1648 Standard: Special Patient Populations (Geriatrics) Objective: 6 19) You are caring for an elderly patient who lives alone. The patient is complaining of feeling unwell for a period of several days and seems to be unable to provide a detailed personal medical history. An appropriate assessment of this patient should include: A) an assessment of living conditions, nutrition, and social support. B) contacting adult protective services to report an unsafe living situation. C) contacting the patient's physician to obtain an accurate history. D) exposing the patient to look for signs of physical abuse. Answer: A Diff: 2 Page Ref: 1639-1640 Standard: Special Patient Populations (Geriatrics) Objective: 9 20) An 85-year-old man has fallen down five stairs to the carpeted floor below. He hit his head and is complaining of a headache. When getting a history from this patient, what question should you ask first? A) "What caused you to fall?" B) "Have you been falling more often in your home?" C) "Do you have a history of medical problems?" D) "Have you ever been diagnosed with dementia?" Answer: A Diff: 2 Page Ref: 1647 Standard: Special Patient Populations (Geriatrics) Objective: 9

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21) An 87-year-old woman fell while getting out of bed. She is on the floor with severe pain to her left hip. Family members tell you that she takes medication for high blood pressure, high cholesterol, and depression. When assessing the patient, what assessment finding is most concerning? A) Heart rate of 118 beats per minute B) External rotation of the hip C) Weak pedal pulse in the left foot D) Respiratory rate of 20 breaths per minute Answer: A Diff: 3 Page Ref: 1662 Standard: Special Patient Populations (Geriatrics) Objective: 9 22) Which statement demonstrates an accurate understanding of vital signs in relation to the geriatric patient? A) The typical resting heart rate is less than 50 beats per minute. B) Blood pressure is typically higher in elderly women. C) The resting respiratory rate is typically higher in the elderly. D) The vital signs of an elderly patient are similar to those of an adolescent. Answer: C Diff: 3 Page Ref: 1653-1654 Standard: Special Patient Populations (Geriatrics) Objective: 5 23) You have been called for a 72-year-old woman with chest pain. On scene, the patient denies ever having chest pain and requests to sign a refusal. Before having the refusal signed, the paramedic must consider that many geriatric patients may deny symptoms because of (select the BEST answer): A) fear of losing independence and dignity. B) apprehension about medical bills. C) confusion regarding their rights as a patient. D) acute onset of dementia or other neurological diseases. Answer: A Diff: 2 Page Ref: 1640 Standard: Special Patient Populations (Geriatrics) Objective: 5

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24) Common mental health problems in the geriatric population include all of the following EXCEPT: A) affective disorders. B) post-traumatic stress disorder. C) depression. D) suicide. Answer: B Diff: 2 Page Ref: 1678 Standard: Special Patient Populations (Geriatrics) Objective: 3 25) Your patient is a 75-year-old woman who is complaining of generalized weakness and loss of appetite. Your physical exam reveals no remarkable findings, and the patient has no significant past medical history. You reassure the patient that these are common complaints among people in her age group. Which of the following should you do next? A) Advise the patient to make an appointment with her doctor. B) Transport the patient for evaluation of a potentially serious medical problem. C) Call a family member to come and stay with the patient. D) Reassure the patient that there is nothing to worry about, and that you don't believe she needs to go to the hospital. Answer: B Diff: 2 Page Ref: 1675 Standard: Special Patient Populations (Geriatrics) Objective: 9 26) You respond to a low-income apartment complex for a report of an unresponsive patient. The landlord reports that the patient, a 90-year-old man, is two months behind on his rent and has not paid his utility bills. The patient presents unresponsive on a tile floor with a slow carotid pulse and skin that is pale and cold. You should have a high index of suspicion for: A) a suicide attempt. B) head trauma. C) hypothermia. D) elder abuse. Answer: C Diff: 3 Page Ref: 1673 Standard: Special Patient Populations (Geriatrics) Objective: 9

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27) Age-related changes in make elderly patients more susceptible to A) circulation; hyperglycemia. B) sweat glands; hyperthermia. C) lung tissue; hypokalemia. D) cardiac cells; ventricular fibrillation. Answer: B Diff: 2 Page Ref: 1673 Standard: Special Patient Populations (Geriatrics) Objective: 3

28) Police have called for EMS assistance at the home of a 78-year-old woman. The patient's daughter called 911 after her mother stated that she "didn't want to live anymore." The police officer tells you, "I don't think she'd actually hurt herself, since she's almost 80 years old." Which is an appropriate response to this statement? A) "You're right, she probably wouldn't. Let me see if she wants to sign a refusal of care form." B) "Actually, elderly patients have a high rate of depression and suicide." C) "I don't think she needs a hospital evaluation; the daughter can take her to her primary physician." D) "She may be being abused; you should question the daughter about it." Answer: B Diff: 2 Page Ref: 1678-1679 Standard: Special Patient Populations (Geriatrics) Objective: 8 29) The elderly patient in shock may be less likely to exhibit which of the following expected manifestations of shock? A) Altered mental status B) Cardiac dysrhythmias C) Hypothermia D) Tachycardia Answer: D Diff: 2 Page Ref: 1679 Standard: Special Patient Populations (Geriatrics) Objective: 3 30) When assessing a 90-year-old woman who fell, what assessment finding should concern the paramedic most? A) Skin tear that appears infected on her arm B) Heart rate of 90 beats per minute C) Sudden onset of confusion D) History of osteoporosis and leg pain Answer: C Diff: 3 Page Ref: 1646-1647 Standard: Special Patient Populations (Geriatrics) Objective: 5

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31) Which of the following statements regarding traumatic injuries and the elderly is TRUE? A) Hip fractures are responsible for 85 percent of traumatic deaths. B) Head injuries are easy to detect in the elderly. C) Bradycardia is an early sign of blood loss. D) Injuries are most commonly caused by falls. Answer: D Diff: 2 Page Ref: 1646-1647 Standard: Special Patient Populations (Geriatrics) Objective: 6 32) Which of the following is an intrinsic factor in falls in the elderly? A) High shelving for storage B) Glaucoma C) Throw rugs in the living area D) Ice on a driveway or sidewalk Answer: B Diff: 1 Page Ref: 1646-1647 Standard: Special Patient Populations (Geriatrics) Objective: 6 33) You have been called to a nursing home for an 86-year-old woman with pneumonia. The patient's airway is patent, respirations labored, and skin cool and pale, with an intact radial pulse. The vital signs are: pulse 124, respirations 20, blood pressure 104/58 mmHg, SpO2 at 89 percent, and temperature 98.2°F. The patient also complains of chest pain and has a cough. Given this situation, the focus of your care should be: A) transport to the hospital. B) adequate oxygenation. C) obtaining a 12-lead ECG. D) eliminating the chest pain. Answer: B Diff: 2 Page Ref: 1659 Standard: Special Patient Populations (Geriatrics) Objective: 9 34) The son of a 73-year-old woman has called 911. The patient is confused and exhibiting outof-character behavior. The son informs you that she is a diabetic, and takes pills and not injectable insulin. Assessment reveals adequate breathing, skin that is cool, and a radial pulse that is rapid and weak. Based on this history, you should be suspicious of: A) hyperglycemia. B) urinary tract infection. C) sepsis. D) hypoglycemia. Answer: A Diff: 3 Page Ref: 1654 Standard: Special Patient Populations (Geriatrics) Objective: 9 293 Copyright © 2023 Pearson Education, Inc.

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35) You have been called for an elderly woman who fell and hit her head. The patient is confused and has a laceration on her forehead. When getting the history from family members, which statement would be most indicative of a stroke? A) "She has a history of progressive dementia." B) "She has been getting fatigued faster lately." C) "She suddenly could not remember her name yesterday." D) "She has been drinking more water than normal." Answer: C Diff: 2 Page Ref: 1664 Standard: Special Patient Populations (Geriatrics) Objective: 5 36) Your patient is an 82-year-old woman whose daughter called EMS because the patient became very short of breath as they walked from their parking spot to the front of their church. On your arrival, the patient states that she just needed a little rest and now feels much better. On questioning, she admits to several such episodes in the past month. She denies chest pain and she says, "I just got winded because I'm getting so old." The patient has a heart rate of 104, a respiratory rate of 20, and blood pressure of 172/90 mmHg. Your history and physical examination should focus on which of these possibilities? A) Myocardial infarction B) Thyroid storm C) Cerebrovascular accident D) COPD Answer: A Diff: 3 Page Ref: 1661 Standard: Special Patient Populations (Geriatrics) Objective: 9 37) A 77-year-old woman is confused and combative. Her daughter states that she has been gradually "acting strange" since waking up this morning. The patient has a history of alcoholism, and reportedly fell two weeks ago. Given your knowledge of the changes associated with aging, you should maintain a high index of suspicion for: A) acute alcohol intoxication. B) internal hemorrhage. C) subdural hematoma. D) hypokalemia. Answer: C Diff: 3 Page Ref: 1655 Standard: Special Patient Populations (Geriatrics) Objective: 5

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38) Which action by the paramedic may lead to decubitus ulcer development in the elderly patient? A) Failing to pad the backboard for a patient in need of SMR B) Allowing the patient to remain in the same position during an extended transport time C) Failing to remove wet or soiled clothing of the incontinent patient D) All of these can contribute to decubitus ulcer development Answer: D Diff: 1 Page Ref: 1669 Standard: Special Patient Populations (Geriatrics) Objective: 9 39) You have been called for an 86-year-old man who fell. The patient is incontinent and has an ulcerative rash beneath his adult diaper. During your assessment, you also find many bruises to his body in various stages of healing. The son reports that the patient fell getting out of bed; however, the daughter-in-law states that the patient fell while getting dressed. Your best action would be to: A) contact the police and wait on scene until they arrive. B) ask the family members why their stories are different. C) document elder abuse in your PCR. D) provide care and transport, and inform the emergency department physician that you suspect abuse. Answer: D Diff: 2 Page Ref: 1680 Standard: Special Patient Populations (Geriatrics) Objective: 5 40) Which of these conditions increases the likelihood that an elder may be abused or neglected? A) Incontinence B) Dementia C) Immobility D) All of the above Answer: D Diff: 1 Page Ref: 1680 Standard: Special Patient Populations (Geriatrics) Objective: 2

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41) You have been called for an 86-year-old man who fell. The patient is incontinent and has an ulcerative rash beneath his adult diaper. During your assessment, you also find many bruises to his body in various stages of healing. The son reports that the patient fell getting out of bed; however, the daughter-in-law states that the patient fell while getting dressed. Which of the following is the BEST example of how to document the patient's history in your PCR? A) "Family members are unable to provide accurate history of event." B) "Son states that the patient fell while getting out of bed; daughter-in-law states that the patient fell while getting dressed." C) "The patient may have fallen while getting out of bed, or while getting dressed." D) "Family members are unable to agree upon history of event, causing suspicion for elder abuse." Answer: B Diff: 2 Page Ref: 1680 Standard: Special Patient Populations (Geriatrics) Objective: 5 42) Which factor does not typically decrease compliance in the elderly? A) Limited mobility B) Fear of toxicity C) Childproof containers D) Poor skin integrity Answer: D Diff: 2 Page Ref: 1646 Standard: Special Patient Populations (Geriatrics) Objective: 4 43) What is the least important physical requirement for effective continence? A) Anatomically correct GI/GU tract B) Ingesting various types of liquids C) Competent sphincter mechanism D) Adequate cognition and mobility Answer: B Diff: 2 Page Ref: 1648 Standard: Special Patient Populations (Geriatrics) Objective: 4

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44) You are caring for an elderly patient who now lives alone as their spouse died six months earlier. The patient is not really making eye contact, is barely participating in conversation, and says "Just leave me here." This patient is most likely suffering from: A) hypoglycemia. B) depression. C) introversion. D) paranoia. Answer: B Diff: 2 Page Ref: 1651 Standard: Special Patient Populations (Geriatrics) Objective: 8 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 49 Abuse, Neglect, and Assault 1) Which of these is NOT an example of human trafficking? A) A Vietnamese woman coerced into traveling to the United States to work off a debt owed to a relative B) A teenager forced into prostitution through threats of violence C) A man who crosses the U.S.-Mexico border illegally to obtain work D) A young woman from China who is forced by her parents to marry an American man Answer: C Diff: 1 Page Ref: 1693-1694 Standard: Special Patient Populations (Patients with Special Needs) Objective: 1 2) Which of these would constitute child abuse? A) Spanking a five-year-old as a form of punishment B) Denying a nine-year-old access to electronics as a form of punishment C) Buying a child clothing only from thrift stores D) Failing to properly bathe a child on a regular basis Answer: D Diff: 1 Page Ref: 1688 Standard: Special Patient Populations (Patients with Special Needs) Objective: 1 3) Which is NOT a factor associated with elder abuse? A) Financial stress of caretaking B) Limited long-term care options C) Multiple prescription medications D) Increased life expectancy Answer: C Diff: 1 Page Ref: 1687 Standard: Special Patient Populations (Patients with Special Needs) 297 Copyright © 2023 Pearson Education, Inc.

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Objective: 2 4) What is the estimated percent range of sexual assaults that are NOT reported? A) 25-35 B) 63-74 C) 0-22 D) 52-63 Answer: B Diff: 1 Page Ref: 1691 Standard: Special Patient Populations (Patients with Special Needs) Objective: 2 5) What is the most common living situation of abused elders? A) They live with their children. B) They live in a nursing facility. C) They live alone. D) They are homeless. Answer: C Diff: 1 Page Ref: 1687 Standard: Special Patient Populations (Patients with Special Needs) Objective: 3 6) Police have called you to the scene of a domestic disturbance. At the scene, you find a woman with a lacerated lip and a man in police custody. Both parties are denying that any abuse occurred; however, a neighbor reports hearing "angry screaming." After conferring with law enforcement, which of the following pieces of information would most raise your index of suspicion for partner abuse? A) The man is unemployed and did not graduate from high school. B) The woman appears not to have showered in several days. C) The couple lives in a middle-income neighborhood. D) The couple has no children. Answer: A Diff: 2 Page Ref: 1685 Standard: Special Patient Populations (Patients with Special Needs) Objective: 3 7) Which of these statements regarding child abusers is TRUE? A) They usually have a diagnosed mental health condition. B) They often have a history of incarceration. C) They were likely abused themselves. D) They are usually violent toward adults as well. Answer: C Diff: 2 Page Ref: 1688 Standard: Special Patient Populations (Patients with Special Needs) Objective: 3

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8) A 19-year-old college student cannot remember what happened to him the night before, and is concerned that he may have been raped. Which of the following factors most supports the suspicion that a predator drug may have been used on this patient? A) The fact that he is a male aged 18-21 B) The fact that he is a college student C) The fact that he has no physical injuries D) The fact that he thinks he was raped Answer: B Diff: 2 Page Ref: 1692 Standard: Special Patient Populations (Patients with Special Needs) Objective: 3 9) You are transporting a five-year-old child who you believe may have been abused. The child withdraws in fear whenever you attempt to touch him. Which of the following may help when trying to assess and care for this child? A) Giving the child a stuffed toy to hold B) Playing music in the back of the ambulance C) Avoiding eye contact and trying to not touch the child D) Talking to the child in neutral, age-appropriate language Answer: A Diff: 1 Page Ref: 1688 Standard: Special Patient Populations (Patients with Special Needs) Objective: 6 10) Law enforcement has requested your presence at the scene of a human trafficking arrest. A 14-year-old girl presents with bruises to her face and abdomen, and reports that she thinks she may be pregnant. Police officers report that the girl's uncle, who is handcuffed at the scene, has confessed to prostituting the girl for the past several months. The patient states repeatedly that she is "fine" and does not want to go to the hospital. What is an appropriate response? A) "It's OK, you are safe now and don't have to lie anymore." B) "I can tell you are trying to not anger your uncle, but you need to tell us the truth." C) "Unfortunately, you are a minor and can't refuse to go with us." D) "You have bruises on your face and may be pregnant. You need to come with us to get checked out at the hospital." Answer: D Diff: 2 Page Ref: 1693-1694 Standard: Special Patient Populations (Patients with Special Needs) Objective: 7 11) When caring for a victim of partner abuse, which statement is appropriate? A) "Here is the phone number of a women's shelter nearby; they help a lot of women in similar situations." B) "When you decide you are tired of this abuse, call the police and they will help you." C) "The best thing to do is get out as quickly as you can." D) "You need to get help quickly, before he hurts you seriously." Answer: A 299 Copyright © 2023 Pearson Education, Inc.

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Diff: 2 Page Ref: 1686 Standard: Special Patient Populations (Patients with Special Needs) Objective: 7

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12) Why is it important to educate victims of partner abuse about the availability of support services in their community? A) So they will leave their abusers. B) Because many victims of partner abuse are often not aware of the resources available to help them. C) Victims need to know how to document evidence of their abuse in order to convict their abuser. D) Often victims think that they are unique and no one shares a similar experience. Answer: B Diff: 2 Page Ref: 1684 Standard: Special Patient Populations (Patients with Special Needs) Objective: 7 13) Which of the following is TRUE of your responsibility to report child abuse? A) Consult your state EMS regulations regarding reporting child abuse; all states' regulations differ. B) It is better to let your immediate supervisor report the abuse. C) It is your responsibility to report all suspected abuse to the appropriate reporting agency. D) In most states, EMS providers are not required to report abuse; only doctors must report. Answer: C Diff: 1 Page Ref: 1691 Standard: Special Patient Populations (Patients with Special Needs) Objective: 6 14) When is a paramedic legally required to report abuse? A) Whenever anything seems unusual in the care of a child, elder, or dependent adult B) Whenever there is physical or behavioral evidence that suggests abuse C) Only when there is clear evidence of abuse D) Only when another provider agrees with the suspicion of abuse Answer: B Diff: 1 Page Ref: 1694 Standard: Special Patient Populations (Patients with Special Needs) Objective: 6

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15) You have responded to a residence for an injured child. The mother presents you with a twoyear-old boy who is crying loudly. She says he fell off the family playground equipment and won't stop crying. You ask the boy what happened, and he points to the jungle gym outside and cries more. You notice some seven- to ten-day-old bruises on his shins, and scrapes on his palms and elbows. What impression could you form using your knowledge of child abuse? A) The child indicates the same story as the mother, and children of that age tend to injure themselves playing. B) Continual crying is a sign of abuse, and so are the old bruises. C) The child was obviously unsupervised and may be neglected. D) There are some warning signs, and the police should be involved. Answer: A Diff: 3 Page Ref: 1688 Standard: Special Patient Populations (Patients with Special Needs) Objective: 6 16) What other common conditions may be mistaken for child abuse? A) Diaper rash B) Rug burns C) Mosquito bites D) Chickenpox Answer: D Diff: 1 Page Ref: 1689 Standard: Special Patient Populations (Patients with Special Needs) Objective: 4 17) What is one of the most important indicators of child abuse? A) Child's behavior B) Family finances C) Attitude of the family members D) Absence of one parent Answer: A Diff: 1 Page Ref: 1688 Standard: Special Patient Populations (Patients with Special Needs) Objective: 3 18) Which type of unique burn pattern would cause you to suspect that a young child may be being abused? A) Splash B) Dipping C) Scattered D) Scald Answer: B Diff: 2 Page Ref: 1689 Standard: Special Patient Populations (Patients with Special Needs) Objective: 4

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19) You arrive on the scene of an alleged rape. A 25-year-old female has been physically assaulted quite badly and has numerous deep lacerations. You must remove her clothes in order to provide care. What is the best procedure when caring for this patient? A) Remove the patient's clothes quickly, and place them in a biohazard bag. B) Cut around the injury sites and leave the rest of the clothes on the patient. C) Carefully remove her clothing in a private area, cover her with blankets, and bag the clothes in a paper bag to give to the police as evidence. D) Cut off her clothes quickly; patient care takes priority over evidence. Answer: C Diff: 2 Page Ref: 1693 Standard: Special Patient Populations (Patients with Special Needs) Objective: 7 20) A 30-year-old woman has been sexually assaulted. She is crying, and appears withdrawn and frightened. Which of the following strategies would be appropriate to use when caring for this patient? A) Give the patient clear direction by telling her where to sit and what to do. B) Calm the patient by providing information on sexual assault support groups. C) Allow the patient to control all aspects of the interaction, such as where she rides in the ambulance and what care is provided. D) Talk to the patient in a low and quiet voice, using simple words, so as not to frighten her. Answer: C Diff: 2 Page Ref: 1693 Standard: Special Patient Populations (Patients with Special Needs) Objective: 7 21) Which of these are commonly used for date rape drugs? A) Ketamine, THC, and tropine B) Rohypnol, GHB, and MDMA C) Sodium pentothal, thiamine, and HDT D) Phenobarbital, glucosamine, and ketamine Answer: B Diff: 1 Page Ref: 1692 Standard: Special Patient Populations (Patients with Special Needs) Objective: 5

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22) A 22-year-old woman called 911 after waking up in an unfamiliar room on her college campus. She has bruises to her wrists and complains of vaginal pain, but has no memory of any events from the previous evening. The last thing she remembers is entering a fraternity party with a group of friends. This patient's history is most consistent with: A) sexual assault involving head trauma. B) alcohol-induced sexual assault. C) date rape. D) predator drug use. Answer: D Diff: 2 Page Ref: 1692-1693 Standard: Special Patient Populations (Patients with Special Needs) Objective: 5 23) What group is LEAST commonly affected by hate crimes? A) Racial minorities B) Religious groups C) Low-income individuals D) Disabled individuals Answer: C Diff: 1 Page Ref: 1695 Standard: Special Patient Populations (Patients with Special Needs) Objective: 2 24) Regarding hate crimes, EMS providers should: A) not rush to the conclusion that a violent act is a hate crime, as hate crimes are rare and often only seen in very urban areas. B) be sure that a health care provider of the same minority group is available to care for a victim of a hate crime. C) document all possible hate crimes and report them to adult protective services. D) assume that any violent act toward a commonly victimized group is a hate crime until proven otherwise, and involve the police if necessary. Answer: D Diff: 1 Page Ref: 1695 Standard: Special Patient Populations (Patients with Special Needs) Objective: 6

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25) When providing a verbal handoff of a sexual assault victim, what information should be included in your report? A) Patient age, any injuries, approximate time of the assault, and any areas of the patient's body or clothes that have been cleaned B) Any injuries, name of assailant, location of the assault, and if drugs were involved C) Relationship of the assailant to the victim, how much alcohol the victim consumed, and if emergency contraception is needed D) Patient age, assailant age, and any injuries Answer: A Diff: 1 Page Ref: 1693 Standard: Special Patient Populations (Patients with Special Needs) Objective: 6 26) What is NOT a common sign of human trafficking? A) The person appears disconnected from family, friends, and community organizations. B) The person has a sudden or dramatic change in behavior. C) The person has bruises in various stages of healing. D) The person does need to be coached on what to say. Answer: D Diff: 1 Page Ref: 1694 Standard: Special Patient Populations (Patients with Special Needs) Objective: 6 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 50 The Challenged Patient 1) What best describes deafness? A) The inability to hear B) A defect in the brain that does not allow sound to be processed C) A congenital defect involving the inner ear D) The inability to hear under 30 decibels Answer: A Diff: 1 Page Ref: 2 Standard: Special Patient Populations (Patients with Special Needs) Objective: 1 2) The inability of nerve impulses to reach the auditory center of the brain is called: A) audioneural deafness. B) conductive deafness. C) sensorineural deafness. D) cochlear imbalance. Answer: C Diff: 1 Page Ref: 2 Standard: Special Patient Populations (Patients with Special Needs) 305 Copyright © 2023 Pearson Education, Inc.

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Objective: 1 3) What is enucleation? A) Removal and replacement of the patient's eyeball with a prosthetic eye B) Corrective laser surgery C) Loss of vision in one eye due to trauma D) Removal of the eyeball Answer: D Diff: 1 Page Ref: 4 Standard: Special Patient Populations (Patients with Special Needs) Objective: 1 4) What is NOT a common cause of vision loss? A) Multiple sclerosis B) Diabetes C) Premature birth D) Cytomegalovirus Answer: A Diff: 1 Page Ref: 4 Standard: Special Patient Populations (Patients with Special Needs) Objective: 2

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5) An injury to which cervical vertebra(e) may prevent a person from breathing? A) C-5 to C-7 B) C-1 to C-3 C) C-1 only D) C-3 to C-5 Answer: D Diff: 1 Page Ref: 8 Standard: Special Patient Populations (Patients with Special Needs) Objective: 2 6) What is the cause of conductive deafness? A) Any condition that prevents voice or vibration from being transmitted to the brain from the outer ear due to nerve damage B) A condition that prevents sound from traveling from the inner to the outer ear C) A decrease in the sensory threshold voltage of the ear D) Any condition that prevents sound from being transmitted from the external ear to the middle or inner ear Answer: D Diff: 1 Page Ref: 2 Standard: Special Patient Populations (Patients with Special Needs) Objective: 2 7) What is/are some cause(s) of cerebral palsy? A) A genetic disorder related to the chromosomes B) German measles, cerebral hypoxia, head injury, or any number of diseases C) Drug and alcohol abuse by the mother D) Typhoid, head injury, or rubella Answer: B Diff: 1 Page Ref: 11-12 Standard: Special Patient Populations (Patients with Special Needs) Objective: 2 8) You arrive at the scene of a vehicle-versus-pedestrian accident. At the scene, you find a 32year-old man with an apparent mid-shaft femur fracture. As you introduce yourself, the man tells you that he is blind, and that a police officer took his guide dog a few minutes ago. Regarding the service dog, you should: A) tell law enforcement to contact animal control, which will hold the dog until the patient is discharged from the hospital. B) locate the dog and transport it with the patient to the hospital. C) inform the patient that he should call a family member or friend to come pick up the dog from law enforcement. D) tell police to transport the dog to the ED, as animals are not allowed inside the ambulance. Answer: B Diff: 2 Page Ref: 5 Standard: Special Patient Populations (Patients with Special Needs) Objective: 3 307 Copyright © 2023 Pearson Education, Inc.

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9) You have arrived on the scene of an injured person. The person has been identified by the police as having a hearing impairment. What is the best way to communicate with this person? A) Use written words or pictures. B) Ask the patient to turn up their hearing aid. C) Speak loudly and make hand gestures. D) Call for an American Sign Language interpreter to meet you at the hospital. Answer: A Diff: 1 Page Ref: 3 Standard: Special Patient Populations (Patients with Special Needs) Objective: 3 10) You are about to transport a cancer patient who complains of dyspnea. She is hemodynamically stable and has a history of asthma. On assessment, you note that she has some diffuse wheezes. You are going to administer an albuterol treatment and your protocol states that you should start an IV when you give a breathing treatment. The patient says that she has very bad veins, but she has an implanted port under the skin of her left chest. What is the best course of action? A) Administer albuterol only, as there is no urgent need for an IV. B) Withhold all treatment, as albuterol may negatively interact with her chemotherapy. C) Contact medical control for orders to access the port before beginning the albuterol treatment. D) Some implanted ports require special catheters, so try for a peripheral line. Answer: A Diff: 3 Page Ref: 11 Standard: Special Patient Populations (Patients with Special Needs) Objective: 5 11) A 22-year-old man has fallen at a local park. He has Down syndrome, and is crying. Which strategy may be helpful when caring for this patient? A) Speak to the patient as you would to a young child, as he has a cognitive age of 3 to 5 years old. B) Begin with simple questions to assess the developmental level of the patient. C) Direct all questions to the patient's caregiver. D) Treat the patient as you would any adult, so as not to offend him. Answer: B Diff: 2 Page Ref: 9-10 Standard: Special Patient Populations (Patients with Special Needs) Objective: 5

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12) You are assisting with the transport of a bariatric patient who needs to be removed from her top-floor bedroom. Due to the patient's size and weight, multiple resources are being used to get the patient out through an upstairs window. What consideration should be a top priority in this scenario? A) Performing the action quickly, so as not to create a spectacle in the neighborhood B) Minimizing damage to the patient's house and property, even if it means extending the operation C) Protecting the patient's dignity throughout the process, ensuring her comfort and safety D) Using as few resources as possible, so as not to deplete the rest of the emergency response system Answer: C Diff: 1 Page Ref: 6-7 Standard: Special Patient Populations (Patients with Special Needs) Objective: 5 13) Which statement is accurate regarding the care for a child with spina bifida? A) Most are able to live normal, healthy lives. B) There is a high chance of a latex allergy, so nonlatex equipment should be used. C) Opiate pain medication is contraindicated. D) Patients will be quadriplegic, so their wheelchairs must be transported with them. Answer: B Diff: 1 Page Ref: 14 Standard: Special Patient Populations (Patients with Special Needs) Objective: 3 14) A 34-year-old man is having trouble breathing. As you introduce yourself, his 7-year-old daughter tells you that he is deaf and communicates via American Sign Language. What could be an appropriate means of communicating with this patient? A) Write down all questions and give them to the patient. B) Use gestures speak slowly so the patient can lip read. C) Ask the daughter to serve as a translator. D) Use the patient's TTY phone as a virtual translator. Answer: C Diff: 1 Page Ref: 3-4 Standard: Special Patient Populations (Patients with Special Needs) Objective: 4

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15) A 22-year-old woman is a quadriplegic and requires transport to the hospital for wound on her leg. She is on a portable home ventilator. What is the best way to transport this patient? A) Keep the patient on her home ventilator, transporting the equipment with the patient. B) Call dispatch and ask for a CCT unit that has a transport ventilator. C) Provide positive-pressure ventilation with a bag-valve device during transport. D) Disconnect the ventilator and passively oxygenate the patient with a nonrebreather mask. Answer: A Diff: 1 Page Ref: 8 Standard: Special Patient Populations (Patients with Special Needs) Objective: 5 16) You have responded to a report of an injured person. When you arrive, you find a 55-yearold woman who has fallen and sustained a small laceration to her forehead. She is holding a small dog and asks if she can bring it with her to the hospital. What is the most appropriate action to take regarding transport? A) Explain to the patient that the ambulance is a sterile area and that she will have to call a friend to come and get the dog. B) Ask the patient if it is a service dog, and what it is trained to do. C) Restrain and transport the dog in the front of the ambulance. D) Transport the dog, but only if she has a carrier for it to ride in. Answer: B Diff: 3 Page Ref: 5 Standard: Special Patient Populations (Patients with Special Needs) Objective: 3 17) A 5-year-old girl has a high fever and cough. The girl's mother informs you that her daughter has leukemia and finished her most recent round of chemotherapy two days ago. She states that the girl is neutropenic. You recognize that: A) neutropenia is a common side effect of chemotherapy, but is not a serious concern. B) neutropenic fevers are always due to pneumonia. C) neutropenia is a serious condition that often leads to sepsis. D) neutropenic cough is a side effect of chemotherapy and should be treated with albuterol. Answer: C Diff: 2 Page Ref: 11 Standard: Special Patient Populations (Patients with Special Needs) Objective: 5

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18) A Muslim woman is ill and requires transport to the hospital. The patient's husband is refusing to allow the patient to be examined, as both members of the crew are male. The patient is quiet, but persistently agrees with her husband. How should you respond to this situation? A) Contact law enforcement, as this is likely partner abuse. B) Direct all questioning to the patient, encouraging her to come with you to the hospital. C) Transport the patient without examining her, allowing the husband to ride in the patient compartment with his wife if he wishes. D) Have the husband take his wife to the hospital, after signing a refusal of care form. Answer: C Diff: 1 Page Ref: 14 Standard: Special Patient Populations (Patients with Special Needs) Objective: 4 19) A school nurse has called EMS because an eight-year-old girl has a fever and is dehydrated. Just after your arrival, the girl's parents arrive. They calmly inform you that they do not believe in Western medicine, and that they will take the girl home to treat her. The child has an altered mental status and appears to be in serious condition. You should: A) advise the parents of the risks and allow them to sign a refusal of treatment form. B) provide treatment to the girl under the concept of implied consent. C) quietly contact law enforcement to assist you in convincing the parents. D) leave the scene and document that there was no patient contact. Answer: A Diff: 1 Page Ref: 14-15 Standard: Special Patient Populations (Patients with Special Needs) Objective: 4 20) You arrive at the scene to find a patient who has fallen. She appears to be homeless. After introducing yourself, you begin to assess her. However, she states that she does not want your help because she cannot afford it. What would be an appropriate response? A) "Don't worry, Medicare will cover it." B) "There is a public hospital that we can bring you to nearby." C) "I'm sorry to hear that. We'll need to call a lower-cost EMS provider." D) "You need medical attention; the hospital will work with you to help cover the cost." Answer: D Diff: 1 Page Ref: 16 Standard: Special Patient Populations (Patients with Special Needs) Objective: 4

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21) You are caring for a male patient who has not spoken to answer any of your questions, but will nod or shake his head. He appears to have a developmental disability. What would be the best way to document this information on your patient care report? A) "Patient refuses to answer questions." B) "Patient is nonverbal, but will nod his head yes and no." C) "Patient is developmentally disabled and unable to speak." D) "Patient is not responsive to questioning." Answer: B Diff: 1 Page Ref: 5-6 Standard: Special Patient Populations (Patients with Special Needs) Objective: 5 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 51 Acute Interventions for the Chronic Care Patient 1) What is the term for the skin's ability to return to its normal appearance after being subjected to pressure? A) Turgor B) Elasticity C) Ductility D) Sepsis Answer: A Diff: 1 Page Ref: 5 Standard: Special Patient Populations (Patients with Special Needs) Objective: 1 2) You arrive on the scene of a chronic care patient with a home ventilator. While looking at the ventilator, you notice there is a control knob labeled "PEEP Setting." What does PEEP stand for in this situation? A) Positive exhalation and excretion pressure B) Preliminary exhaustive expiratory plan C) Pulmonary expulsion/end perfusion D) Positive end-expiratory pressure Answer: D Diff: 1 Page Ref: 13 Standard: Special Patient Populations (Patients with Special Needs) Objective: 8 3) Which of these best describes a tracheostomy? A) An opening from the esophagus to the trachea B) A temporary opening made from the posterior neck through the trachea C) A surgical opening from the anterior neck into the trachea D) An opening made by incision from the larynx through the neck Answer: C 312 Copyright © 2023 Pearson Education, Inc.

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Diff: 1 Page Ref: 17 Standard: Special Patient Populations (Patients with Special Needs) Objective: 1

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4) Your patient has Guillain-Barré syndrome. Which of these sets of symptoms would you expect to find? A) Fever, followed by weakness and paralysis B) Headache, respiratory distress, and neuropathy C) Visual disturbances and motor deficits D) Rash, GI upset, and dizziness Answer: A Diff: 1 Page Ref: 15 Standard: Special Patient Populations (Patients with Special Needs) Objective: 7 5) Which of these factors has contributed to the increase in individuals who receive health care at home? A) More families can afford home health care. B) Research shows that patients recover faster at home. C) Fewer people have insurance and therefore cannot afford hospital care. D) There are tax breaks for individuals who provide care for a loved one at home. Answer: B Diff: 2 Page Ref: 2 Standard: Special Patient Populations (Patients with Special Needs) Objective: 2 6) The majority of home health care patients fall into which demographic category? A) Males, age 55+ B) Females, between ages 70 and 82 C) Females, age 65+ D) Males, between ages 75 and 85 Answer: C Diff: 2 Page Ref: 2 Standard: Special Patient Populations (Patients with Special Needs) Objective: 2

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7) While assessing a chronically ill 85-year-old male patient who is cared for at home, you notice that his wife appears tired and unkempt. The patient is well cared for; however, he has multiple health problems and requires constant attention. Understanding the psychosocial needs of a family member who provides care, which of the following would be appropriate to say to the wife? A) "It is obviously difficult for you to care for him. It might be best to put him in a nursing facility". B) "It is very expensive to pay for a home health aide, but perhaps you could ask your children to help with the cost." C) "I can see that you provide excellent care for your husband. Would you like some information on a support group for spouses who provide care?" D) "You are compromising your well-being for your husband and may require medical attention." Answer: C Diff: 2 Page Ref: 11 Standard: Special Patient Populations (Patients with Special Needs) Objective: 5 8) Which of these is NOT a common reason for ALS intervention with a chronic care patient? A) Equipment failure B) Desire for hospice care C) Absence of a primary caregiver at time of emergency D) Acute change in condition Answer: B Diff: 1 Page Ref: 12 Standard: Special Patient Populations (Patients with Special Needs) Objective: 3 9) You are called to the home of a 75-year-old patient with end-stage lung cancer. The patient's daughter states that she called because the patient is experiencing increasing dyspnea. The patient is on home oxygen at 4 liters per minute; however, the daughter states that the patient's SpO2 is "way lower than normal." What would be the best course of action in this situation? A) Transport the patient to the ED. B) Ask the daughter if the patient has a DNR. C) Examine the patient's oxygen equipment to be sure it is working. D) Prepare to administer oxygen via CPAP. Answer: C Diff: 3 Page Ref: 20 Standard: Special Patient Populations (Patients with Special Needs) Objective: 8

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10) A 13-day-old infant is suffering from bronchopulmonary dysplasia. His family, along with a home health nurse, called 911 after the child's oxygen saturation began to fluctuate. The home health nurse reports that although the baby is on a ventilator, the nurse has been weaning him to lower intermittent mandatory ventilation settings. The child has a heart rate of 160 bpm and is ventilator dependent with an SpO2 of 86 percent. Lung sounds reveal crackles and rhonchi in the left lung; the child is hot to the touch and has cyanotic extremities and central mottling. You suspect: A) pneumothorax secondary to bronchopulmonary dysplasia. B) aspiration secondary to ventilator usage. C) sepsis secondary to lower respiratory infection. D) barotrauma secondary to high ventilator pressure settings. Answer: C Diff: 3 Page Ref: 14 Standard: Special Patient Populations (Patients with Special Needs) Objective: 8 11) Which of these is NOT a common sign of sepsis? A) Nausea and vomiting B) Fever C) Altered mental status D) Hyperactivity Answer: D Diff: 1 Page Ref: 5 Standard: Special Patient Populations (Patients with Special Challenges) Objective: 8 12) You are sent to a home for a cardiac arrest. You find a patient in cardiac arrest who has been under hospice care for end-stage AIDS. The palliative care nurse tells you that some family members who were present when the patient went into cardiac arrest became very upset and called 911. The patient has been pulseless and apneic for approximately 15 minutes without resuscitation. A relative interrupts and says she doesn't care what the nurse says; she wants you to help her brother. What should your next action(s) be? A) Have the nurse provide the DNR, ask the sister if she was aware of her brother's end-of-life wishes, and explain that you are ethically bound to honor the DNR. B) Provide all the interventions you can–immediate family are always able to override the DNR. C) Explain to the sister that because the family did not start CPR right away, the chances of resuscitation are extremely small. D) Start CPR and ACLS. Do a round of drugs, then call for orders for field termination of resuscitative efforts. Answer: A Diff: 3 Page Ref: 12 Standard: Special Patient Populations (Patients with Special Needs) Objective: 9

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13) When you arrive on the scene of an incident in which a home health care provider is present, what is the best way to deal with this provider? A) Tell the home care provider that your certification overrides theirs and that you are in charge now. B) Respect the home care provider's position, use the person's information accordingly, and request the person's help should the need arise. C) Let the person talk to a member of the crew not involved in patient care to keep the person busy and out of the way. D) Ascertain the person's certification level. If the person is not an RN, ask the person to stand back. Answer: B Diff: 2 Page Ref: 3 Standard: Special Patient Populations (Patients with Special Needs) Objective: 4 14) You are dispatched to an extended care facility for a "sick person." On arrival, you speak with the staff who tells you that Ms. Johnson "just started acting differently and is slow to respond." Your assessment reveals that she is febrile and has vomited. When you move her to the gurney, you notice a stage 3 ulcer on her lower back that has a foul smell. Which statement is most likely to be TRUE? A) This is most probably due to neglect. Report the facility to the appropriate authorities. B) This is most likely a GI emergency, such as norovirus or C. diff. C) The signs could be masking a more serious issue, such as a cardiac event. D) The ulcer may be infected, causing sepsis and requiring immediate intervention. Answer: D Diff: 3 Page Ref: 5-6 Standard: Special Patient Populations (Patients with Special Needs) Objective: 4 15) You are caring for a child with muscular dystrophy who is on a home ventilator. The boy's father called 911 after noticing his son repeatedly attempting to cough–something that is atypical for this patient. The father states that he believes the child's tracheostomy tube may be dislodged, and he is unsure what to do. Your assessment reveals that the inner cannula appears to be dislodged. Which of the following is your best course of action? A) Detach the home ventilator, orally intubate the trachea, and reattach the ventilator to the ET tube. B) Deflate the cannula cuff and remove the cannula, then hyperventilate the patient. C) Transport, with an early alert that a respiratory therapist will be needed. D) Attempt to reposition the inner cannula with sterile Magill forceps. Answer: B Diff: 1 Page Ref: 18 Standard: Special Patient Populations (Patients with Special Needs) Objective: 8

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16) Which of these findings outside a home is LEAST likely an indication that leads you to assume that a home health care situation might exist inside? A) A "No Smoking, Oxygen in Use" sign B) A wheelchair ramp C) A vehicle in the driveway that appears to be used for convalescent transport D) An entry way with double front doors Answer: D Diff: 1 Page Ref: 9-10 Standard: Special Patient Populations (Patients with Special Needs) Objective: 10 17) You have arrived at the home of an elderly man who called 911 for pain in his penis. He has a Foley catheter in place. He is supposed to have a home health aide visiting him daily, but, although it is 1500 hours, she has not yet visited today. You visualize the catheter and bag and note that the Foley bag is full of urine, so much so that it appears to be pulling the tube taut. You should: A) call the home health care service and ask when the health aide is scheduled to arrive. B) access the drain, drain the urine into a container, and reassess the patient's discomfort. C) transport to the ED, as any procedure involving a Foley requires special training. D) remove the Foley catheter using aseptic technique and transport. Answer: B Diff: 3 Page Ref: 23-24 Standard: Special Patient Populations (Patients with Special Needs) Objective: 10 18) Many patients with neuromuscular degenerative diseases receive chronic respiratory support at home. Ultimately, what step may you, as a paramedic, have to take immediately, regardless of the type of respiratory support available in the patient's home? A) Alter dosages of medications already in use to achieve a better effect. B) Intubate and ventilate the patient manually. C) Call the patient's physician and get orders not addressed by your protocols. D) Rapidly become familiar with the patient's medical equipment. Answer: B Diff: 2 Page Ref: 27-28 Standard: Special Patient Populations (Patients with Special Needs) Objective: 3

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19) You are dispatched to a residence for a report of a "man down." Upon arrival, you find a well-kept home with the door open, and a van in the driveway with "palliative care specialist" printed on the side. As you enter the home, a woman meets you and says, "It's my mother. She has terminal cancer and we can't seem to wake her up." Which question would be most appropriate to ask at this time? A) "Did anyone check for a pulse?" B) "What type of cancer does your mother have?" C) "Is your mother receiving hospice care?" D) "What hospital does she normally go to?" Answer: A Diff: 1 Page Ref: 3 Standard: Special Patient Populations (Patients with Special Needs) Objective: 8 20) A wheelchair transport driver has called 911 after transporting a 68-year-old man from a dialysis center back to his residential care home. The patient has a blood-soaked bandage on his right forearm and states, "My fistula has been bleeding since I left dialysis. I can't get it to stop!" You should: A) lift the bandage to ascertain whether the bleeding is from the dialysis fistula or another source. B) immediately apply a tourniquet proximal to the fistula. C) apply firm, direct pressure over the fistula with your gloved hand. D) apply pressure to the brachial artery pressure point to slow the bleeding. Answer: C Diff: 1 Page Ref: 22 Standard: Special Patient Populations (Patients with Special Needs) Objective: 10 21) You are caring for a patient with a gastrostomy tube. The patient complains of pain around the tube, and states that the surrounding area has been sore for a few days. Your physical exam reveals red, swollen skin around the G tube that is warm to the touch. You suspect: A) an obstruction in the G tube. B) an infection at the insertion site. C) that the tube has been dislodged. D) that the patient is not properly caring for the device. Answer: B Diff: 1 Page Ref: 24-25 Standard: Special Patient Populations (Patients with Special Needs) Objective: 8

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22) A 24-year-old man has called 911 after experiencing heart palpitations and dizziness. You direct your partner to apply a 4-lead ECG and see a narrow complex tachycardia on the monitor at a rate of 196 bpm. The patient is wearing a halter monitor and states, "My doctor is making me wear this because I keep having these episodes." How should you handle the presence of the halter monitor? A) Leave it in place and alter your treatment so as not to disturb the monitor. B) Remove the monitor and treat the patient per protocol. C) Leave the monitor on and delay treatment until you arrive at the ED. D) Contact the hospital for medical direction. Answer: B Diff: 1 Page Ref: 12 Standard: Special Patient Populations (Patients with Special Needs) Objective: 10 23) Which of these most accurately describes why it is best to avoid taking a blood pressure on an arm with an AV graft in place? A) The blood pressure cuff will compress the graft, causing damage. B) The pressure created by the cuff is guaranteed to rupture the AV graft. C) Restricting circulation through the graft is likely to cause clot formation, a common problem with AV grafts. D) It is uncomfortable for a patient with an AV graft to have blood pressure taken on that arm. Answer: C Diff: 2 Page Ref: 22 Standard: Special Patient Populations (Patients with Special Challenges) Objective: 6 24) Who may be the best person to ask questions regarding a patient's home medical devices should the patient be unresponsive? A) The ED physician B) The neighbor who is on scene C) The home care provider who is on scene D) The EMS supervisor who has been to this residence in the past Answer: C Diff: 2 Page Ref: 3 Standard: Special Patient Populations (Patients with Special Challenges) Objective: 4

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25) You are called to the scene for a male patient who recently came home from the hospital with a tracheostomy and mechanical ventilator secondary to a traumatic brain injury. His wife calls EMS because she said the machine started "beeping." Upon your arrival and assessment, you determine it was alarming because it was not plugged into an outlet wall. Which of these is a statement the paramedic should NOT say to the wife? A) "Next time, try troubleshooting the problem yourself before calling EMS." B) "Let's look at the paperwork sent with the equipment to see what we can learn about the alarms." C) "I realize these kind of situations with a loved one can be very stressful." D) "We are glad you called, even though it was a simple fix. Never be afraid to summon EMS in the future." Answer: A Diff: 2 Page Ref: 8 Standard: Special Patient Populations (Patients with Special Challenges) Objective: 4 26) The presence of which piece of medical equipment would alert you that your unresponsive patient has a GI/GU disease complication? A) Home mechanical ventilator B) PEG tube C) Oxygen tank and nasal cannula D) CPAP machine Answer: B Diff: 2 Page Ref: 5 Standard: Special Patient Populations (Patients with Special Challenges) Objective: 7 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 52 Trauma and Trauma Systems 1) The purpose of determining the mechanism of injury and the index of suspicion for the trauma patient at the same time is to allow you to: A) decide whether to transport the patient. B) identify comorbid factors. C) document a complete scene size up. D) anticipate your patient's injuries. Answer: D Diff: 2 Page Ref: 1751 Standard: Trauma (Trauma Overview) Objective: 7 2) What accounts for the highest number of trauma deaths in the United States? A) Motor vehicle collisions B) Falls 321 Copyright © 2023 Pearson Education, Inc.

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C) Assaults D) Firearms injuries Answer: A Diff: 2 Page Ref: 1744 Standard: Trauma (Trauma Overview) Objective: 2 3) Which act resulted in the development of modern EMS systems? A) Ryan White Act B) Highway Safety Act of 1966 C) Good Samaritan Act D) The Trauma Care Systems Planning and Development Act of 1990 Answer: B Diff: 2 Page Ref: 1745 Standard: Trauma (Trauma Overview) Objective: 4 4) In addition to handling all types of specialty trauma, which level of trauma center provides continuing medical and public education programs? A) IV B) III C) I D) II Answer: C Diff: 2 Page Ref: 1749 Standard: Trauma (Trauma Overview) Objective: 4 5) Upon arriving on a scene where the mechanism of injury indicates a potentially lifethreatening injury, you should employ which of the following interventions to best help deliver the care that is needed? A) Reevaluate the scene size up. B) Initiate transport immediately, delaying more extensive care until you are en route. C) Ask a surgeon to respond to the scene. D) Call immediately for air medical transport to reduce the "Golden Period." Answer: B Diff: 2 Page Ref: 1753 Standard: Trauma (Trauma Overview) Objective: 7 6) Which of the following physical findings indicates the need for immediate transport? A) Vital signs: systolic blood pressure 80, respiratory rate 8 B) Glasgow Coma Scale score of 15 C) Second-degree burns involving 9 percent of total body surface area in an adult patient D) Fractured right femur Answer: A Diff: 2 Page Ref: 1753-1754 322 Copyright © 2023 Pearson Education, Inc.

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Standard: Trauma (Trauma Overview) Objective: 7 7) Which of the following requires immediate transport to a trauma center? A) A 40-year-old who fell 12 feet from a garage roof with a radius fracture B) A 36-year-old woman in a motor vehicle crash who has a blood pressure of 100/60 C) A 22-year-old soccer player with lower leg pain D) A 47-year-old involved in a motor vehicle crash that resulted in the death of his passenger Answer: D Diff: 2 Page Ref: 1754 Standard: Trauma (Trauma Overview) Objective: 7 8) As a paramedic, your role in trauma care consists of all of these activities, EXCEPT: A) providing rapid transport to appropriate facilities. B) promoting injury prevention. C) providing care to seriously injured trauma patients. D) providing surgical interventions to stop hemorrhage. Answer: D Diff: 2 Page Ref: 1745 Standard: Trauma (Trauma Overview) Objective: 3

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9) Trauma triage criteria application, field skill performance, response times, patient assessment, patient care and transport are all monitored through which of the following? A) Quality improvement B) Trauma registry C) Centers for Disease Control and Prevention D) Public healthcare model Answer: A Diff: 2 Page Ref: 1755 Standard: Trauma (Trauma Overview) Objective: 8 10) Which of the following is the best definition of the Golden Period? A) The ideal time it takes to assess a multi-system trauma patient B) The ideal timeframe from time of injury until surgery C) The ideal time from requesting a helicopter to it landing on scene D) The ideal timeframe from call dispatch to arrival on scene Answer: B Diff: 2 Page Ref: 1752 Standard: Trauma (Trauma Overview) Objective: 1 11) Which of the following is NOT an example of trauma? A) An abrasion to the knee B) Chest pain C) Cerebral contusion D) A stab wound to the abdomen Answer: B Diff: 2 Page Ref: 1744-1745 Standard: Trauma (Trauma Overview) Objective: 1 12) Establishment of educational programs and improved auto technology are examples of which part of the public health model? A) Surveillance B) Risk identification C) Intervention D) Implementation Answer: C Diff: 2 Page Ref: 1747 Standard: Trauma (Trauma Overview) Objective: 3

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13) Which level of trauma facility has minimal surgical support but can stabilize before transferring to a higher-level trauma facility? A) III B) II C) IV D) I Answer: A Diff: 2 Page Ref: 1749 Standard: Trauma (Trauma Overview) Objective: 4 14) Which statement about trauma is FALSE? A) Life-threatening injuries may exist with little external evidence. B) Dramatic-appearing extremity injuries may draw the paramedic's focus away from lifethreatening internal injuries. C) Life-threatening injury occurs in less than 10 percent of trauma patients. D) Most patients with life-threatening trauma will have sustained external injury to the extremities (arms/legs). Answer: D Diff: 2 Page Ref: 1744-1745 Standard: Trauma (Trauma Overview) Objective: 2 15) The leading cause of death in people under age 44 is: A) heart attack. B) trauma. C) cancer. D) cardiovascular disease. Answer: B Diff: 2 Page Ref: 1744 Standard: Trauma (Trauma Overview) Objective: 2 16) Which patient is NOT a candidate for air medical transport? A) Combative trauma patient B) Seriously injured patient with cardiac tamponade C) Patient with prolonged extrication time D) Burn patient with over 50 percent second-degree burns Answer: A Diff: 2 Page Ref: 1753 Standard: Trauma (Trauma Overview) Objective: 7

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17) Which trauma patient would be classified as "stable"? A) Patient with facial burns and associated hoarseness and stridor B) Patient who is unconscious, with no ventilations and no pulse C) Patient with controlled bleeding from a laceration to the right forearm from a glass cut D) Patient with closed, bilateral femur fractures but adequate ventilations Answer: C Diff: 2 Page Ref: 1752 Standard: Trauma (Trauma Overview) Objective: 5 18) Modern medicine treats trauma as a: A) crisis. B) disease. C) life threat. D) medical problem. Answer: B Diff: 2 Page Ref: 1745 Standard: Trauma (Trauma Overview) Objective: 2 19) A trauma center that has surgical care capability available at all times and can handle all but the most seriously injured specialty and multisystem trauma patients should receive what trauma level designation? A) III B) I C) IV D) II Answer: D Diff: 2 Page Ref: 1749 Standard: Trauma (Trauma Overview) Objective: 4 20) What is the best, most cost-effective way for EMS personnel to help reduce trauma-related morbidity and mortality? A) Participate in injury prevention programs. B) Keep up to date on trauma management knowledge and skills. C) Transport all trauma patients to a trauma center. D) Provide complete patient care reports so that accurate data can be entered into the trauma registry. Answer: A Diff: 2 Page Ref: 1753 Standard: Trauma (Trauma Overview) Objective: 3

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21) Which level of trauma facility strictly stabilizes trauma patients and prepares to transport, often by helicopter, to a more distant and higher-level trauma center? A) I B) II C) IV D) III Answer: C Diff: 2 Page Ref: 1749 Standard: Trauma (Trauma Overview) Objective: 4 22) Which mechanism of injury would yield the greatest index of suspicion for serious injury? A) Helmeted bicyclist losing control and falling off his bike onto a grassy surface at 15 miles per hour B) Adult falling 5 feet from a ladder and landing in the mud C) Seventy-mile-per-hour motor vehicle crash with partial ejection D) Pedestrian struck by a car traveling 5 miles/hour Answer: C Diff: 2 Page Ref: 1751 Standard: Trauma (Trauma Overview) Objective: 5 23) Which level of trauma facility can provide neurosurgery, microsurgery, and care for multisystem trauma? A) III B) II C) I D) IV Answer: C Diff: 2 Page Ref: 1749 Standard: Trauma (Trauma Overview) Objective: 4 24) Which patient does NOT require specialty-center capabilities beyond that offered by a trauma center? A) A 67-year-old with second- and third-degree burns over 50 percent of the body B) A 25-year-old with amputation of three fingers C) A 4-year-old with a closed-head injury D) A 22-year-old with bilateral open femur fractures Answer: D Diff: 2 Page Ref: 1749-1750 Standard: Trauma (Trauma Overview) Objective: 4

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25) Which description best differentiates medical and trauma patient assessment? A) There is no concept for "medical load and go" patients. B) Trauma triage guidelines are not critical with medical patients. C) Scene safety is not an issue with the medical patient. D) Assessing breath sounds is not crucial to trauma assessment. Answer: B Diff: 2 Page Ref: 1750 Standard: Trauma (Trauma Overview) Objective: 2 26) What is the only functional way to determine which patient care procedures benefit trauma patients and which don't? A) Surveillance B) Risk identification C) Implementation D) Evaluation Answer: D Diff: 2 Page Ref: 1748 Standard: Trauma (Trauma Overview) Objective: 8 27) What would be a good strategy to reduce prehospital time to maximize the use of the "Golden Period" for trauma patients? A) Skip SMR procedures in the blunt trauma patient. B) Start all IVs on the scene to allow for more rapid transport. C) Load the patients and begin transport before doing a primary assessment. D) Call for air medical transport, if indicated. Answer: D Diff: 2 Page Ref: 1752-1753 Standard: Trauma (Trauma Overview) Objective: 6 28) What is the "mental summation of suspected injuries based on the event analysis"? A) Index of injury B) Index of suspicion C) Newton's First Law of Motion D) Mechanism of injury Answer: B Diff: 2 Page Ref: 1751 Standard: Trauma (Trauma Overview) Objective: 1

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29) What is the target time emergency medicine should try to meet whenever possible with critical trauma patients as it relates from time of injury till time to surgery? A) About 1 hour B) About 2 hours C) About 3 hours D) About 4 hours Answer: A Diff: 1 Page Ref: 1752 Standard: Trauma (Trauma Overview) Objective: 6 30) You assess a trauma patient who has an airway that cannot be maintained or secured. How should this patient be classified? A) Critical B) Unstable C) Potentially unstable D) Stable Answer: A Diff: 2 Page Ref: 1752 Standard: Trauma (Trauma Overview) Objective: 5 31) According to the Haddon Matrix, what would be a pre-event host factor affecting the risk for injury in a vehicle collision? A) Level of EMS providers responding to the scene B) Presence of crash barriers near bridge abutments C) Texting and/or talking on a cellphone while driving D) Advanced automatic collision notification Answer: C Diff: 2 Page Ref: 1746 Standard: Trauma (Trauma Overview) Objective: 3 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 53 Mechanism of Injury 1) Vehicle supplemental restraint systems (air bags) are meant to: A) prevent unrestrained occupants from taking the down-and-under pathway in frontal impacts. B) protect infants and children who ride in the front seat of the vehicle. C) prevent injury from secondary impacts. D) absorb the energy exchange of rapid deceleration. Answer: D Diff: 1 Page Ref: 1764-1765 Standard: Trauma (Trauma Overview) 329 Copyright © 2023 Pearson Education, Inc.

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Objective: 5 2) When assessing a patient with a crush injury, which of these findings would indicate that toxins have entered the central circulation? A) Hot, red skin B) Increased urine output C) Cardiac arrhythmia D) Central hyperventilation syndrome Answer: C Diff: 2 Page Ref: 1779 Standard: Trauma (Soft Tissue Trauma) Objective: 12 3) People in which of these age groups are prone to significant trauma due to falls? A) College-aged adults B) Geriatric population C) Pediatric population D) Teenagers Answer: B Diff: 1 Page Ref: 1773 Standard: Trauma (Special Considerations in Trauma) Objective: 9 4) Which of these is NOT a complication of crush injury? A) Renal failure B) Difficult-to-control hemorrhage C) Cardiac arrhythmias D) Systemic alkalosis Answer: D Diff: 1 Page Ref: 1779 Standard: Trauma (Soft Tissue Trauma) Objective: 12 5) The two factors that refer to the rate of change of speed are: A) deceleration and velocity. B) mass and weight. C) acceleration and deceleration. D) acceleration and inertia. Answer: C Diff: 1 Page Ref: 1759 Standard: Trauma (Trauma Overview) Objective: 2 6) Which of these injuries is MOST likely in a rear-end impact? A) Thoracic and abdominal injuries B) Head and neck injuries 330 Copyright © 2023 Pearson Education, Inc.

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C) Pelvic fractures D) Lumbar spine injuries Answer: B Diff: 1 Page Ref: 1768 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 6 7) You are called to the scene of a vehicle crash in which a car was rear-ended while stopped at a stop sign. Which of these laws of physics serves as the basis for analyzing the mechanism of injury and the associated index of suspicion for injuries? A) The amount of energy transmitted to an object is inversely proportional to its rate of deceleration. B) Energy can neither be created nor destroyed. C) A body at rest will remain at rest unless acted on by an outside force. D) A body in motion will remain in motion unless acted on by an outside force. Answer: C Diff: 2 Page Ref: 1759 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 2 8) When a patient falls, which section of the spinal column is the most prone to compression injury? A) Sacral B) Cervical C) Thoracic D) Lumbar Answer: D Diff: 1 Page Ref: 1773 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9

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9) Which of these injuries is NOT associated with the use of vehicle restraint systems? A) Traumatic brain injury B) Abrasions and contusions to the clavicle and chest area C) Lumbar spine trauma D) Abdominal injury Answer: A Diff: 1 Page Ref: 1764 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 5 10) Applying Newton's second law of motion to a vehicle traveling 70 miles per hour, crashing into which of these would transfer the most force to the patient? A) Bridge abutment B) Shrubbery C) A body of water D) Signpost Answer: A Diff: 1 Page Ref: 1772-1773 Standard: Trauma (Trauma Overview) Objective: 2 11) Which of these is TRUE of the differences between adult and pediatric pedestrians when struck by a vehicle? A) Adults tend to be thrown under the vehicle. B) Children tend to be thrown onto the hood of the vehicle. C) Children tend to be thrown under the vehicle. D) Adults tend to have injuries higher on the body. Answer: C Diff: 1 Page Ref: 1771 Standard: Trauma (Special Considerations in Trauma) Objective: 6 12) Which of these is MOST likely to be fractured from a fall onto outstretched hands? A) Carpals B) Metacarpals C) Clavicle D) Ulna Answer: C Diff: 1 Page Ref: 1773 Standard: Trauma (Orthopedic Trauma) Objective: 9

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13) Your patient, a 23-year-old woman, was the unrestrained driver of a vehicle that rear-ended a parked car. Considering the likelihood of organ collision, for which of these injuries should you maintain a high index of suspicion? A) Cardiac contusion B) Anterior flail segment C) Whiplash D) Fractured sternum Answer: C Diff: 3 Page Ref: 1765 Standard: Trauma (Special Considerations in Trauma) Objective: 3 14) Which of these best describes why the occupants of a vehicle moving at 50 miles per hour will be injured when the vehicle strikes a tree, but not when it brakes to a stop? A) Braking allows the kinetic energy to be absorbed evenly into the frame of the vehicle, rather than concentrating it at the point of impact. B) The energy gradually dissipates as heat due to the friction of braking, rather than transferring to the vehicle and its occupants. C) The inertia of the tree increases the kinetic energy transmitted to the occupants by a factor of 10. D) None of the above describes why. Answer: B Diff: 2 Page Ref: 1759 Standard: Trauma (Trauma Overview) Objective: 7 15) Which pathway of patient travel results in higher mortality with a frontal impact collision? A) Vertical B) Straight C) Up-and-over D) Down-and-under Answer: C Diff: 1 Page Ref: 1766 Standard: Trauma (Trauma Overview) Objective: 6

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16) Upon arriving at the scene of a single-vehicle collision in which the vehicle struck a utility pole, you note that the windshield is "starred," and that the driver is not restrained. Which of these injuries is MOST likely? A) Whiplash injury of the neck muscles B) Compression injury of the cervical spine C) Distraction injury of the cervical spine D) Ligamentous neck injury due to rotation beyond the range of motion Answer: B Diff: 2 Page Ref: 1766 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 6 17) Which of these factors is NOT a consideration in the severity of injury related to falls? A) Landing surface B) Wind resistance C) The initial point of impact D) Distance of the fall Answer: B Diff: 1 Page Ref: 1773 Standard: Trauma (Trauma Overview) Objective: 9 18) Which of these is TRUE regarding a motorcycle collision? A) Frontal impact can result in intraabdominal, pelvic, and femur injuries. B) A rider who "lays down the bike" will generally receive more severe injuries than a rider who stays with the bike. C) The structural steel of the vehicle absorbs most of the kinetic energy in a motorcycle collision. D) The use of helmets has drastically reduced the incidence of cervical spine injuries. Answer: A Diff: 2 Page Ref: 1770-1771 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 8 19) For which of these impacts should you maintain a higher index of suspicion because the degree of injury may be greater than the damage alone indicates? A) Rear-end B) Oblique C) Lateral D) Frontal Answer: C Diff: 1 Page Ref: 1777 Standard: Trauma (Trauma Overview) Objective: 6

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20) Which of these best defines the term energy? A) The ability to deform solid objects B) The rate of motion related to time C) The capacity to do work D) The amount of heat generated through friction Answer: C Diff: 1 Page Ref: 1759 Standard: Trauma (Trauma Overview) Objective: 1 21) Which of these contributes to a greater degree of injury than anticipated from vehicle damage alone in a lateral-impact motor vehicle collision? A) Increased gravitational forces due to multiple changes in direction and velocity B) Lack of a crumple zone C) Taking the up-and-over pathway D) The force of side-impact air bag deployment Answer: B Diff: 2 Page Ref: 1777 Standard: Trauma (Trauma Overview) Objective: 5 22) Which of these injuries is NOT commonly related to snowmobiling? A) Ejections B) Crush injuries C) Drowning D) Glancing blows against obstructions in the snow Answer: C Diff: 2 Page Ref: 1772 Standard: Trauma (Trauma Overview) Objective: 8 23) Which of these is the most important priority when caring for a patient with a shallow-water diving injury? A) Assessing the cervical spine for deformity B) Maintaining cervical spine stabilization while opening the airway C) Removing the patient from the water as soon as possible D) Initiating rescue breathing once out of the water Answer: B Diff: 1 Page Ref: 1773 Standard: Trauma (Environmental Emergencies) Objective: 9

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24) Which of these affects the severity of injury sustained in a motor vehicle collision? A) Gross vehicle weight B) Rate of acceleration or deceleration C) Vehicle speed D) All of the above Answer: D Diff: 1 Page Ref: 1759 Standard: Trauma (Environmental Emergencies) Objective: 2 25) Which of these is NOT a type of collision that must be considered when analyzing a motor vehicle collision? A) The vehicle strikes an object. B) The occupants' organs strike the interior of the body cavity. C) The body of the occupant strikes the interior of the vehicle. D) A hubcap flies off and strikes a tree. Answer: D Diff: 1 Page Ref: 1763-1764 Standard: Trauma (Environmental Emergencies) Objective: 7 26) Which of these best describes what happens to the kinetic energy of a vehicle traveling at 65 miles per hour when it collides into a concrete barrier wall? A) The energy dissipates as sound waves. B) The body of the vehicle and its occupants absorb the energy. C) The wall's foundation absorbs the energy. D) The energy converts to heat through friction. Answer: B Diff: 2 Page Ref: 1759-1760 Standard: Trauma (Environmental Emergencies) Objective: 2 27) Which two of these factors proportionately affect the kinetic energy of a bullet fired from a gun? A) Friction and distance B) Mass and friction C) Velocity and mass D) Friction and velocity Answer: C Diff: 1 Page Ref: 1759 Standard: Trauma (Multi-System Trauma) Objective: 15

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28) Which of these injuries is associated with the pressure wave produced by a blast? A) Pneumothorax B) Lacerated liver C) Fractures D) Ruptured spleen Answer: A Diff: 1 Page Ref: 1774 Standard: Trauma (Chest Trauma) Objective: 10 29) Axial loading is MOST likely to occur in which type of impact? A) Frontal with an up-and-over pathway B) Frontal with a down-and-under pathway C) Rear with the headrest too low D) Lateral on the side of the vehicle opposite the occupant Answer: A Diff: 2 Page Ref: 1766 Standard: Trauma (Environmental Emergencies) Objective: 3 30) Which of these "paper bag syndrome" injuries may occur due to sudden compression of the thorax or abdomen? A) Pulmonary and myocardial contusions B) Pneumothorax and diaphragmatic rupture C) Cardiac tamponade and aortic dissection D) Pneumothorax and myocardial contusion Answer: B Diff: 2 Page Ref: 1766 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 3 31) Which of these statements about lateral impact collisions is TRUE? A) The substantial lateral crumple zone prevents most injuries. B) Damage to the vehicle is a reliable indication of the seriousness of injuries. C) The degree of injury may be greater than the damage alone would indicate. D) Fatalities are rare because the upper extremities absorb the energy. Answer: C Diff: 1 Page Ref: 1777 Standard: Trauma (Multi-System Trauma) Objective: 6

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32) Which of these mechanisms is most consistent with fractured vertebrae from a rapid lateral twisting motion? A) Direct trauma, such as from a blow to the head B) Low-velocity penetrating trauma from an ice pick C) High-velocity penetrating trauma from a gunshot wound D) Lateral-impact motor vehicle collision Answer: D Diff: 2 Page Ref: 1767 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 7 33) Frontal impacts in which the patient takes a "down-and-under" pathway typically result in which of these injury patterns? A) Traumatic brain injury B) Hip and femur fractures C) Rupture of the diaphragm D) Rupture of hollow organs Answer: B Diff: 1 Page Ref: 1768 Standard: Trauma (Orthopedic Trauma) Objective: 6 34) Which of these scenarios would likely lead to the development of compartment syndrome? A) A crush injury to the lower leg B) A loose-fitting cast that covers the thigh and leg C) An excessive release of intracellular potassium D) A tennis shoe that doesn't fit correctly Answer: A Diff: 2 Page Ref: 1780-1781 Standard: Trauma (Soft Tissue Trauma) Objective: 12 35) Which of these is TRUE of the injuries sustained by the elderly due to falls? A) The injuries sustained by the elderly are less likely to result in hospitalization. B) Only more significant falls cause fractures. C) Less significant falls may cause fractures. D) The elderly sustain injuries similar to other age groups in comparable falls. Answer: C Diff: 1 Page Ref: 1773 Standard: Trauma (Special Considerations in Trauma) Objective: 9

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36) Which of these is NOT one of the major types of recreational vehicles involved in crashes? A) Snowmobiles B) Jet skis C) All-terrain vehicles D) Go-karts Answer: D Diff: 1 Page Ref: 1772 Standard: Trauma (Trauma Overview) Objective: 8 37) Infants and very small children (up to two years of age) should have their child safety seat positioned where in a car? A) The front seating area, facing backward B) The rear seating area, facing backward C) The front seating area, facing frontward D) The rear seating area, facing frontward Answer: B Diff: 2 Page Ref: 1765 Standard: Trauma (Special Considerations in Trauma) Objective: 5 38) When the driver's chest strikes the steering wheel during a motor vehicle collision, what produces the next injury? A) The air bag deploys a second time. B) The steering column shears off, causing penetrating trauma. C) Unsecured objects in the vehicle become projectiles. D) The heart continues its forward motion until it strikes the chest wall. Answer: D Diff: 2 Page Ref: 1776 Standard: Trauma (Chest Trauma) Objective: 4 39) When inspecting the interior of a vehicle involved in a frontal collision, you note that the dash panel beneath the steering wheel is broken. Which of these injuries might this indicate? A) Fracture of the acetabulum B) Femur fracture C) Knee injury D) All of the above Answer: D Diff: 2 Page Ref: 1766-1767 Standard: Trauma (Orthopedic Trauma) Objective: 6

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40) Which of these injuries is associated with the tertiary phase of a blast? A) Crush injuries B) Barotrauma C) Burns D) Projectile injuries Answer: A Diff: 1 Page Ref: 1776 Standard: Trauma (Soft Tissue Trauma) Objective: 10 41) Which of these statements about the impact of motorcycle helmet usage is TRUE? A) Helmet use moderately increases the incidence of cervical spine injury. B) Helmet use moderately decreases the incidence of cervical spine injury. C) Helmet use substantially decreases the incidence of cervical spine injury. D) Helmet use neither increases nor decreases the incidence of cervical spine injury. Answer: D Diff: 1 Page Ref: 1771 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 8 42) Which of these mechanisms in a motor vehicle collision would MOST likely result in a tear of the liver at the ligamentum teres? A) Gradual deceleration B) Sudden acceleration C) Sudden deceleration D) Gradual acceleration Answer: C Diff: 1 Page Ref: 1762 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 3 43) Which of these statements is NOT true of occupant ejection in motor vehicle collisions? A) Ejection accounts for 27 percent of motor vehicle fatalities. B) The number of occupant impacts increases with ejection. C) Ejection has not been reported with lateral-impact collisions. D) Ejection is most often associated with frontal-impact collisions. Answer: C Diff: 1 Page Ref: 1766-1767 Standard: Trauma (Trauma Overview) Objective: 6

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44) Which of these may result from aggressive ventilation of the blast patient? A) Emboli B) Pericardial tamponade C) Hemorrhage D) Acidosis Answer: A Diff: 1 Page Ref: 1778 Standard: Trauma (Multi-System Trauma) Objective: 10 45) A vehicle is struck in its right front as it passes through an intersection, resulting in an oblique impact. Which of the passengers is subjected to the greatest acceleration forces? A) The right-rear passenger B) The left-rear passenger C) The front-seat passenger D) The driver Answer: B Diff: 2 Page Ref: 1767-1768 Standard: Trauma (Trauma Overview) Objective: 6 46) You have responded to a soccer field on which two 13-year-olds have collided during a game. Which of these findings in either patient requires ambulance transport for further evaluation in the emergency department? A) Weakness in the upper extremities B) Complaint of "getting the wind knocked out of me" C) Contusion to the thigh D) Minor epistaxis Answer: A Diff: 2 Page Ref: 1779 Standard: Trauma (Special Considerations in Trauma) Objective: 11 47) Which type of motor vehicle collision is most common in rural areas? A) Frontal B) Lateral C) Rollover D) Rear-end Answer: A Diff: 1 Page Ref: 1766-1767 Standard: Trauma (Trauma Overview) Objective: 4

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48) The branch of physics dealing with objects in motion and energy exchanges that occur as these objects collide is called what? A) Kinematics B) Kinetics C) Inertia D) Force Answer: B Diff: 2 Page Ref: 1759-1760 Standard: Trauma (Trauma Overview) Objective: 1 49) Which of these is TRUE of supplemental restraint systems? A) They may deploy during rescue operations, injuring the patient and/or EMS personnel. B) When worn incorrectly, they may cause spinal injury or decapitation. C) They guard against thoracic impact with the steering wheel. D) They are primarily useful in preventing injury to infants and children riding in the front seat. Answer: A Diff: 1 Page Ref: 1764-1765 Standard: Trauma (Trauma Overview) Objective: 5 50) Which of these mechanisms may result in a conventional explosion? A) Fumes B) Dust C) Natural gas D) All of the above Answer: D Diff: 1 Page Ref: 1774 Standard: Trauma (Multi-System Trauma) Objective: 10 51) Which of these statements about low-velocity penetrating trauma is TRUE? A) Shorter knives and ice picks may be removed if they are left in the wound. B) There is no pressure shock wave with a knife wound as there is with an arrow wound. C) More injuries are sustained from arrows than from knives. D) Knives, arrows, ice picks, and similar weapons cause damage only in their direct path. Answer: D Diff: 2 Page Ref: 1781 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 15

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52) Your patient is an eight-year-old boy with a pencil impaled 2 centimeters inferior to the xiphoid process. You note that the pencil is pulsating. Which of these is the best action? A) Start an IV and request orders for analgesia and sedation. B) Remove the pencil and apply direct pressure to the wound; transport to a trauma center if the bleeding does not stop with direct pressure. C) Stabilize the pencil in place and transport to a trauma center. D) Stabilize the pencil in place and transport to the nearest medical facility. Answer: C Diff: 2 Page Ref: 1792-1793 Standard: Trauma (Chest Trauma) Objective: 17 53) The pathway of injury left in the wake of a penetrating mechanism of injury is called: A) cone of injury. B) cavitation. C) profile. D) trajectory. Answer: B Diff: 1 Page Ref: 1783 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 14 54) Which of these statements is TRUE of the permanent cavity created by penetrating trauma? A) It is filled with disrupted tissues, some air, fluid, and debris. B) It is the damage done when the projectile fragments penetrate. C) It is a space created by a projectile as tissue moves rapidly away in its path. D) It is a potential space, not an actual space. Answer: A Diff: 1 Page Ref: 1787 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 15 55) Which of these is TRUE of the pressure wave that accompanies high-velocity penetrating trauma? A) Hollow organs are less tolerant of the stress than solid organs are. B) Pressure waves cause no injury to surrounding tissues; they only momentarily disrupt function. C) Elastic tissues are less tolerant of the stress than nonelastic tissues. D) The pressure wave may be transmitted through blood, resulting in damage to blood vessels some distance from the primary wound. Answer: D Diff: 2 Page Ref: 1788-1789 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 14

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56) Your patient is a 50-year-old man with a gunshot wound to the right anterior chest. He is unresponsive. Which of these should you do first? A) Check for a carotid pulse. B) Seal the chest wound. C) Auscultate breath sounds. D) Check for breathing. Answer: D Diff: 1 Page Ref: 1791-1792 Standard: Trauma (Chest Trauma) Objective: 16 57) Your patient is a 30-year-old woman with a stab wound to the neck. She is sitting up and appears very anxious and short of breath. Minimal external bleeding is noted, but there is bubbling from the wound. Which of these should you suspect, based on the mechanism of injury and assessment findings? A) Laceration of the trachea B) An injury to the spinal cord at the level of the stab wound C) Laceration of the ipsilateral carotid artery D) All of the above Answer: A Diff: 2 Page Ref: 1791 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 15 58) If you were to design a bullet to have the highest energy exchange, what would you do? A) Decrease the drag. B) Increase the caliber. C) Decrease the bullet's trajectory. D) Design the bullet to become more unstable. Answer: D Diff: 2 Page Ref: 1782-1783 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 13 59) Which of these is most important when assessing the damage done by a gunshot? A) The type of gun used B) The size of the bullet C) The distance from the shooter D) Whether there was an upward or a downward trajectory when the bullet was fired Answer: C Diff: 2 Page Ref: 1782-1783 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 14

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60) A penetrating injury to which of these organs is LEAST likely to result in severe hemorrhage? A) Liver B) Kidney C) Spleen D) Ureter Answer: D Diff: 2 Page Ref: 1788 Standard: Trauma (Bleeding) Objective: 15 61) Which of these is TRUE of shotgun ammunition? A) A shotgun may either fire one slug or use ammunition with multiple pellets. B) The shot is dispersed from the cartridge with high velocity. C) The closer the shooter is to the victim, the larger the area of visible damage. D) "Double ought" or #00 shot contains a large number of relatively small pellets. Answer: A Diff: 2 Page Ref: 1785 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 16 62) Which of these abdominal organs is the LEAST affected by the pressure wave associated with penetrating trauma? A) Spleen B) Bowel C) Kidneys D) Liver Answer: B Diff: 2 Page Ref: 1774-1775 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 13 63) The study of the characteristics of projectiles in motion and their effects on the objects they impact is called: A) trajectory. B) cavitation. C) ballistics. D) forensics. Answer: C Diff: 1 Page Ref: 1781 Standard: Trauma (Trauma Overview) Objective: 1

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64) You have arrived on the scene of a 17-year-old male patient with a gunshot wound to the thigh. Police are on the scene. There is significant ongoing hemorrhage from the wound. The patient is screaming for someone to help him. Which of these should you do first? A) Control hemorrhage with direct pressure. B) Perform a rapid trauma assessment. C) Ask the police if they have searched the patient for weapons yet. D) Begin high-concentration oxygen administration. Answer: C Diff: 1 Page Ref: 1791 Standard: Trauma (Bleeding) Objective: 14 65) As a bullet tumbles, the potential to inflict damage: A) increases. B) remains the same. C) is determined by the trajectory. D) decreases. Answer: A Diff: 1 Page Ref: 1791 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 14 66) The path a projectile follows during a flight is called its: A) cavity. B) ballistics. C) trajectory. D) drag. Answer: C Diff: 1 Page Ref: 1782 Standard: Trauma (Trauma Overview) Objective: 1 67) Which of these is TRUE of body armor use? A) There are no reported cases of penetrating trauma among victims who were shot while wearing body armor. B) Blunt trauma may be significant, but the potential for life-threatening injury is less than if armor had not been worn. C) Blunt trauma occurs only if ceramic inserts are placed in the vest. D) Ceramic inserts are dangerous and should not be used, because they generally fragment and create secondary projectiles when they are struck by a bullet. Answer: B Diff: 2 Page Ref: 1784 Standard: Trauma (Trauma Overview) Objective: 14

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68) Which of these is most susceptible to damage from the pressure wave when a bullet enters it? A) Intestines B) Femoral artery C) Liver D) Lungs Answer: C Diff: 2 Page Ref: 1786-1787 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 14 69) Which of these is TRUE about determining the pathway of the bullet when assessing a patient with a gunshot wound? A) You should try to determine the bullet's pathway. B) The purpose of determining the bullet's pathway is to anticipate which organs may have been affected, which will help to guide your priorities for on-scene care or rapid transport. C) It is difficult to determine the pathway of a bullet because it may not travel in a straight line, possibly being deflected by structures in its path or being shifted by natural movements of the diaphragm and other organs and structures of the body. D) All of the above. Answer: D Diff: 3 Page Ref: 1786 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 14 70) Which statement about ballistics is TRUE? A) Damage is less when the bullet does not exit the body. B) When a bullet tumbles, it decreases the damage. C) In penetrating trauma, the mass of a projectile is more significant than its velocity when determining kinetic energy. D) When a bullet yaws, it increases the damage. Answer: D Diff: 2 Page Ref: 1781 Standard: Trauma (Trauma Overview) Objective: 14 71) When you are assessing someone with a gunshot wound from a rifle, which of these is important to remember? A) The zone of injury is larger than that expected with other types of weapons. B) The muzzle velocity is less than that of a handgun. C) The trajectory is longer, allowing more energy to be dissipated by drag before it strikes the victim. D) The cavitation is limited to the direct path of the bullet. Answer: A Diff: 2 Page Ref: 1784-1785 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 15 347 Copyright © 2023 Pearson Education, Inc.

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72) Which of these is typical of the trajectory of a knife when a female assailant stabs someone? A) The trajectory is lateral: right-to-left if she is right-handed and left-to-right if she is lefthanded. B) The movement is downward, as the assailant raises the knife and swings downward. C) The movement is upward, as the assailant drives upward with the knife. D) The trajectory tends to be in a horizontal plane at the level of the assailant's shoulder. Answer: B Diff: 2 Page Ref: 1787-1788 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 16 73) Greater velocity of a bullet will cause a A) wavier; straighter B) flatter; wavier C) more rounded; curved D) flatter; straighter Answer: D Diff: 1 Page Ref: 1784-1785 Standard: Trauma (Trauma Overview) Objective: 13

path of travel and a _

trajectory.

74) Which of these is TRUE of the temporary cavity formed by penetrating trauma? A) It heals more slowly than the permanent cavity because of the nature of the tissue damage. B) It fills with disrupted tissues, some air, fluid, and debris. C) It is a space indirectly created by a projectile as tissue moves rapidly away from its path. D) It is the damage that occurs when the projectile fragments. Answer: C Diff: 1 Page Ref: 1787 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 15 75) Which of these is TRUE of defense wounds in the victim of a knife attack? A) They usually occur to the shoulder as the victim attempts to turn away from the attack. B) They often occur to the neck and head as the victim doubles over into a protective posture. C) They usually occur to the hands and arms as the victim raises them to ward off the attacker. D) They rarely occur because the victim is usually taken by surprise. Answer: C Diff: 2 Page Ref: 1788 Standard: Trauma (Soft Tissue Trauma) Objective: 16

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76) To gain an appreciation for the potential for trauma from high-velocity projectiles, it is important to remember that the shock wave produced can exceed atmospheric pressure by up to how many times normal? A) 25 B) 100 C) 50 D) 80 Answer: B Diff: 1 Page Ref: 1786-1787 Standard: Trauma (Trauma Overview) Objective: 14 77) Which of these is associated with assault rifle wounds but not hunting rifle wounds? A) Permanent cavitation B) Multiple wounds C) Smaller exit wounds D) Larger exit wounds Answer: B Diff: 2 Page Ref: 1784-1785 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 14 78) Which of these statements about bullets is TRUE? A) A high-velocity bullet is three times less likely to do major harm. B) The larger the bullet, the smaller its energy. C) A small, light bullet can do significant harm. D) The hunting rifle's bullet is usually a lighter bullet, but it travels faster. Answer: C Diff: 2 Page Ref: 1781-1782 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 13 79) During the scene size up on a call for a patient with penetrating trauma due to a stab wound, which of these should you do? A) Collect anything that could be used as evidence. B) Check for weapons on or near the patient. C) Try to find out in which direction the assailant fled. D) Assume that the patient has no weapons if law enforcement is on the scene. Answer: B Diff: 2 Page Ref: 1791 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 16

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80) Which of these statements about stab wounds is TRUE? A) The presence of defense wounds decreases the likelihood of trauma to the neck, thorax, and abdomen. B) Damage is usually limited to physical injury caused by direct contact between the blade and the victim's tissue. C) The size and shape of the weapon allow precise prediction of the injury. D) Stab wounds by female attackers are seldom lethal. Answer: B Diff: 2 Page Ref: 1792 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 15 81) Which of these statements about entrance and exit wounds is TRUE? A) Exit wounds are usually the size of the bullet's profile. B) Entrance wounds most often appear as stellate. C) Cavitational wave energy is greatest at a bullet's point of entrance. D) Only a thorough forensic examination by a qualified expert can determine with certainty whether a given wound is an entrance wound or an exit wound. Answer: D Diff: 2 Page Ref: 1790-1791 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 14 82) Which of these is best described as "the area of contused tissue resulting from penetrating trauma that may be slow to heal due to disrupted blood flow and tissue damage"? A) Temporary cavity B) Zone of injury C) Zone of coagulation D) Permanent cavity Answer: B Diff: 1 Page Ref: 1787-1788 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 1 83) Penetrating trauma to the face can complicate airway management by which of these mechanisms? A) Laryngotracheal edema B) Airway obstruction C) Destruction of anatomical landmarks D) Both B and C Answer: D Diff: 2 Page Ref: 1792 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 17

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84) The primary assessment of a patient with a gunshot wound to the chest should focus on detecting which of these? A) Pancreatitis B) Tension pneumothorax C) Cardiac contusion D) Peritonitis Answer: B Diff: 2 Page Ref: 1794 Standard: Trauma (Chest Trauma) Objective: 17 85) Which two factors related to kinetic energy proportionately affect the damage a projectile will do? A) Velocity and yaw B) Velocity and mass C) Mass and fragmentation D) Fragmentation and velocity Answer: B Diff: 1 Page Ref: 1781 Standard: Trauma (Trauma Overview) Objective: 13 86) Which type of firearm usually limits trauma to direct injury? A) Hunting rifle B) Military rifle C) Automatic weapon D) Handgun Answer: D Diff: 1 Page Ref: 1784 Standard: Trauma (Trauma Overview) Objective: 14 87) Your patient is a construction worker who fell 15 feet and has a 3-foot metal concrete reinforcement bar (rebar) impaled in his right thigh. Which of these is the best action? A) Administer sodium bicarbonate to combat acidosis resulting from the destruction of muscle tissue. B) If the proper tools and personnel are present, have rescuers cut the rebar to a manageable length. C) If you can see both ends of the rebar, gently remove it and irrigate the wound with sterile saline. D) Transport the patient without attempting to shorten or remove the rebar. Answer: B Diff: 2 Page Ref: 1793 Standard: Trauma (Soft Tissue Trauma) Objective: 17

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88) Which of these bullet characteristics would create the most damage? A) Lack of tumble B) A small profile C) A full metal jacket D) "Mushrooming" or flattening on impact Answer: D Diff: 1 Page Ref: 1784 Standard: Trauma (Trauma Overview) Objective: 14 89) As the mass of an object increases, which of these occurs? A) The maximum speed it can attain increases. B) The amount of energy decreases. C) The maximum speed it can attain decreases. D) The amount of energy increases. Answer: D Diff: 1 Page Ref: 1781 Standard: Trauma (Trauma Overview) Objective: 13 90) Which of these statements about rifles is TRUE? A) Assault rifles generally increase the number of wounds the victim sustains. B) Hunting rifles have larger magazines and operate semiautomatically. C) Assault rifles do not accept domestic hunting ammunition and thus create a projectile profile that is smaller and causes less damage. D) Assault rifles have greater velocity than hunting rifles and only operate automatically. Answer: A Diff: 2 Page Ref: 1784-1785 Standard: Trauma (Trauma Overview) Objective: 14 91) Which of these is NOT considered penetrating trauma? A) Receiving a wood splinter in the foot while walking on an unfinished deck B) A superficial wound resulting from a pellet from a pellet gun being lodged under the skin C) A laceration from a kitchen knife D) A laceration on the forehead as a result of being struck with a metal pipe Answer: D Diff: 2 Page Ref: 1780-1781 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 16

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92) Which of these increases a bullet's profile? A) "Mushrooming" on impact B) The use of rifling in the barrel of the firearm C) Tumbling 180 degrees on impact D) Both A and C Answer: D Diff: 2 Page Ref: 1784 Standard: Trauma (Trauma Overview) Objective: 14 93) As the energy from a medium- or high-velocity projectile pushes tissue from its path, which of these occurs? A) Damage depends on the net difference between pressure at the entrance wound and pressure at the exit wound. B) No vacuum is created when there are both an entrance and an exit wound. C) Negative pressure is generated inside the cavity, drawing debris into the wound. D) There is negative pressure at the entrance wound and positive pressure at the exit wound. Answer: C Diff: 2 Page Ref: 1788 Standard: Trauma (Trauma Overview) Objective: 15 94) Which of these is MOST likely to occur to the bullet when military ammunition is used? A) It will "mushroom" or flatten. B) It will remain intact. C) It will fragment. D) It will explode. Answer: B Diff: 2 Page Ref: 1784 Standard: Trauma (Trauma Overview) Objective: 14 95) Which of these is considered a high-velocity weapon? A) Shotgun B) Arrow C) Handgun D) Rifle Answer: D Diff: 2 Page Ref: 1781 Standard: Trauma (Trauma Overview) Objective: 15

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96) You are doing a standby for a high school play off football game. During one play, the star quarterback was hit so hard that his helmet flew off and he sustained a 1-2 minute period of unresponsiveness, although his vitals were never significantly abnormal. By the time you have him transported off the field, he is alert and well oriented. As there is only 3 minutes left to play, the coach, parents, and the patient want to stay in the game to finish it out. "I am fine" the patient says, "just lemme finish out these last few plays." Since the patient is alert and oriented, the paramedic should? A) Allow the quarterback to finish the game, so long as he is given a new helmet B) Restrain the quarterback against his will and summon PD to place him in protective custody C) Tell the team to use their last few time-outs so he has a longer rest period before reentering the game D) Strongly encourage the patient and parents that any measure of unresponsiveness is bad and he should be evaluated in an emergency department Answer: D Diff: 2 Page Ref: 1780 Standard: Trauma (Trauma Overview) Objective: 11 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 54 Hemorrhage and Shock 1) Which of the following guidelines applies to the prehospital administration of IV fluids in the patient with hemorrhagic shock? A) Administer hypertonic saline solution or colloids at a keep-open rate. B) Administer synthetic oxygen-carrying fluids as necessary to increase the level of consciousness. C) Begin with a 2,000 mL bolus of isotonic crystalloid solution infused under pressure. D) Administer isotonic crystalloid fluids only as necessary to maintain perfusion. Answer: D Diff: 2 Page Ref: 1800-1801 Standard: Trauma (Bleeding) Objective: 12 2) Your patient is a 23-year-old man with a gunshot wound to the abdomen and an exit wound in the right flank. He responds to verbal stimuli; has pale, cool, diaphoretic skin; and has a heart rate of 128, respirations at 24, and a blood pressure of 82/60. These findings indicate which of the following kind of shock? A) Compensated B) Irreversible C) Decompensated D) Neurogenic Answer: C Diff: 2 Page Ref: 1807 Standard: Trauma (Bleeding) 354 Copyright © 2023 Pearson Education, Inc.

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Objective: 9 3) As a patient with hemorrhagic blood loss becomes more acidotic, what homeostatic process is usually impaired? A) Coagulation B) Hemoptysis C) Vascular phase D) Aerobic metabolism Answer: A Diff: 2 Page Ref: 1799-1800 Standard: Trauma (Bleeding) Objective: 4

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4) Your patient is a 42-year-old man with multiple lacerations on his arms, head, and torso after falling through a plate-glass window. On your arrival, he appears to be unresponsive, lying prone on the sidewalk. Which of the following is the correct sequence of actions in caring for this patient? 1. Control major hemorrhage. 2. Take Standard Precautions. 3. Check the area for broken glass before kneeling next to the patient. 4. Turn him to a supine position. 5. Open his airway. A) 2, 3, 1, 4, 5 B) 2, 5, 1, 3, 4 C) 2, 3, 4, 1, 5 D) 2, 3, 4, 5, 1 Answer: C Diff: 3 Page Ref: 1799-1800 Standard: Trauma (Bleeding) Objective: 10 5) Managing a laceration with arterial bleeding most often requires: A) cauterization. B) a tourniquet. C) fluid bolus. D) direct pressure. Answer: D Diff: 2 Page Ref: 1802 Standard: Trauma (Bleeding) Objective: 5 6) Which of the following patients with hemorrhagic shock is likely to be internally bleeding? A) A 50-year-old man with a stab wound to the neck B) A 45-year-old woman with a suspected ruptured ectopic pregnancy C) A 38-year-old man with an open femur fracture D) A 26-year-old man with a gunshot wound involving the popliteal artery Answer: B Diff: 2 Page Ref: 1808 Standard: Trauma (Bleeding) Objective: 5

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7) When a patient has lost 2 liters or more of blood from hemorrhage, which classification is that? A) I B) III C) IV D) II Answer: C Diff: 2 Page Ref: 1805 Standard: Trauma (Bleeding) Objective: 6 8) Which of the following is defined as the volume of blood ejected from the heart with each beat? A) Stroke volume B) Ventricular capacitance C) Cardiac output D) Afterload Answer: A Diff: 1 Page Ref: 1799 Standard: Trauma (Bleeding) Objective: 1 9) A fracture of the femur may result in a hematoma that contains enough blood to make it what class of hemorrhage? A) I B) III C) IV D) II Answer: B Diff: 3 Page Ref: 1805 Standard: Trauma (Bleeding) Objective: 6 10) Your patient is a 45-year-old man who has received several stab wounds to the chest and abdomen. Although bleeding was significant at first, the rate of bleeding had slowed considerably before your arrival. The patient is agitated and confused, pale, diaphoretic, and cool to the touch. He lacks a radial pulse, and his carotid pulse is weak and rapid. Respirations are 28 and shallow. Which of the following is certain with this patient? A) He is in irreversible shock. B) He is in decompensated shock. C) He is in compensated shock. D) None of the above is certain. Answer: B Diff: 2 Page Ref: 1806-1807 Standard: Trauma (Bleeding) Objective: 8 357 Copyright © 2023 Pearson Education, Inc.

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11) Peripheral vascular resistance is measured as which of the following? A) Pulse pressure B) Mean arterial pressure C) Hydrostatic pressure D) Oncotic pressure Answer: B Diff: 1 Page Ref: 1799 Standard: Trauma (Bleeding) Objective: 2 12) Which of the following is the preferred in-hospital fluid for resuscitation in hemorrhagic shock? A) Fresh frozen plasma B) Lactated Ringer's C) Whole blood D) Normal saline Answer: C Diff: 1 Page Ref: 1818 Standard: Trauma (Bleeding) Objective: 5 13) The phase of blood clotting in which the smooth muscle of an injured blood vessel contracts is known as: A) hemolytic phase. B) hemostatic phase. C) vascular phase. D) ischemic phase. Answer: C Diff: 1 Page Ref: 1799 Standard: Trauma (Bleeding) Objective: 4 14) Which of the following findings indicates a progression from compensated shock to decompensated shock? A) Narrowing pulse pressure B) Tachycardia C) Altered mental status D) Diaphoresis Answer: C Diff: 1 Page Ref: 1799 Standard: Trauma (Bleeding) Objective: 8

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15) When assessing the chest during a rapid trauma assessment, what is MOST likely to indicate major internal hemorrhage? A) Hyporesonance to percussion B) Increased respiratory rate C) Distended neck veins D) Muffled heart tones Answer: A Diff: 2 Page Ref: 1811 Standard: Trauma (Bleeding) Objective: 5 16) Which type of wound facilitates the effectiveness of normal blood clotting mechanisms? A) Vessels torn by stretching, such as when a limb is caught in farm machinery B) Transverse laceration of the vessel C) Longitudinal laceration of the vessel D) Crushing injuries Answer: B Diff: 1 Page Ref: 1800 Standard: Trauma (Bleeding) Objective: 4 17) Which of the following mechanisms is responsible for accumulating lactic acid in shock? A) The citric acid cycle B) Gluconeogenesis C) Hemostasis D) Anaerobic metabolism Answer: D Diff: 1 Page Ref: 1802 Standard: Trauma (Bleeding) Objective: 8 18) A hematoma resulting from a fracture of the humerus may contain enough blood to make it which class of hemorrhage? A) II B) IV C) III D) I Answer: D Diff: 3 Page Ref: 1805 Standard: Trauma (Bleeding) Objective: 6

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19) Which of these does NOT indicate compensated shock? A) Anxiety B) Altered mental status C) Weakness D) Thirst Answer: B Diff: 1 Page Ref: 1806-1807 Standard: Trauma (Bleeding) Objective: 8 20) What is the best course of action in the case of hemorrhage from either the nose or ear canal? A) Cover the area with a soft, porous dressing B) Apply direct pressure to the upper face C) Squeeze the nostrils closed D) Apply pressure to the forehead Answer: A Diff: 2 Page Ref: 1816 Standard: Trauma (Bleeding) Objective: 12 21) Even with intervention, survival is unlikely with blood loss over what percentage of the total blood volume? A) 25 B) 15 C) 50 D) 35 Answer: D Diff: 1 Page Ref: 1805 Standard: Trauma (Bleeding) Objective: 3 22) Which of the following indicates that a patient has transitioned from compensated to decompensated shock? A) Widening pulse pressure B) Increased respiratory rate C) Hypotension D) Peripheral vasoconstriction Answer: C Diff: 2 Page Ref: 1806-1807 Standard: Trauma (Bleeding) Objective: 8

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23) Red blood cells make up approximately what percent of whole blood volume? A) 45 B) 60 C) 30 D) 15 Answer: A Diff: 1 Page Ref: 1808 Standard: Trauma (Bleeding) Objective: 2 24) Which of the following is a manifestation of orthostatic hypotension? A) Your patient's pulse is 76 when he is supine but 88 when he sits up. B) Your patient's blood pressure is 142/90 when she is supine but 116/88 when she sits up. C) Your patient's blood pressure is 150/100 when he is supine but 134/90 when he sits up. D) Your patient's pulse is 80 when she is supine but 96 when she sits up. Answer: B Diff: 2 Page Ref: 1812 Standard: Trauma (Bleeding) Objective: 10 25) What method of controlling hemorrhage should be done as a last resort? A) Elevation B) Direct pressure C) Tourniquet D) Packing the wound with bandages and dressings Answer: C Diff: 3 Page Ref: 1815-1816 Standard: Trauma (Bleeding) Objective: 5 26) The blood flowing to the heart best describes: A) contractility. B) afterload. C) preload. D) vascular phase. Answer: C Diff: 1 Page Ref: 1799 Standard: Trauma (Bleeding) Objective: 2

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27) Under normal circumstances, at any given moment most of the blood is in what part of the vascular system? A) Venous B) Capillary C) Hematopoietic D) Arterial Answer: A Diff: 1 Page Ref: 1798 Standard: Trauma (Bleeding) Objective: 2 28) Which of the following best describes definitive care for the trauma patient with ongoing, significant hemorrhage? A) Administration of blood or blood products B) Administration of hypertonic crystalloid or colloid solution C) Invasive hemodynamic monitoring and serial hematocrits D) Immediate surgery Answer: D Diff: 1 Page Ref: 1802 Standard: Trauma (Bleeding) Objective: 5 29) Which of the following impairs blood clotting? A) Hypothermia B) Administration of IV fluids C) Use of nonsteroidal, anti-inflammatory medications D) All of the above Answer: D Diff: 1 Page Ref: 1801 Standard: Trauma (Bleeding) Objective: 4

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30) The rapid trauma exam focuses on finding injuries that may cause shock by quickly assessing which of the following body areas? 1. Head 2. Neck 3. Chest 4. Abdomen 5. Pelvis 6. Proximal extremities 7. Distal extremities A) 1, 2, 3, 4, and 5 B) 1, 4, 5, and 6 C) 1, 2, 3, 4, 5, 6, and 7 D) 3, 4, 5, and 6 Answer: A Diff: 1 Page Ref: 1810-1811 Standard: Trauma (Bleeding) Objective: 10 31) Which of the following statements about the patient in neurogenic shock is FALSE? A) Signs of hypovolemic shock may be masked. B) Unopposed sympathetic nervous stimulation results in systemic pallor and diaphoresis. C) Can present with neck and/or back pain. D) Neurogenic shock may require IV fluid resuscitation. Answer: B Diff: 2 Page Ref: 1808 Standard: Trauma (Bleeding) Objective: 9 32) Your patient is an obese 39-year-old woman involved in a lateral-impact motor vehicle collision. Which of the following should you remember when assessing and treating this patient? A) Relative to body size, this patient can tolerate a larger amount of hemorrhage before showing signs of shock. B) This patient will tolerate blood loss well, as only nonvital tissues will become ischemic. C) Relative to body weight, a smaller amount of hemorrhage may result in shock. D) Blood volume increases proportionally with body weight, and the patient will experience signs of shock consistent with the classic stages of hemorrhage. Answer: C Diff: 2 Page Ref: 1806 Standard: Trauma (Bleeding) Objective: 9

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33) Which of the following fluids is appropriate for the prehospital management of hypovolemic shock? A) Five percent dextrose in water B) Lactated Ringer's C) A 0.2 percent sodium chloride solution D) A 0.45 percent sodium chloride solution Answer: B Diff: 2 Page Ref: 1808 Standard: Trauma (Bleeding) Objective: 5 34) Which of the following would be the MOST likely cause of neurogenic shock? A) Pericardial tamponade B) Spinal cord injury C) Systemic infection D) Massive histamine release Answer: B Diff: 1 Page Ref: 1808 Standard: Trauma (Bleeding) Objective: 9 35) Rapid volume replacement is best achieved under which of the following conditions? A) Use of a long catheter with a large internal diameter B) Use of a long catheter with a small internal diameter C) Use of a short catheter with a small internal diameter D) Use of a short catheter with a large internal diameter Answer: D Diff: 1 Page Ref: 1819 Standard: Trauma (Bleeding) Objective: 12 36) Which of the following vessels has the greatest ability to change diameter? A) Arteriole B) Capillary C) Systemic artery D) Aorta Answer: A Diff: 1 Page Ref: 1799 Standard: Trauma (Bleeding) Objective: 1

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37) Your patient is a 29-year-old man who works in a meat-processing plant. He received a knife wound in the proximal anteromedial thigh, which is continuing to bleed on your arrival. He is restless and thirsty and has pale, cool skin. He has a weak radial pulse of 130 and a blood pressure of 118/88 mmHg. This patient is exhibiting signs and symptoms consistent with which class of hemorrhage? A) III B) II C) IV D) I Answer: B Diff: 2 Page Ref: 1805 Standard: Trauma (Bleeding) Objective: 6 38) Which of the following early signs of shock is easily missed? A) Tachycardia B) Decrease in respiratory rate and volume C) Decrease in blood pressure D) Narrowing pulse pressure Answer: A Diff: 2 Page Ref: 1805 Standard: Trauma (Bleeding) Objective: 10 39) Which of the following is TRUE of the elderly trauma patient? A) The elderly trauma patient is more likely to experience myocardial ischemia as a result of hemorrhage. B) Medications like beta blockers may interfere with normal compensatory mechanisms. C) Hemorrhage may not result in tachycardia as expected. D) All of the above are true. Answer: D Diff: 2 Page Ref: 1806 Standard: Trauma (Bleeding) Objective: 7 40) Which of the following is NOT a characteristic of arterial bleeding? A) Rapid blood loss B) Spurting or pumping as it leaves the body C) Clots quickly on its own D) Bright red Answer: C Diff: 1 Page Ref: 1799 Standard: Trauma (Bleeding) Objective: 3

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41) In responding to a trauma patient at the scene of a motor vehicle crash, which of the following is an early sign or signs of shock you might encounter during the primary assessment? A) Rapid heart rate and anxiety B) Rapidly dropping blood pressure C) Rapid breathing and air hunger D) Rapidly dropping level of responsiveness Answer: A Diff: 3 Page Ref: 1805 Standard: Trauma (Bleeding) Objective: 10 42) Which of the following represents the correct sequence for controlling hemorrhage from an extremity? A) Direct pressure on the dressing and wound, finger pressure through the dressing to the leaking vessel, and, if pressure fails, application of a tourniquet B) Direct pressure on the dressing and wound, elevation, ice C) Finger pressure through the dressing to the leaking vessel, splinting, ice, elevation D) Direct pressure on the dressing and wound, elevation, ice, tourniquet as a last resort Answer: A Diff: 1 Page Ref: 1802 Standard: Trauma (Bleeding) Objective: 5 43) Which of the following terms is best described as the loss of blood from the vascular space? A) Hypovolemia B) Hemorrhage C) Hemostasis D) Shock Answer: B Diff: 1 Page Ref: 1796 Standard: Trauma (Bleeding) Objective: 1 44) Brighter red, slow and oozing blood flow is characteristic of which type of hemorrhage? A) Arterial B) Venous C) Capillary D) Arteriole Answer: C Diff: 1 Page Ref: 1798 Standard: Trauma (Bleeding) Objective: 3

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45) Which of the following may move more slowly through the early stages of hemorrhage with greater loss percentages needed to transition from one stage class to another? A) Elderly patients B) Infants C) Alcoholics D) Athletes Answer: D Diff: 1 Page Ref: 1806 Standard: Trauma (Bleeding) Objective: 7 46) In which stage of shock are the body's cells are so badly injured and die in such quantities that organs no longer are able to function normally? A) Decompensated B) Irreversible C) Compensated D) Class I Answer: B Diff: 1 Page Ref: 1807-1808 Standard: Trauma (Bleeding) Objective: 8 47) Which of the following findings is NOT likely with a patient in cardiogenic shock? A) Pulmonary edema B) Excessive urination C) Arrhythmias D) Jugular vein distention Answer: B Diff: 1 Page Ref: 1808 Standard: Trauma (Bleeding) Objective: 9 48) What is the mechanism of TXA? A) Antifibrinolytic B) Coagulopathy C) Thrombocytopenia D) Development of metabolic acidosis Answer: A Diff: 1 Page Ref: 1803 Standard: Trauma (Bleeding) Objective: 5

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49) Which of the following vessels does NOT make up the microcirculation in the circulatory system? A) Arterioles B) Capillaries C) Venules D) Veins Answer: D Diff: 1 Page Ref: 1797 Standard: Trauma (Bleeding) Objective: 2 50) Blood present in the stool of a patient is known as: A) hemoptysis. B) hematemesis. C) hematochezia. D) hemorrhage. Answer: C Diff: 1 Page Ref: 1804 Standard: Trauma (Bleeding) Objective: 1 51) You are on the scene of a shooting where a male patient was shot by a police sniper while he had hostages. Upon safe entry to the patient, you find he has an entrance wound in the crease of the groin. He is presenting with shock and is bleeding significantly from the wound. What would be the BEST adjunct to stop the bleed, of the provided options? A) Elevation with ice application B) Junctional tourniquet C) Tourniquet D) Hemostatic clamping of the damaged blood vessel Answer: B Diff: 1 Page Ref: 1816 Standard: Trauma (Bleeding) Objective: 1 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 55 Soft Tissue Trauma 1) You are called to a commercial creamery, where an employee got his arm trapped in the ice cream mixing machinery. You note that the skin has been pulled off his hand and arm from the mid forearm down. The patient's muscles, tendons, and bones are exposed. This type of injury is a(n): A) amputation. B) skinning injury. C) degloving injury. 368 Copyright © 2023 Pearson Education, Inc.

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D) crush injury. Answer: C Diff: 2 Page Ref: 1828 Standard: Trauma (Soft Tissue Trauma) Objective: 1 2) You are assessing an assault victim and note a contusion over the abdomen. Which of these should you remember while caring for this patient? A) Unless the contusion is over a critical area, such as the spleen or liver, the likelihood of serious injury is minimal. B) A contusion to the abdomen should always increase your index of suspicion for underlying injury. C) If there is no rigidity or distension of the abdomen, serious injury is unlikely. D) The significance of the trauma is related to the amount of pain the patient experiences on palpation. Answer: B Diff: 2 Page Ref: 1825-1826 Standard: Trauma (Soft Tissue Trauma) Objective: 9 3) A nonpenetrating injury caused by blunt trauma that damages blood vessels, causing pain and discoloration, is a(n): A) ecchymosis. B) strain. C) abrasion. D) contusion. Answer: D Diff: 2 Page Ref: 1825-1826 Standard: Trauma (Soft Tissue Trauma) Objective: 1

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4) You have responded for an injured person at an address you know to be a motorcycle clubhouse. Your patient was attacked by another party with a broken beer bottle. Your patient has a large laceration on her neck with moderate bleeding. Which property of your dressing material is most important in caring for this patient? A) Occlusive B) Sterile C) Absorbent D) Adherent Answer: A Diff: 2 Page Ref: 1836 Standard: Trauma (Soft Tissue Trauma) Objective: 7 5) The tough, fibrous sheaths that bundle skeletal muscle are called: A) tendons. B) fibers. C) sarcolemma. D) fascia. Answer: D Diff: 1 Page Ref: 1825 Standard: Trauma (Soft Tissue Trauma) Objective: 3 6) Which of these statements about crush injuries is most accurate? A) Only closed injuries can be classified as crush injuries. B) The actual source of bleeding in crush injuries may be hard to identify. C) A spongy sensation on palpation of the injured area indicates crush injury. D) Crush injuries are easily identifiable because they invariably result in deformity. Answer: B Diff: 1 Page Ref: 1826 Standard: Trauma (Soft Tissue Trauma) Objective: 6 7) Which of these is best described as the accumulation of a pocket of blood in the tissues? A) Hematoma B) Abrasion C) Compartment syndrome D) Contusion Answer: A Diff: 1 Page Ref: 1826 Standard: Trauma (Soft Tissue Trauma) Objective: 1

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8) The acute breakdown of muscle fibers in crushing injury is called: A) myoglobinemia. B) sarcoidosis. C) rouleaux formation. D) rhabdomyolysis. Answer: D Diff: 1 Page Ref: 1835 Standard: Trauma (Soft Tissue Trauma) Objective: 6 9) When caring for an amputated part, which of these principles apply? 1. Place the unwrapped part in a dry plastic bag, and seal it. 2. Place the part in a plastic bag with the part wrapped in gauze moistened with lactated Ringer's solution or normal saline, and seal it. 3. Always transport the part with the patient. 4. Keep the part moist, and place it in a container of cold water. 5. Keep the part dry, and place it in an ice-filled container. A) 2, 4 B) 2, 3, 4 C) 1, 3, 5 D) 2, 5 Answer: A Diff: 2 Page Ref: 1845 Standard: Trauma (Soft Tissue Trauma) Objective: 9 10) You arrive on the scene of a patient with severe blunt trauma to the face. You hear gurgling as you approach the patient. After opening the airway with a manual maneuver, what should your next action be? A) Ventilate B) Apply a cervical collar C) Control the source of hemorrhage D) Suction Answer: D Diff: 3 Page Ref: 1847-1848 Standard: Trauma (Soft Tissue Trauma) Objective: 8

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11) Which of the following substances is NOT likely to accumulate in the bloodstream following a large crush injury? A) Myoglobin B) Potassium C) Lactic acid D) Chloride Answer: D Diff: 1 Page Ref: 1835 Standard: Trauma (Soft Tissue Trauma) Objective: 6 12) Your patient is an 18-year-old man who stepped on a nail in the barnyard. The nail penetrated his tennis shoe and punctured his foot. On your arrival, the patient has removed the nail and the shoe. The wound is about 2 mm in diameter with minor bleeding that has been controlled. The skin around the wound is red. The patient does not want to be transported but asks if you can give him "some ointment and a Band-Aid." You should explain to the patient that this type of injury is associated with an increased risk of: A) infection. B) delayed bleeding. C) scarring. D) nerve damage. Answer: A Diff: 2 Page Ref: 1832 Standard: Trauma (Soft Tissue Trauma) Objective: 10 13) In which of these ways does the integumentary system prevent pathogens from entering the body? A) Via humoral immunity B) Via cell-mediated immunity C) By secreting chemotactic factors D) By providing a barrier to the environment Answer: D Diff: 1 Page Ref: 1822 Standard: Trauma (Soft Tissue Trauma) Objective: 3 14) In which type of soft tissue injury is the skin cut or torn, leaving a flap of skin attached? A) Avulsion B) Laceration C) Amputation D) Abrasion Answer: A Diff: 1 Page Ref: 1828 Standard: Trauma (Soft Tissue Trauma) Objective: 4 372 Copyright © 2023 Pearson Education, Inc.

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15) Your patient is a 35-year-old man who has his leg trapped under a section of concrete from an industrial accident. While awaiting removal of the concrete, which type of IV fluid is indicated for administration to this patient? A) Five percent dextrose in water B) Normal saline C) Lactated Ringer's D) Whole blood Answer: B Diff: 2 Page Ref: 1847 Standard: Trauma (Soft Tissue Trauma) Objective: 9 16) The layer of skin that contains adipose tissue is known as which layer? A) Dermal B) Connective C) Epidermal D) Subcutaneous Answer: D Diff: 1 Page Ref: 1824 Standard: Trauma (Soft Tissue Trauma) Objective: 3 17) Which medication may be indicated in the treatment of a patient with a crush injury? A) Sodium bicarbonate B) Potassium chloride C) Lactated Ringer's D) Furosemide Answer: A Diff: 2 Page Ref: 1846 Standard: Trauma (Soft Tissue Trauma) Objective: 9 18) For most open soft tissue wounds managed by the paramedic in the prehospital setting, which of these is a desirable characteristic of the dressing applied? A) Occlusive B) Dry C) Adherent D) Nonabsorbent Answer: B Diff: 2 Page Ref: 1836 Standard: Trauma (Soft Tissue Trauma) Objective: 7

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19) Your patient is a 19-year-old man who received a penetrating knife wound to his chest. On your arrival, he is lying supine with a visible chest wound that is bleeding slightly. You can hear the sucking sound of air moving in and out of the wound. This wound is best managed with: A) a bulky dressing held in place with adhesive strips. B) an occlusive bandage sealed on three sides and open on the fourth side. C) a dry dressing covered by an adherent bandage. D) a sterile, wet dressing held in place with an elastic bandage. Answer: B Diff: 2 Page Ref: 1848 Standard: Trauma (Soft Tissue Trauma) Objective: 7 20) The first stage of wound healing is: A) hemostasis. B) neovascularization. C) inflammation. D) epithelialization. Answer: A Diff: 1 Page Ref: 1829 Standard: Trauma (Soft Tissue Trauma) Objective: 5 21) A laceration that is perpendicular to the tension lines of the body is more likely to: A) become infected. B) heal without a scar. C) be caused by blunt trauma. D) gape open. Answer: D Diff: 1 Page Ref: 1827 Standard: Trauma (Soft Tissue Trauma) Objective: 4 22) Your patient is a 30-year-old machinist who had his right hand caught in a press. Upon extrication, there is no evidence of significant trauma. You should: A) splint the hand in the position found, elevate above the heart, apply ice. B) splint in position of function, start an IV of normal saline, consider morphine for analgesia. C) wrap the hand in a bulky dressing held in place by an elastic bandage. D) apply oxygen by nonrebreather, splint using a sling and swath, insert a large-bore IV of lactated Ringer's. Answer: B Diff: 1 Page Ref: 1847 Standard: Trauma (Soft Tissue Trauma) Objective: 9

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23) Which of these most accurately describes the injury that removes the epidermis and the upper portion of the dermis? A) Avulsion B) Incision C) Laceration D) Abrasion Answer: D Diff: 2 Page Ref: 1826 Standard: Trauma (Soft Tissue Trauma) Objective: 4 24) Which of these is a principle that should be used when considering application of a tourniquet to control bleeding? A) A tourniquet should be used for severe bleeding that cannot be controlled by any other means. B) Every 15 minutes, the tourniquet will need to be removed for 5 minutes, then reapplied. C) A narrow, nonelastic material is best for generating the pressure needed to stop bleeding. D) A blood pressure cuff used as a tourniquet will maintain its pressure if it has been properly applied. Answer: A Diff: 2 Page Ref: 1842 Standard: Trauma (Soft Tissue Trauma) Objective: 9 25) Your patient is a 15-year-old soccer player who was kicked in the calf by another player. She has a contusion on her calf, but the amount of pain she is experiencing seems out of proportion to the apparent injury. You note that although you can palpate a pedal pulse, there is swelling in the foot and ankle, and the skin is cool to the touch. You should suspect which of these at this time? A) Compartment syndrome B) Volkmann's ischemic contracture C) Crush syndrome D) Degloving injury Answer: A Diff: 2 Page Ref: 1847 Standard: Trauma (Soft Tissue Trauma) Objective: 6 26) The bacteria most often associated with infection of open soft tissue injury is (are): A) Pasteurella multocida. B) Pseudomonas aeruginosa. C) Staphylococcus. D) Clostridium tetani. Answer: C Diff: 1 Page Ref: 1831 Standard: Trauma (Soft Tissue Trauma) Objective: 4

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27) Your patient is a three-year-old boy who has struck his head on a concrete patio. He has a linear wound that penetrates the dermis and is approximately 2 cm long. This wound would be best described as a(n): A) contusion. B) puncture. C) avulsion. D) laceration. Answer: D Diff: 2 Page Ref: 1827 Standard: Trauma (Soft Tissue Trauma) Objective: 1 28) Your patient is a 45-year-old type 2 diabetic man who has a nonhealing wound on his right foot. You note that the right leg is discolored and edematous and has subcutaneous emphysema and a foul odor. Which of these should you suspect? A) MRSA B) Gangrene C) Tetanus D) Compartment syndrome Answer: B Diff: 2 Page Ref: 1832 Standard: Trauma (Soft Tissue Trauma) Objective: 6 29) The occurrence of wounds becoming infected is one in: A) 5. B) 10. C) 15. D) 20. Answer: C Diff: 1 Page Ref: 1831 Standard: Trauma (Soft Tissue Trauma) Objective: 2 30) You are reassessing the distal circulation on a patient's forearm you have bandaged. The distal hand and wrist are cool to the touch and turning pale. The patient complains of numbness and tingling in that hand. What is your next course of action? A) Loosen the bandage and see if that relieves the signs and symptoms. B) Keep the dressing and bandage in place and expedite transport. C) Administer pain medication to help relieve the symptoms. D) Sling and swathe the arm to the chest and reassess the distal circulation. Answer: A Diff: 1 Page Ref: 1844 Standard: Trauma (Soft Tissue Trauma) Objective: 8

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31) What is the most common form of trauma in the United States? A) Sprains B) Fractures C) Soft tissue trauma D) Strains Answer: C Diff: 1 Page Ref: 1822 Standard: Trauma (Soft Tissue Trauma) Objective: 2 32) What is the third phase in the soft tissue wound healing process? A) Remodeling B) Scar tissue formation C) Scab formation D) Pain resolution Answer: B Diff: 1 Page Ref: 1830 Standard: Trauma (Soft Tissue Trauma) Objective: 5 33) What must be in place in order for a patient with a soft tissue trauma to be treated by EMS and then released to follow up with their primary care physician? A) Online medical control is advised. B) The wound must not break through the surface of the skin. C) Pain must be rated less than "2" out of "10" in intensity. D) The EMS agency must still charge the patient a bill as a "medical visit." Answer: A Diff: 1 Page Ref: 1849 Standard: Trauma (Soft Tissue Trauma) Objective: 11 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 56 Burns 1) The three primary factors that determine the severity of radiation are: A) distance, shielding, and symptoms. B) duration, shielding, and dose. C) duration, distance, and shielding. D) dose, symptoms, and shielding. Answer: C Diff: 2 Page Ref: 1858 Standard: Trauma (Soft Tissue Trauma) Objective: 4

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2) Which of these has contributed most significantly to the decline in U.S. burn mortality? A) Public service announcements on radio, television, and billboards B) Paramedic involvement in public education C) Visits to elementary schools by firefighters D) Improved building codes and construction and sprinkler and smoke detector use Answer: D Diff: 1 Page Ref: 1852 Standard: Trauma (Soft Tissue Trauma) Objective: 2 3) Which classification of burn is characterized mainly by blisters? A) Full thickness B) Superficial C) Partial thickness D) Minor Answer: C Diff: 1 Page Ref: 1860-1861 Standard: Trauma (Soft Tissue Trauma) Objective: 5 4) Based on total body surface area and burn depth, you have determined that an 88-year-old woman has a moderate burn. Considering the age of the patient, this burn is classified as: A) critical. B) significant. C) fatal. D) moderate. Answer: A Diff: 2 Page Ref: 1867 Standard: Trauma (Soft Tissue Trauma) Objective: 6 5) An area of burned tissue that is not painful is MOST likely what type of burn injury? A) Deep partial thickness B) Full thickness C) Superficial D) Partial thickness Answer: B Diff: 1 Page Ref: 1869 Standard: Trauma (Soft Tissue Trauma) Objective: 5 6) You have been dispatched to a call for a burn patient. Upon arriving, you find a 23-year-old woman who was sunbathing and fell asleep. She is alert and oriented and in moderate pain. She has blisters covering her extremities, abdomen, face, and chest. This patient's burns fall into which one of these categories? A) Superficial 378 Copyright © 2023 Pearson Education, Inc.

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B) Critical C) Minor D) Moderate Answer: B Diff: 2 Page Ref: 1867 Standard: Trauma (Soft Tissue Trauma) Objective: 6 7) Which of these phases of burn injury is best described as including a pain response, an outpouring of catecholamines, tachycardia, tachypnea, mild hypertension, and anxiety? A) Resolution B) Emergent C) Fluid shift D) Hypermetabolic Answer: B Diff: 1 Page Ref: 1855 Standard: Trauma (Soft Tissue Trauma) Objective: 4 8) A scoring system used to estimate burn severity is known as: A) severity calculation. B) Baux score. C) Cleveland score. D) Boris calculation. Answer: B Diff: 1 Page Ref: 1867 Standard: Trauma (Soft Tissue Trauma) Objective: 1

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9) Contact with strong alkalis results in what type of tissue necrosis? A) Coagulation B) Liquefaction C) Thermal D) Ischemic Answer: B Diff: 1 Page Ref: 1857 Standard: Trauma (Soft Tissue Trauma) Objective: 1 10) Your patient has circumferential full thickness burns of the thorax. He is intubated, and you have noticed an increase in resistance as you bag him. His skin is very tight and inflexible as you try to ventilate. Which of these is required to improve this patient's ventilatory status? A) IV sedation B) Needle thoracostomy C) Escharotomy D) Fasciotomy Answer: C Diff: 2 Page Ref: 1870 Standard: Trauma (Soft Tissue Trauma) Objective: 10 11) Which body area warrants special attention when burned? A) Legs B) Arms C) Abdomen D) Feet Answer: D Diff: 1 Page Ref: 1867 Standard: Trauma (Soft Tissue Trauma) Objective: 6 12) Which patient factor increases the criticality of the patient's burn injuries? A) Taking antidepressants B) Male gender C) Prior history of burns D) Being in the geriatric age group Answer: D Diff: 2 Page Ref: 1867 Standard: Trauma (Soft Tissue Trauma) Objective: 6

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13) You are dispatched to a structure fire at which there is a report of a burned person. Your patient is a 32-year-old man with blisters on his anterior chest and circumferential superficial burns to both lower extremities. Using the "rule of nines," the percentage of burn is: A) 54. B) 27. C) 36. D) 45. Answer: D Diff: 2 Page Ref: 1861-1862 Standard: Trauma (Soft Tissue Trauma) Objective: 8 14) Which agent is the best choice for analgesia in a patient with 9 percent partial thickness burns involving the right lower extremity? A) Naproxen sodium B) Ketorolac C) Acetaminophen D) Fentanyl Answer: D Diff: 1 Page Ref: 1869 Standard: Trauma (Soft Tissue Trauma) Objective: 10 15) The type of electricity supplied to homes is current may result in . A) indirect; rhabdomyolysis B) direct; rhabdomyolysis C) direct; muscle tetany D) alternating; muscle immobolization Answer: D Diff: 1 Page Ref: 1856 Standard: Trauma (Soft Tissue Trauma) Objective: 4

current. Contact with this type of

16) You are caring for a patient with 30 percent full and partial thickness burns. He is an 80 kg man. According to the Parkland formula, he should receive liters of fluid over 24 hours, with liters infused in the first 8 hours. A) 9.6; 4.8 B) 5; 3 C) 8.2; 2 D) 4.5; 1.25 Answer: A Diff: 2 Page Ref: 1869 Standard: Trauma (Soft Tissue Trauma) Objective: 9

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17) According to Jackson's theory of thermal wounds, which zone has suffered the greatest damage? A) Coagulation B) Hyperemia C) Stasis D) Disintegration Answer: A Diff: 1 Page Ref: 1854 Standard: Trauma (Soft Tissue Trauma) Objective: 4 18) Which type of radiation particle can travel through 6 to 10 feet of air, penetrate a few layers of clothing, and cause external and internal injuries? A) Gamma B) Alpha C) Neutron D) Beta Answer: D Diff: 1 Page Ref: 1858 Standard: Trauma (Soft Tissue Trauma) Objective: 4 19) What mechanism accounts for the most severe thermal burns of the airway? A) Inhalation of toxic gases B) Inhalation of radioactive particles in smoke C) Inhalation of superheated steam D) Inhalation of superheated air Answer: C Diff: 1 Page Ref: 1859 Standard: Trauma (Soft Tissue Trauma) Objective: 4 20) Which of these may occur from watching arc welding without proper protection? A) Hyphema B) Retinal detachment C) Ultraviolet keratitis D) Radial keratotomy Answer: C Diff: 1 Page Ref: 1861 Standard: Trauma (Soft Tissue Trauma) Objective: 4

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21) For which of these burn patients could you use local cooling? A) An 18-month-old child with partial and full thickness scald burns on the lower extremities, buttocks, genitalia, and lower abdomen B) A 19-year-old woman with approximately 40 percent superficial and 45 percent partial thickness burns from sunbathing C) A 15-year-old man with partial thickness burns of his left upper extremity, anterior chest, and neck resulting from playing with gasoline and matches D) A 52-year-old man with a 1-inch-wide full thickness burn across the entire width of the palm of his right hand resulting from picking up a hot grate from a barbecue grill Answer: D Diff: 2 Page Ref: 1868 Standard: Trauma (Soft Tissue Trauma) Objective: 9 22) A burn patient who has signs and symptoms of inhalation injury with associated respiratory compromise should be classified as: A) serious. B) moderate. C) critical. D) minor. Answer: C Diff: 1 Page Ref: 1867 Standard: Trauma (Soft Tissue Trauma) Objective: 9 23) You are assessing a 17-year-old male patient with a burn on the lateral aspect of his thigh. Which guideline is most helpful when estimating the percentage of total body surface area involved? A) The rule of palms B) The Parkland formula C) The rule of nines D) The modified pediatric rule of nines Answer: A Diff: 1 Page Ref: 1861-1862 Standard: Trauma (Soft Tissue Trauma) Objective: 6 24) Which of these is TRUE of the heat generated when electricity flows through the body? A) Dry skin offers less resistance to electricity, generating more heat. B) Wet skin offers less resistance to electricity, generating more heat. C) Wet skin offers greater resistance to electricity, generating more heat. D) Dry skin offers more resistance to electricity, generating more heat. Answer: D Diff: 1 Page Ref: 1855 Standard: Trauma (Soft Tissue Trauma) Objective: 3 383 Copyright © 2023 Pearson Education, Inc.

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25) Cool-water immersion of a burned part effectively reduces burning only when done within which of these time frames? A) The first 24 hours B) The first 10 to 15 minutes C) The first 1 to 2 minutes D) The first hour Answer: C Diff: 1 Page Ref: 1868 Standard: Trauma (Soft Tissue Trauma) Objective: 10 26) Paralysis of the muscles of respiration may occur when there is body contact with electrical currents as low as: A) 60 mA. B) 100 hertz. C) 20 mA. D) 5 hertz. Answer: C Diff: 1 Page Ref: 1856 Standard: Trauma (Soft Tissue Trauma) Objective: 4 27) The first step for treating a patient who has been contaminated with dry lime is to: A) neutralize the lime with a mild acidic solution, such as vinegar and water. B) brush away as much of the powder as possible. C) flush the skin with large amounts of isopropyl alcohol. D) flush with copious amounts of tepid water. Answer: B Diff: 1 Page Ref: 1872 Standard: Trauma (Soft Tissue Trauma) Objective: 10 28) Which of these best explains the pathophysiology of most burns to the human body? A) Heat causes evaporation of water and denatures protein. B) Radiation, including solar radiation and radiant heat, alters cell structures. C) Chemicals cause an endothermic reaction that destroys tissue. D) The skin, and sometimes deeper tissues, is destroyed through combustion. Answer: A Diff: 1 Page Ref: 1857 Standard: Trauma (Soft Tissue Trauma) Objective: 7

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29) Which of these represents the modified body surface area percentages in the "rule of nines" for pediatric patients? A) Posterior chest is 7 percent. B) Upper extremities are 13.5 percent each. C) External genitalia is 1 percent. D) Lower extremities are 13.5 percent each. Answer: D Diff: 1 Page Ref: 1861 Standard: Trauma (Soft Tissue Trauma) Objective: 8 30) The voltage of a bolt of lightning may be as much as may reach degrees Fahrenheit. A) 5,000; 150,000 B) 150,000; 5,000 C) 50,000; 100,000 D) 100,000; 50,000 Answer: D Diff: 1 Page Ref: 1871 Standard: Trauma (Soft Tissue Trauma) Objective: 4

volts, and its temperature

31) Most inhalation injuries in burn patients are due to: A) toxic inhalation, B) radiation burns of the airway. C) thermal burns of the lower airway. D) thermal burns of the upper airway. Answer: A Diff: 1 Page Ref: 1859 Standard: Trauma (Soft Tissue Trauma) Objective: 4 32) During which phase of a burn injury does extravasation of proteins, water, and electrolytes occur, resulting in edema and potential hypovolemia? A) Emergent B) Hyperemia C) Hypermetabolic D) Fluid shift Answer: D Diff: 2 Page Ref: 1855 Standard: Trauma (Soft Tissue Trauma) Objective: 7

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33) Your patient is a 23-year-old woman who was rescued from a burning house. She was asleep in a back bedroom when the fire started, and there was no smoke alarm. She has a pulse oximetry reading of 99 percent after receiving oxygen by nonrebreather mask. What is the most appropriate interpretation of this finding? A) Effects of smoke inhalation have been resolved by oxygen administration. B) You cannot rely on this alone to assess oxygenation. C) There was minimal smoke inhalation. D) Carboxyhemoglobin is less than 1 percent. Answer: B Diff: 2 Page Ref: 1865 Standard: Trauma (Soft Tissue Trauma) Objective: 8 34) Which body structure is the best electricity conductor? A) Bones B) Nerves C) Muscle D) Skin Answer: B Diff: 1 Page Ref: 1855 Standard: Trauma (Soft Tissue Trauma) Objective: 4 35) Which of these burns would be classified as moderate? A) Superficial < 50 percent BSA B) Full thickness < 2 percent BSA C) Partial thickness < 30 percent BSA D) Partial thickness > 30 percent BSA Answer: C Diff: 1 Page Ref: 1867 Standard: Trauma (Soft Tissue Trauma) Objective: 9 36) Patients who survive the first several days of a moderate to critical burn are MOST likely to die from which complication? A) Hypovolemia B) Organ failure C) Infection D) Hypothermia Answer: C Diff: 2 Page Ref: 1868 Standard: Trauma (Soft Tissue Trauma) Objective: 8

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37) Flash burns associated with electricity occur because: A) air is a moderately good conductor of electricity, generating moderate heat. B) air is an excellent conductor of electricity, generating moderate heat. C) air is mildly resistant to the passage of electricity, generating only enough heat to cause superficial burns. D) air is highly resistant to the passage of electricity, generating intense heat. Answer: D Diff: 2 Page Ref: 1856 Standard: Trauma (Soft Tissue Trauma) Objective: 4 38) You are assessing a 37-year-old woman who was rescued from an apartment fire. She has a harsh, stridorous, "brassy" sounding cough productive of sooty sputum. Her eyebrows and the hair around her face are singed. Respirations = 28, heart rate = 108, and blood pressure = 124/84. You have a 30-minute transport time. Which of these is the best intervention for this patient? A) One hundred percent oxygen by nonrebreather mask B) Sedation and cricothyrotomy C) A nebulized albuterol treatment D) Rapid sequence intubation and endotracheal intubation Answer: D Diff: 3 Page Ref: 1865-1866 Standard: Trauma (Soft Tissue Trauma) Objective: 10 39) What is the estimated number of deaths annually for Americans? A) < 200,000 B) > 480,000 C) > 520,000 D) < 375,000 Answer: B Diff: 1 Page Ref: 1852 Standard: Trauma (Soft Tissue Trauma) Objective: 2 40) Which of these chemicals must be brushed off the skin, then covered with oil? A) Phenol B) Sodium metal C) Oleoresin capsicum D) Dry lime Answer: B Diff: 1 Page Ref: 1872 Standard: Trauma (Soft Tissue Trauma) Objective: 10

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41) Due to the damage to skin layers from a thermal burn, what pathophysiology is LEAST likely to occur? A) Pain perception may be altered. B) Heat regulation may be lost. C) Infection barrier is reduced. D) Muscle tetany causes significant pain. Answer: D Diff: 1 Page Ref: 1853 Standard: Trauma (Soft Tissue Trauma) Objective: 3 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 57 Head, Face, Neck, and Spinal Trauma 1) Which of these best describes the effect of hyperventilation in the brain-injured patient? A) It is beneficial, because vasodilation results in increased cerebral blood flow. B) It is detrimental, because vasodilation causes an increase in tissue edema. C) It is beneficial, because vasoconstriction results in improved cerebral blood flow. D) It is detrimental, because vasoconstriction results in decreased cerebral perfusion. Answer: D Diff: 2 Page Ref: 1901 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 6 2) Your patient is a 45-year-old man with extensive blunt trauma to the face. He has decorticate posturing in response to pain; weak, irregular respiratory effort at 6 per minute; and a heart rate of 50 with a good radial pulse. The patient appears to have nasal and mandibular fractures, and an oropharyngeal airway is insufficient to keep the tongue from the posterior pharynx. Which of these treatments has the greatest potential to negatively impact the patient? A) Retrograde intubation B) Oral intubation under direct laryngoscopy C) Nasotracheal intubation D) Use of a supraglottic airway Answer: C Diff: 3 Page Ref: 1914 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9 3) Which of these medications may be indicated in the prehospital management of the patient with traumatic brain injury? A) Methylprednisolone B) Diazoxide C) Mannitol D) Furosemide 388 Copyright © 2023 Pearson Education, Inc.

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Answer: C Diff: 2 Page Ref: 1929 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10

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4) Circulation to the face is provided by which artery? A) External carotid B) Internal carotid C) Midfacial D) Mandibular Answer: A Diff: 2 Page Ref: 1881 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 5) Which of these correctly describes the impact of motorcycle helmet use? A) Helmet usage is associated with a 10 percent reduction in serious head injuries. B) There have been no reported fatalities from motorcycle collisions in which the riders were wearing helmets. C) Helmet usage decreases the risk of serious head injuries but increases the risk of cervicalspine injuries. D) Helmet usage results in a more than 50 percent reduction in serious head injuries. Answer: D Diff: 1 Page Ref: 1873-1884 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 2 6) Which of these parameters should be used to guide the oxygenation and ventilation of the patient with a traumatic brain injury? A) Maintain an oxygen saturation level of at least 96 percent and a capnography reading between 35 and 40 mmHg. B) Maintain an oxygen saturation level of at least 90 percent and a capnography level < 45 mmHg. C) Maintain an oxygen saturation level of at least 98 percent and a capnography reading > 45 mmHg. D) Maintain an oxygen saturation level of at least 90 percent and a capnography reading < 35 mmHg. Answer: A Diff: 2 Page Ref: 1918 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10

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7) You are caring for a 22-year-old amateur boxer who complained of a sudden obstruction of part of his visual field. This complaint is most consistent with which of these conditions? A) Extrusion of the eyeball B) Subconjunctival hemorrhage C) Hyphema D) Retinal detachment Answer: D Diff: 2 Page Ref: 1915 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 8 8) Regarding the primary assessment of the patient with suspected traumatic brain injury, which of these describes the best approach to assessing the patient's neurological functioning? A) The use of AVPU B) Assessing the patient for level of consciousness and orientation to person, place, and time C) Assessing a revised trauma score D) Assessing a Champion trauma scale score Answer: B Diff: 1 Page Ref: 1917 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9 9) Which of these best describes the percentage of mortality from penetrating gunshot wounds to the cranium? A) 35 to 50 B) 75 to 80 C) 90 to 95 D) 10 to 15 Answer: B Diff: 1 Page Ref: 1874 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 2 10) Your patient has received blunt facial trauma due to an assault. For which of these injuries should you maintain a high index of suspicion? A) Airway obstruction B) Hypoxia due to aspiration of blood C) Basilar skull fracture D) Lumbar spine trauma Answer: C Diff: 2 Page Ref: 1911 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 8

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11) Which is one of the thinnest and most frequently fractured cranial bones? A) Temporal B) Ethmoid C) Parietal D) Occipital Answer: A Diff: 1 Page Ref: 1911 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 2 12) Which of these patients fit the criteria for application of spine motion restriction precautions in the prehospital setting? A) An 85-year-old man who has fallen down three steps and has a large laceration to the occipital region of the skull, but no complaints of cervical pain or peripheral numbness B) A 21-year-old man who was diving into a pool and states he hit his head, but is out of the pool and ambulatory upon your arrival with no complaint of neck or back pain C) A 36-year-old woman who was involved in a minor motor vehicle crash with an obvious closed tibia fracture D) A 44-year-old male who was in a bar fight was knocked unconscious and was kicked repeatedly about the head and neck Answer: D Diff: 2 Page Ref: 1925-1927 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10 13) During the early care for a patient with a basilar skull fracture in the prehospital setting, which of these would be an unexpected finding? A) Periorbital ecchymoses or "raccoon eyes" B) CSF otorrhea C) Blood mixed with cerebral spinal fluid flowing from the mouth D) CSF rhinorrhea Answer: A Diff: 2 Page Ref: 1911 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9 14) Which of these skull fractures is most common? A) Linear B) Basilar C) Depressed D) Comminuted Answer: A Diff: 1 Page Ref: 1911 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 2

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15) Which of these features of the cranium exacerbates the severity of intracranial trauma? A) It is rigid. B) It is formed of dense, heavy bone. C) It is relatively thin in the frontal region. D) The sutures allow for separation of the bones. Answer: A Diff: 1 Page Ref: 1875 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 16) Your patient is a seven-year-old male pedestrian who was struck by a vehicle. Your assessment reveals bleeding from the right auditory canal. Which of these describes the most appropriate way to manage this? A) Determining the presence or absence of cerebrospinal fluid is a low priority. Pack the auditory canal with sterile gauze to control bleeding. B) Use a "halo" test to determine whether cerebrospinal fluid is in the blood. If it is, loosely cover the ear with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. If cerebrospinal fluid is not present, pack the ear canal with sterile gauze to control bleeding. C) Determining the presence or absence of cerebrospinal fluid in the blood is a low priority. Loosely cover the ear with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. D) Check the glucose level in the blood draining from the ear. If it is less than the patient's blood glucose level, there is cerebrospinal fluid present. Cover the ear loosely with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. If the glucose level of the blood from the ear is the same as the patient's blood glucose level, pack the auditory canal with sterile gauze to control bleeding. Answer: C Diff: 3 Page Ref: 1912 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10 17) When developing a spinal clearance policy, age: A) should never be considered, as age does not matter. B) should be considered only when the patient is a man between the ages of 21 and 35. C) should be considered, as the very old may not be able to describe their symptoms accurately. D) should be considered only if the patient is a minor. Answer: C Diff: 1 Page Ref: 1925 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9

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18) Your patient is a 22-year-old female assault victim. She has blunt trauma to the face with swelling around the right eye and zygomatic area. Upon assessing her eye movement, you note that the right eye cannot follow your finger and does not move. Which of these MOST likely explains this finding? A) She has a fracture of the orbit that has trapped the optic nerve, thereby paralyzing her gaze. B) She has direct trauma to the eyeball that has damaged the intrinsic muscles of the eye. C) She has a fracture of the orbit that has trapped the extrinsic eye muscles. D) She has direct trauma to the eyeball that has damaged the optic nerve, thereby paralyzing her gaze. Answer: C Diff: 2 Page Ref: 1914 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 8 19) Which of these groups is NOT among those with the highest incidence of serious head trauma? A) The elderly B) Young men C) Middle-aged men D) Infants Answer: C Diff: 1 Page Ref: 1874 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 2 20) For the head injury patient without signs of herniation, adjust ventilation rates to maintain a capnography reading of between: A) 15 and 20 mmHg. B) 25 and 30 mmHg. C) 45 and 50 mmHg. D) 35 and 40 mmHg. Answer: D Diff: 2 Page Ref: 1918 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 6

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21) Your patient is a 37-year-old male unrestrained driver of a vehicle. You find him with his upper body across the console and his head hanging down into the passenger's side floorboard area. You note pooled blood from a scalp wound. After immobilizing him and loading him into the ambulance, where you have more light for your examination, you note that he has a large, full-thickness avulsion of the scalp. The patient's heart rate is 112, respirations are 20, and blood pressure is 82/50. Which of these statements about this patient are TRUE? 1. The scalp wound itself cannot account for the patient's vital signs. 2. The scalp wound itself may account for the patient's vital signs. 3. The patient's vital signs are consistent with increasing intracranial pressure. 4. Nothing about the vital signs indicates increased intracranial pressure. A) 1 and 4 B) 2 and 3 C) 1 and 3 D) 2 and 4 Answer: D Diff: 3 Page Ref: 1920 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 8 22) When palpating the spine of a patient during your assessment, you are feeling the: A) spinous processes. B) vertebral bodies. C) transverse vertebral processes. D) vertebral pedicles. Answer: A Diff: 1 Page Ref: 1886 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 23) A patient who has dived into a shallow pool and hit his head on the bottom is MOST likely to have which of these types of injury? A) Cervical hyperextension B) Cervical hyperflexion C) Axial distraction D) Axial loading Answer: D Diff: 2 Page Ref: 1904 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 4

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24) Recent research has provided evidence of which of these regarding spinal injury assessment? A) Only trauma patients with signs and symptoms of neurological deficit need to receive spinal immobilization. B) Paramedics cannot reliably identify patients who are likely to have spinal injuries. C) All trauma patients should be assumed to have spinal injuries. D) There are reliable criteria for determining the likelihood of spinal injury. Answer: D Diff: 2 Page Ref: 1925 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9 25) Which of these is a common mechanism of injury associated with spinal cord injuries? A) Falls greater than 20 feet B) Bungee jumping C) Shallow water diving D) All of the above Answer: D Diff: 1 Page Ref: 1903-1905 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 4 26) Which of these best describes the goals of manual cervical spine stabilization? A) Preventing movement of the head in any direction; prevent any flexion/extension, rotation, or lateral bending B) Keeping the head in an "eyes forward" position; applying enough traction to cause axial unloading, which is 18 to 22 pounds in the average adult C) Preventing rotation of the head; avoiding any upward lifting or downward pressure on the cervical spine D) Preventing movement of the head in any direction; applying gentle axial pressure to stabilize the vertebral column Answer: A Diff: 2 Page Ref: 1923-1924 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9

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27) Which of these statements about the administration of dextrose to the patient with a traumatic brain injury is TRUE? A) Hypoglycemia is associated with a poorer neurologic outcome; if the blood glucose level is less than 60 mg/dL, administer 25 grams of dextrose. B) Hypoglycemia is inconsequential to neurologic outcome; assessing the blood glucose level is not a priority. C) Hyperglycemia is associated with a poorer neurologic outcome; never administer dextrose to a patient with traumatic brain injury. D) Hypoglycemia is associated with a poorer neurologic outcome. All patients with suspected traumatic brain injury who have an altered mental status should receive 25 grams of dextrose intravenously. Answer: A Diff: 2 Page Ref: 1929 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10 28) You are caring for a 20-year-old skateboarder who crashed into a brick retaining wall at the bottom of a steep hill. He has blunt trauma to his face with nose deformity, loose teeth, and bleeding from the nose and mouth. Although you have answered him several times, he keeps repeating to you, "What happened? It seems like I'm having a bad day." This is most indicative of what condition? A) Aphasia B) Retrograde amnesia C) Decorticate disorientation D) Anterograde amnesia Answer: D Diff: 2 Page Ref: 1902 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 5 29) What are the two most important prehospital considerations for head injury patients? A) Initiating spine motion restriction and providing mechanical ventilation B) ICP monitoring and administering corticosteroids to limit cerebral edema C) Initiating ventilation and administering corticosteroids for spinal shock D) Assuring adequate ventilation and maintaining adequate blood pressure Answer: D Diff: 2 Page Ref: 1918 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10

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30) Your patient states that he had a traumatic brain injury from a motorcycle collision three years ago. You notice that his gait is unsteady and his movements are a bit jerky. You suspect that he has damage to which of these structures? A) Falx cerebri B) Reticular activating system C) Third cranial nerve D) Cerebellum Answer: D Diff: 2 Page Ref: 1877-1878 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 5 31) Which of these is NOT a component of the Glasgow Coma Scale? A) Eye opening B) Motor ability C) Pupillary reaction D) Verbal response Answer: C Diff: 1 Page Ref: 1917 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9 32) Which of these is the largest structure of the nervous system? A) Cerebellum B) Pons C) Medulla oblongata D) Cerebrum Answer: D Diff: 1 Page Ref: 1877 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 33) Which of these Glasgow Coma Scale scores indicates serious brain injury? A) < 3 B) Between 12 and 15 C) < 8 D) < 15 Answer: C Diff: 2 Page Ref: 1917 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9

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34) The cerebral perfusion pressure is represented by which of these equations? A) CPP = MAP − CVP B) CPP = CVP − ICP C) CPP = MAP − ICP D) CPP = ICP − MAP Answer: C Diff: 1 Page Ref: 1879 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 35) Which of these mechanisms causes indirect brain injury? A) Coup/contrecoup injuries B) Systemic hypotension combined with increasing intracranial pressure C) Cushing's reflex D) Acceleration/deceleration forces without a direct blow to the cranium Answer: B Diff: 2 Page Ref: 1900 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 6 36) Which of these best describes consensual reactivity of the pupils? A) It is a pathological phenomenon. When a penlight is shone into one eye, both pupils constrict. B) It is a normal phenomenon. When a penlight is shone into one eye, only that pupil will constrict, while the other pupil is unaffected. C) It is a normal phenomenon. When a penlight is shone into one eye, both pupils constrict. D) It is a pathological phenomenon. When a penlight is shone into one eye, only that pupil constricts, while the other pupil is unaffected. Answer: C Diff: 2 Page Ref: 1919 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3

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37) Your patient is a 12-year-old boy who was struck in the right temporal area of the head with a baseball. He had a brief loss of consciousness per bystanders, and is now alert on your arrival. You note that he is becoming drowsy again and has a strong radial pulse of 60, a blood pressure of 140/70, and a respiratory rate of 12. Which of these best describes this patient's condition? A) He is stable, and he most likely has a subarachnoid hemorrhage with no increase in intracranial pressure. B) He is critical, and he most likely has an epidural hematoma with rapidly increasing intracranial pressure. C) He is stable, and he most likely has a mild diffuse axonal injury with no increase in intracranial pressure. D) He is serious, and he most likely has a subdural hematoma with an increase in intracranial pressure. Answer: B Diff: 3 Page Ref: 1998 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 5 38) The shearing, stretching, and tearing associated with rapid acceleration/deceleration forces acting on the brain result in which of these types of brain injury? A) Direct, diffuse B) Indirect, diffuse C) Indirect, focal D) Direct, focal Answer: A Diff: 2 Page Ref: 1899-1900 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 4 39) A concussion is best described as which of these types of brain injuries? A) Indirect, diffuse B) Indirect, focal C) Direct, focal D) Direct, diffuse Answer: D Diff: 2 Page Ref: 1899 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 5

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40) For the patient with suspected traumatic brain injury, the ideal positioning of the patient for transport is: A) in a left lateral recumbent position on the backboard. B) on a long backboard with the foot of the backboard in a 15-degree Trendelenburg position. C) on a long backboard with the patient's feet elevated on pillows to achieve a 15-degree angle. D) on a long backboard with the head of the backboard elevated 15 to 30 degrees. Answer: D Diff: 2 Page Ref: 1928 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10 41) When CPP falls below the critical level of 50 mmHG, autoregulation does which of these to maintain CPP and cerebral perfusion? A) Decreases systolic blood pressure B) Increases systolic blood pressure C) Decreases intracranial pressure D) Increases intracranial pressure Answer: B Diff: 1 Page Ref: 1879 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 6 42) Which of these about the use of prehospital fluid resuscitation in the patient with a traumatic brain injury is TRUE? A) Administer fluids aggressively regardless of the patient's blood pressure. B) Do not administer fluids unless the patient's blood pressure drops below 60 mmHg, because the administration of fluids leads to increased cerebral edema. C) Administer fluids as needed to maintain a systolic blood pressure above 90 mmHg. D) The use of hypertonic fluids is indicated to maintain vascular volume while reducing tissue edema. Answer: C Diff: 2 Page Ref: 1920 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10

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43) Which of these best describes the role of rapid sequence intubation (RSI) in the prehospital management of patients with traumatic brain injury? A) It is beneficial and should be used for all patients with traumatic brain injury who are experiencing trismus or who have an intact gag reflex. B) It is supported by anecdotal evidence, but no studies have been done to determine its feasibility or usefulness. C) It is controversial because of conflicting study results. D) It is detrimental, resulting in poorer neurological outcomes than in patients who received standard airway management. Answer: C Diff: 2 Page Ref: 1927 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10 44) Which of these statements about the patient in neurogenic shock is NOT true? A) The patient's heart rate may be slow. B) The patient's blood pressure is decreasing. C) Signs of hypovolemic shock may be masked. D) Unopposed sympathetic nervous system stimulation results in generalized pallor and diaphoresis. Answer: D Diff: 2 Page Ref: 1908 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 7 45) Coup injuries commonly occur in which region of the brain? A) Frontal region B) Occipital region C) Temporal region D) Neuronal region Answer: A Diff: 1 Page Ref: 1897 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 5 46) Anterior cord syndrome is caused by which of these mechanisms? A) Tearing of the anterior cord due to hyperextension mechanisms B) Disruption of arterial blood supply to the anterior cord C) Laceration of the anterior cord caused by bone fragments D) Contusion of the anterior cord caused by blunt trauma Answer: B Diff: 1 Page Ref: 1907 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 7

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47) The diaphragm is controlled by peripheral nerve roots: A) C3 to C7. B) C3 to C5. C) C1 to C7. D) C1 to C5. Answer: D Diff: 1 Page Ref: 1894 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 48) The spinal cord is continuous from the brain to the level of: A) T12 or T13. B) L5 or L6. C) the coccyx. D) L1 or L2. Answer: D Diff: 1 Page Ref: 1916 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 49) You are treating a 16-year-old male patient who fell while practicing a new move on his skateboard. Bystanders relate that the patient was not wearing a helmet. The bystanders also relate that the patient was alert and oriented following the fall; however, while waiting for you to arrive, the patient became unconscious. While performing your physical exam, you note that the patient has a hematoma to the right temporal area. Your assessment leads you to believe that your patient has an epidural hematoma. You know that an epidural hematoma is caused by what type of bleeding? A) Venous bleeding B) Capillary bleeding C) Arterial bleeding D) Venous and capillary bleeding Answer: C Diff: 2 Page Ref: 1898 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 5

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50) You have intubated a five-year-old girl with a suspected head injury. You note that the patient is exhibiting signs of herniation. What is the desired range for this patient's end-tidal CO2? A) 35 to 40 B) 30 to 35 C) 25 to 30 D) 40 to 45 Answer: B Diff: 2 Page Ref: 1918 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10 51) The phrenic nerve consists of peripheral nerve roots: A) C1 to C3. B) C5 to C8. C) C3 to C5. D) C1 to C8. Answer: C Diff: 1 Page Ref: 1894 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 52) Your patient is a 17-year-old female who fell from a horse. She is complaining of being unable to move. During your assessment, you have placed her arms at her sides, but her arms keeping returning to a "stick-up" or "hold-up" position. Based on this, which of these is MOST likely? A) The patient has a spinal cord injury at T1. B) The patient has Brown-Séquard syndrome. C) The patient is feigning the injury. D) The patient has a spinal cord injury in the midcervical region. Answer: D Diff: 2 Page Ref: 1922 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 7 53) All the following are seen in Cushing's triad, EXCEPT: A) increased blood pressure. B) irregular respirations. C) tachycardia. D) all of the above are seen in Cushing's triad. Answer: C Diff: 1 Page Ref: 1903 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 6

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54) Which of these spinal cord injuries is LEAST likely to result in residual neurologic deficit? A) Compression B) Transection C) Contusion D) Laceration Answer: C Diff: 1 Page Ref: 1906 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 7 55) Pediatric patients are likely to become hypovolemic from head injuries than adult patients. A) more B) less C) equally D) Pediatric patients always become hypovolemic due to the movable fontanels. Answer: A Diff: 1 Page Ref: 1903 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 2 56) A spinal cord lesion may result in paralysis of both lower extremities. This condition is known as: A) hemiplegia. B) hemiparesis. C) quadriplegia. D) paraplegia. Answer: D Diff: 1 Page Ref: 1906-1907 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 1 57) When assessing an individual who has lost sensation below the umbilicus, at what level do you suspect injury? A) T10 B) T4 C) L1 D) T8 Answer: A Diff: 1 Page Ref: 1894 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 7

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58) Which of these is a function of the sympathetic nervous system? A) Digestion B) Sexual functioning C) Constriction of the pupils D) Increased heart rate Answer: D Diff: 1 Page Ref: 1895 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 59) All of these are used in the sedation of patients for rapid sequence intubation, EXCEPT: A) Valium. B) Romazicon. C) etomidate. D) ketamine. Answer: B Diff: 1 Page Ref: 1927 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10 60) A patient unable to extend the leg or flex the hip is MOST likely to have incurred an injury in which nerve plexus? A) Cervical B) Lumbar C) Brachial D) Sacral Answer: B Diff: 1 Page Ref: 1894 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 61) Which of these is noted in the patient with a positive Babinski's sign? A) Fanning of the toes with plantar flexion of the great toe B) Dorsiflexion of the second to fifth toes with plantar flexion of the great toe C) Fanning of the toes with dorsiflexion of the great toe D) Plantar flexion of the second to fifth toes with dorsiflexion of the great toe Answer: C Diff: 1 Page Ref: 1920 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 6

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62) The cerebrum, cerebellum, and brainstem account for what percentage of the cranial volume? A) 60 percent B) 80 percent C) 50 percent D) 75 percent Answer: B Diff: 1 Page Ref: 1877 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 63) A patient who had a spinal cord T4 injury two years ago calls 911 for a pounding headache, blurred vision, and flushing. On your arrival, her vital signs include a blood pressure of 240/120 and pulse of 58. What is this condition called? A) Autonomic hyperreflexia syndrome B) Spinal shock C) Malignant hypertension D) Brown-Séquard syndrome Answer: A Diff: 2 Page Ref: 1908-1909 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 7 64) You are on the scene of a domestic assault in which the female victim defended herself against further attack by stabbing her attacker. Your patient is a 36-year-old man who has been stabbed in the posterior thorax about 1 centimeter to the right of the spinous process of T6. Your assessment reveals loss of motor and sensory function on the right side distal to T6 but intact motor function with some loss of sensation on the left side distal to T6. Which of these best explains this patient's presentation? A) "Pseudoneurologic" deficit to avoid being arrested B) Brown-Séquard syndrome C) Central cord syndrome D) Autonomic hyperreflexia Answer: B Diff: 2 Page Ref: 1908 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 7

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65) In a subdural hematoma, the vessel most commonly involved is the: A) superior sagittal sinus. B) inferior sagittal sinus. C) middle meningeal artery. D) superior meningeal artery. Answer: A Diff: 1 Page Ref: 1898 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 5 66) A concussion is what type of brain injury? A) Deformed B) Indirect C) Diffuse D) Delayed Answer: C Diff: 2 Page Ref: 1899 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 5 67) Which of these mechanisms are involved in neurogenic shock? 1. Unopposed vasodilation 2. Loss of innervation to the adrenal medulla 3. Decreased preload 4. Unopposed sympathetic tone A) 1, 2, 3 B) 1, 3, 4 C) 1, 2, 3, 4 D) 1, 3 Answer: A Diff: 2 Page Ref: 1908 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 7 68) When providing fluid resuscitation for a one-year-old child with hypovolemia from a head injury, the goal is to maintain a systolic blood pressure of: A) 90 mmHg. B) 85 mmHg. C) 75 mmHg. D) 65 mmHg. Answer: D Diff: 1 Page Ref: 1928 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10

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69) Which syndrome causes motor weakness that affects the upper extremities and usually occurs in patients older than 50 years of age? A) Central cord B) Anterior cord C) Brown-Séquard D) Cauda equina Answer: A Diff: 1 Page Ref: 1908 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 7 70) Which facial fracture characteristically involves the entire facial region below the brow ridge, including the zygoma, nasal bone, and maxilla? A) Le Fort I B) Le Fort II C) Le Fort III D) Le Fort IV Answer: C Diff: 1 Page Ref: 1913 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 8 71) Intracranial Volume = Brain Volume + CSF Volume + Blood Volume is the basis behind which of these? A) Cerebral perfusion pressure B) Monroe-Kellie doctrine C) Mean arterial pressure D) Traumatic brain injury Answer: B Diff: 1 Page Ref: 1879 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 1 72) Which of these trauma patients is MOST likely to have SCIWORA when examined in the hospital? A) 5-year-old male B) 80-year-old female C) 21-year-old male D) 45-year-old female Answer: A Diff: 2 Page Ref: 1909-1910 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 2

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73) Which of the cervical vertebrae is quite pronounced and can be felt as the first bony prominence along the spine and just above the shoulders? A) C3 B) C1 C) C6 D) C7 Answer: D Diff: 1 Page Ref: 1887 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 74) When assessing the eyes of a patient with head trauma, you can tell the function of all the following cranial nerves, EXCEPT: A) II. B) VII. C) IV. D) VI. Answer: B Diff: 2 Page Ref: 1919 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9 75) Your patient has sustained trauma to the eye. Upon examination, you see blood pooling in the anterior chamber and in front of the iris and pupil. What is this condition called? A) Mediastinitis B) Otorrhea C) Icterus D) Hyphema Answer: D Diff: 1 Page Ref: 1915 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 1 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 58 Chest Trauma 1) Which of these is the correct description of a wound that is below the fifth rib, directly in line with the armpit? A) Sixth intercostal space, midclavicular B) Sixth intercostal space, midaxillary line C) Fifth intercostal space, midclavicular line D) Fifth intercostal space, midaxillary line Answer: D Diff: 2 Page Ref: 1935 410 Copyright © 2023 Pearson Education, Inc.

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Standard: Trauma (Chest Trauma) Objective: 3 2) The morbidity associated with simple pneumothorax is primarily due to: A) occlusion of pulmonary circulation. B) increased intrathoracic pressure. C) loss of chest wall integrity. D) ventilation/perfusion mismatch. Answer: D Diff: 2 Page Ref: 1943 Standard: Trauma (Chest Trauma) Objective: 5 3) On maximal expiration, the diaphragm may be: A) as high as the fourth intercostal space anteriorly. B) as high as the second intercostal space anteriorly. C) as low as the ninth intercostal space anteriorly. D) as low as the eleventh intercostal space anteriorly. Answer: A Diff: 2 Page Ref: 1951 Standard: Trauma (Chest Trauma) Objective: 3 4) Which of these occurs during the onset of inspiration? A) Intrathoracic pressure increases and venous return to the heart is impeded. B) Intrathoracic pressure increases and venous return to the heart is facilitated. C) Intrathoracic pressure decreases and venous return to the heart is impeded. D) Intrathoracic pressure decreases and venous return to the heart is facilitated. Answer: D Diff: 2 Page Ref: 1936 Standard: Trauma (Chest Trauma) Objective: 3 5) The trachea divides into the right and left mainstem bronchi at the: A) carina. B) hilum. C) lingual. D) thoracic inlet. Answer: A Diff: 1 Page Ref: 1936 Standard: Trauma (Chest Trauma) Objective: 3 6) Which of these has the greatest likelihood of resulting in an open pneumothorax? A) Any opening between the pleural cavity and the atmosphere B) Open defects that are two-thirds the size of the trachea or larger 411 Copyright © 2023 Pearson Education, Inc.

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C) Open defects that are larger in diameter than the trachea D) Open defects that are one-quarter the size of the trachea or larger Answer: B Diff: 2 Page Ref: 1944 Standard: Trauma (Chest Trauma) Objective: 4 7) Your patient is a 38-year-old man who was pinned beneath the frame of a vehicle when it slipped off the makeshift jacks he was using to elevate it. The patient's brother thinks he may have been trapped for up to 20 minutes. The rescue unit is preparing to use airbags to lift the vehicle off the patient. Which of these medications could you consider giving this patient? A) Magnesium sulfate B) Calcium chloride C) Sodium bicarbonate D) Potassium chloride Answer: C Diff: 2 Page Ref: 1962 Standard: Trauma (Chest Trauma) Objective: 8 8) Your patient is a 27-year-old man with one stab wound at the fifth intercostal space posteriorly, on the right. He is ambulatory at the scene, but dyspneic and has air movement at the site of the injury. What should you do first? A) Apply oxygen by nonrebreather. B) Cover the wound with rolled gauze. C) Cover the wound with an occlusive dressing. D) Perform a needle thoracostomy. Answer: C Diff: 3 Page Ref: 1958 Standard: Trauma (Chest Trauma) Objective: 8

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9) Which of the following statements is NOT true of pericardial tamponade? A) It is most often associated with penetrating trauma. B) The systolic blood pressure increases significantly on inspiration. C) As little as 150 mL of blood can cause pericardial tamponade. D) The pathophysiology results in increased venous pressure and decreased cardiac output. Answer: B Diff: 1 Page Ref: 1949 Standard: Trauma (Chest Trauma) Objective: 6 10) Which of the following statements concerning blunt thoracic trauma in the pediatric population is most accurate? A) Children are more likely than adults to suffer both rib fracture and organ injury. B) Children are less likely than adults to suffer either rib fractures or organ injury. C) Children are more likely than adults to suffer rib fractures but less likely to suffer significant organ injury. D) Children are less likely than adults to suffer rib fractures but more likely to have significant organ injury. Answer: D Diff: 2 Page Ref: 1938-1939 Standard: Trauma (Chest Trauma) Objective: 4 11) An individual is struck in the left ventricle with a low-velocity projectile. As compared to high-velocity penetrating trauma, you should have a higher index of suspicion for: A) ventricular rupture. B) pericardial tamponade. C) simple penetrating injury. D) blunt cardiac injury. Answer: B Diff: 3 Page Ref: 1948 Standard: Trauma (Chest Trauma) Objective: 7 12) Your patient received a blow to the left lateral chest at the level of the sixth and seventh ribs. You should suspect fractures at: A) the point of impact of the sixth rib only. B) the point of impact and the posterior axillary line of the sixth rib only. C) the point of impact on both ribs. D) the point of impact and along the axillary line of both ribs. Answer: D Diff: 2 Page Ref: 1940-1941 Standard: Trauma (Chest Trauma) Objective: 4

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13) You have arrived on the scene of a paramedic who was shot as she approached a residence on a call. The scene has since been secured. Your patient is a 38-year-old woman with one gunshot wound to the left side of the chest at the fifth intercostal space in the midaxillary line. She is pale, cool, and awake but agitated. She is diaphoretic and complaining of pain in her left side and difficulty breathing. The patient's EMT partner has applied oxygen by nonrebreather mask and placed an occlusive dressing over the entry wound before your arrival. As you continue your assessment, the patient's level of consciousness decreases. She responds to verbal stimuli. Her airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her breath sounds are absent on the left side. The patient lacks a radial pulse, and her abdomen is nonguarded and nontender. Which of these best explains the presentation of this patient? A) Simple pneumothorax B) Tension pneumothorax C) Pericardial tamponade D) Hemothorax Answer: D Diff: 3 Page Ref: 1946 Standard: Trauma (Chest Trauma) Objective: 7 14) You have arrived on the scene of a paramedic who was shot as she approached a residence on a call. The scene has since been secured. Your patient is a 38-year-old woman with one gunshot wound to the left side of the chest at the fifth intercostal space in the midaxillary line. She is pale, cool, and awake but agitated. She is diaphoretic and complaining of pain in her left side and difficulty breathing. The patient's EMT partner has applied oxygen by nonrebreathing mask and placed an occlusive dressing over the entry wound before your arrival. As you continue your assessment, the patient's level of consciousness decreases. She responds to verbal stimuli. Her airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her breath sounds are absent on the left side. The patient lacks a radial pulse, and the abdomen is nonguarded and nontender. Which should you do first? A) Start a large-bore IV of isotonic crystalloid solution. B) Do a rapid trauma assessment. C) Assist ventilations with a bag-valve-mask device. D) Do an immediate needle chest decompression. Answer: C Diff: 3 Page Ref: 1958 Standard: Trauma (Chest Trauma) Objective: 8

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15) Which of these is TRUE regarding pulmonary contusions? A) Signs and symptoms generally develop gradually. B) Pulmonary contusion is typically an isolated injury. C) The primary pathophysiology is that the alveoli are filled with blood. D) Pulmonary contusion results in paradoxical motion of the chest wall. Answer: A Diff: 2 Page Ref: 1947 Standard: Trauma (Chest Trauma) Objective: 5 16) Which of these is the primary prehospital concern with a simple, isolated fracture of the fifth rib in the right posterior–axillary line? A) Hemorrhage B) Pneumonia C) Hypoventilation D) Liver contusion Answer: C Diff: 2 Page Ref: 1957 Standard: Trauma (Chest Trauma) Objective: 5 17) Which of these best describes the threat to life associated with traumatic rupture of the esophagus? A) Entry of gastric contents into the mediastinum B) Hypoxia C) Decreased cardiac output D) Massive hemorrhage Answer: A Diff: 1 Page Ref: 1952 Standard: Trauma (Chest Trauma) Objective: 5 18) Which of these best describes the epidemiology of sternal fracture? A) Low incidence, low mortality B) High incidence, high mortality C) High incidence, low mortality D) Low incidence, high mortality Answer: D Diff: 1 Page Ref: 1942 Standard: Trauma (Chest Trauma) Objective: 2

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19) Abdominal trauma should be suspected with penetrating thoracic wounds below the rib anteriorly and the rib posteriorly. A) fourth; ninth B) second; fifth C) fourth; sixth D) second; tenth Answer: C Diff: 2 Page Ref: 1951 Standard: Trauma (Chest Trauma) Objective: 5 20) Your patient is an 80-year-old man who was the unrestrained driver of a vehicle without airbags that was involved in a frontal collision with a parked car. Your assessment reveals that he is dyspneic, tachypneic, and tachycardic. He is awake but unable to respond to questions. There are no obvious signs of injury to the head or neck. The patient has paradoxical movement of the sternum with breathing, along with crepitus and subcutaneous air noted on palpation. Chest excursion is limited, and the patient has cyanosis of his lips, ears, and nail beds. Which of these is most needed in this patient? A) Infusion of isotonic crystalloid solution using a large-bore IV B) Application of bulky dressings over the site of paradoxical motion C) Being placed in a prone position to stabilize the chest wall D) Intubation and positive-pressure ventilation Answer: D Diff: 3 Page Ref: 1958 Standard: Trauma (Chest Trauma) Objective: 8 21) Traumatic asphyxia is from what type of mechanism of injury? A) Compression B) Deceleration C) Decompression D) Acceleration Answer: A Diff: 1 Page Ref: 1952 Standard: Trauma (Chest Trauma) Objective: 5

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22) Which of these is a complication of positive-pressure ventilation in the patient with significant chest trauma? A) Pulmonary contusion B) Atelectasis C) Exacerbation of flail chest D) Impaired venous return to the heart Answer: D Diff: 3 Page Ref: 1957 Standard: Trauma (Chest Trauma) Objective: 7 23) Which of these most accurately characterizes simple pneumothorax? A) Untreated, it will lead to mediastinal shift and compression of the contralateral lung. B) It is a problem of ventilation/perfusion mismatch. C) It results from air entering the pleural cavity through a defect in the chest wall. D) It results from the creation of a one-way valve that continues to allow air into, but not out of, the pleural cavity. Answer: B Diff: 1 Page Ref: 1943 Standard: Trauma (Chest Trauma) Objective: 5 24) Which of the following findings BEST differentiates a simple pneumothorax from a tension pneumothorax? A) Decreased breath sounds on the affected side B) Hemodynamic compromise C) Absent breath sounds on the affected side D) An open defect in the chest wall Answer: B Diff: 2 Page Ref: 1945-1956 Standard: Trauma (Chest Trauma) Objective: 7 25) Hemothorax is primarily a problem of: A) blood loss. B) impaired ventilation. C) upper airway occlusion. D) increased intrathoracic pressure. Answer: A Diff: 2 Page Ref: 1946 Standard: Trauma (Chest Trauma) Objective: 6

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26) Your patient is a 15-year-old male who was struck in the chest with a baseball. He is unresponsive, pulseless, and apneic. The monitor shows ventricular fibrillation. This condition is most accurately described as: A) pericardial tamponade. B) blunt cardiac injury. C) commotio cordis. D) traumatic asphyxia. Answer: C Diff: 2 Page Ref: 1948 Standard: Trauma (Chest Trauma) Objective: 1 27) Your patient is a 21-year-old man with a single, small-caliber gunshot wound to the left anterior chest, just lateral to the sternum at the fourth intercostal space. Bleeding from the wound is minimal. The patient is initially anxious, combative, and diaphoretic. Initial vital signs include a heart rate of 100, respirations of 20, and a blood pressure of 110/80. Breath sounds are clear bilaterally and equal. En route, the patient becomes quieter but still restless. The heart rate increases to 120, respirations are 24, blood pressure 106/88, and breath sounds remain clear and equal. The patient has also developed significant JVD. You are 15 minutes from a Level I trauma center and 5 minutes away from a large community hospital. You should: A) immediately decompress the left chest and divert to the community hospital for chest tube insertion. B) immediately decompress the left chest and continue to the trauma center for chest tube insertion. C) continue to the Level I trauma center for pericardiocentesis. D) divert to the community hospital for pericardiocentesis. Answer: D Diff: 3 Page Ref: 1961 Standard: Trauma (Chest Trauma) Objective: 8 28) Which of the following best describes the mechanism of blunt thoracic trauma associated with blast injuries? A) Deceleration B) Acceleration C) Compression D) Compression and decompression Answer: D Diff: 1 Page Ref: 1938 Standard: Trauma (Chest Trauma) Objective: 4

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29) Thoracic trauma accounts for approximately what percent of mortality from trauma? A) 20 to 25 B) 10 to 15 C) 75 to 80 D) 45 to 50 Answer: A Diff: 1 Page Ref: 1934 Standard: Trauma (Chest Trauma) Objective: 2 30) Which of the following is the primary concern in the patient with a hemothorax? A) Hypovolemia B) Increased intrathoracic pressure C) Mediastinal shift D) Atelectasis Answer: A Diff: 2 Page Ref: 1961 Standard: Trauma (Chest Trauma) Objective: 6 31) Your patient was the unrestrained driver of a motor vehicle without airbags. The vehicle struck a large utility pole at about 45 miles per hour. Your patient has a contusion over his chest and upper abdomen consistent with the shape of the steering wheel. You should suspect which injury in this patient? A) Compression B) Compression and acceleration C) Compression and deceleration D) Deceleration Answer: C Diff: 2 Page Ref: 1938-1939 Standard: Trauma (Chest Trauma) Objective: 4 32) The location of the neurovascular bundles containing the intercostal arteries is best described as the bundle that runs along the: A) intercostal space equally distant from both associated ribs. B) anterior surface of the associated rib. C) superior margin of the associated rib. D) lower inside rib margin of the associated rib. Answer: D Diff: 1 Page Ref: 1959 Standard: Trauma (Chest Trauma) Objective: 3

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33) Your patient is a 24-year-old man who was struck just below the left scapula with a 3-inchdiameter metal pipe. He is awake but having difficulty breathing. His pulse is 112 at the radial artery, and his respiratory rate is 28 per minute and shallow. His breath sounds are present bilaterally but diminished on the left. He has a blood pressure of 108/68. The pulse ox is not reading right. The patient is coughing up some bloody sputum. He has no other complaints, and a rapid trauma survey reveals no additional life-threatening injuries. What represents the best sequence of interventions for this patient? A) Begin transport immediately, positive pressure ventilation, a large-bore IV of isotonic solution to maintain a systolic blood pressure of 120 mmHg or greater. B) High-concentration oxygen by nonrebreather mask, begin transport, a 16-gauge IV at a keep open rate. C) Positive-pressure ventilation, a large-bore IV of normal saline solution at a keep open rate, transport. D) High-concentration oxygen by nonrebreather mask, begin transport, two 14-gauge IVs of 50 percent dextrose solution wide open. Answer: B Diff: 3 Page Ref: 1957 Standard: Trauma (Chest Trauma) Objective: 8 34) Which of these best describes the incidence of pericardial tamponade? A) It occurs in 10 to 15 percent of all trauma patients. B) It occurs in less than 2 percent of all patients with serious chest trauma. C) It occurs in 10 to 15 percent of patients with serious chest trauma. D) It occurs in 2 percent of all trauma patients. Answer: B Diff: 1 Page Ref: 1948 Standard: Trauma (Chest Trauma) Objective: 2 35) The angle of Louis serves as a landmark to help identify needle thoracostomy at which of the following locations? A) Second intercostal space anteriorly B) Second intercostal space laterally C) Fourth intercostal space anteriorly D) Fourth intercostal space laterally Answer: A Diff: 2 Page Ref: 1935 Standard: Trauma (Chest Trauma) Objective: 3

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36) The central area in the thorax that contains the heart, great vessels, trachea, and esophagus is the: A) mediastinum. B) pulmonary hilum. C) hemothorax. D) carina. Answer: A Diff: 1 Page Ref: 1936 Standard: Trauma (Chest Trauma) Objective: 1 37) You have just inserted a large-bore catheter into the chest of a patient with a tension pneumothorax and received a return of air. Which of these should NOT be done? A) Insert a second, or even a third, catheter if the patient is symptomatic, despite the release of air. B) Leave the catheter in place, and create a flutter valve. C) Leave the catheter in place and open to air. D) Remove the catheter. Answer: D Diff: 2 Page Ref: 1960 Standard: Trauma (Chest Trauma) Objective: 8 38) Another name for an open pneumothorax is: A) tension pneumothorax. B) sucking chest wound. C) flail chest. D) hemopneumothorax. Answer: B Diff: 1 Page Ref: 1944 Standard: Trauma (Chest Trauma) Objective: 5 39) Which of these is LEAST likely to be a sign of an open pneumothorax? A) Penetration injury to the posterior chest B) Frothy blood around the injury site C) Jugular vein distention D) Dyspnea Answer: C Diff: 2 Page Ref: 1944 Standard: Trauma (Chest Trauma) Objective: 5

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40) Which of these best describes the finding of tracheal shift in the trauma patient? A) Its absence rules out tension pneumothorax. B) It is the earliest sign of tension pneumothorax. C) It is a rare finding in patients with tension pneumothorax. D) It is a contraindication to needle thoracostomy in tension pneumothorax. Answer: C Diff: 2 Page Ref: 1945 Standard: Trauma (Chest Trauma) Objective: 7 41) The finding of jugular venous distention in the patient with thoracic trauma is LEAST likely to be associated with which of the following? A) Traumatic asphyxia B) Hemothorax C) Tension pneumothorax D) Pericardial tamponade Answer: B Diff: 2 Page Ref: 1946 Standard: Trauma (Chest Trauma) Objective: 7 42) Which intervention may improve breathing in the patient with isolated rib fractures? A) Nitrous oxide B) Taping circumferentially around the chest C) Morphine sulfate D) None of the above Answer: C Diff: 2 Page Ref: 1957 Standard: Trauma (Chest Trauma) Objective: 8 43) Which of these are the most commonly fractured ribs? A) 1 to 3 B) 4 to 8 C) 7 to 12 D) 5 to 10 Answer: B Diff: 1 Page Ref: 1941 Standard: Trauma (Chest Trauma) Objective: 4

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44) You are treating a patient whose open chest wound has been sealed by EMTs on the scene before your arrival with an occlusive dressing. During transport the patient becomes more dyspneic, tachycardic, and hypotensive. There are no breath sounds on the affected side, and the patient has JVD. Which is the best action? A) Reinforce the dressing with additional tape, using tincture of benzoin, if necessary, to improve the seal. B) Perform a needle thoracostomy at the second intercostal space in the midclavicular line. C) Perform a needle thoracostomy at the fourth intercostal space in the midaxillary line. D) Remove the dressing and see if the patient's clinical status improves, then replace the dressing. Answer: D Diff: 2 Page Ref: 1944 Standard: Trauma (Chest Trauma) Objective: 8 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 59 Abdominal and Pelvic Trauma 1) Which of the following patients may have trauma to abdominal organs? 1. A 30-year-old construction worker who fell from a second-story roof but managed to land on his feet 2. A 17-year-old male with a gunshot wound to the right buttock 3. A 50-year-old male with a stab wound 4 cm inferior to the right scapula 4. A 45-year-old female restrained driver of an SUV with a moderate-speed frontal impact A) 1, 2, 3, 4 B) 3, 4 C) 1, 4 D) 1, 3, 4 Answer: A Diff: 2 Page Ref: 1968 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 4 2) Which physiological change is NOT of concern in the pregnant trauma patient? A) Disproportionate increase in vascular volume as compared to red blood cells B) The high likelihood of trauma to the uterus in the first trimester C) Compression of the inferior vena cava D) Rupture of the urinary bladder Answer: B Diff: 2 Page Ref: 1972 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 3 3) Which structure is a double peritoneal fold containing blood vessels, lymphatic vessels, 423 Copyright © 2023 Pearson Education, Inc.

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nerves, and fatty tissue? A) Retroperitoneal space B) Pancreas C) Peritoneum D) Mesentery Answer: D Diff: 2 Page Ref: 1971 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 1

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4) What is the best description for shear injuries to the abdominal organs? A) Sudden compression of gas-containing hollow organs, resulting in their rupture B) Sudden decompression of solid or hollow organs C) Tearing of the organ in which the organ is fixed at its point of attachment but free to move otherwise D) Impact of solid organs with the abdominal wall in rapid deceleration Answer: C Diff: 1 Page Ref: 1975 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 5 5) What percentage of time is the liver injured with penetrating knife abdominal trauma? A) 10 B) 40 C) 25 D) 75 Answer: B Diff: 1 Page Ref: 1968 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 2 6) Your patient is a 30-year-old pregnant woman at 36 weeks' gestation. She was injured in a fall from a horse and is complaining of painful contractions. Her abdomen is tender to palpation over the uterus, and the uterus becomes firm with contractions, but she denies vaginal bleeding. The patient is anxious, but her skin is warm and dry. Her blood pressure is 112/70, her heart rate is 92, and her respirations are 24. Which of the following statements best describes this situation? A) The mechanism and patient complaints are suspicious for abruptio placentae. The mother's condition is not life-threatening, but fetal demise has most likely already occurred. B) The mechanism and patient complaints are consistent with placenta previa. The mother is stable, but the fetus is in jeopardy. C) The mechanism and patient complaints are consistent with uterine rupture. Both the mother and fetus are in jeopardy. D) The mechanism and patient complaints are suspicious for abruptio placentae. Both the mother and the fetus are in jeopardy. Answer: D Diff: 3 Page Ref: 1978-1979 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 6

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7) Which of the following can reduce the potential for abdominal injury? A) Proper placement of automobile lap belts in adults B) Side-impact airbags C) Proper placement of automobile lap belts in children D) Proper seatbelt use, side-impact airbags, and proper seatbelt use in children Answer: D Diff: 1 Page Ref: 1968 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 2 8) Which of these is TRUE regarding abdominal trauma? A) A soft, nontender, nondistended abdomen with intact bowel sounds reliably rules out hollow organ injury. B) Due to the vascular nature of abdominopelvic organs, the onset of signs and symptoms is abrupt and severe. C) A soft, nontender, nondistended abdomen reliably rules out solid organ injury. D) A significant amount of blood can accumulate in the abdominal cavity before signs and symptoms of abdominal injury appear. Answer: D Diff: 2 Page Ref: 1976-1977 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 5 9) Which statement is true regarding definitive care of the patient with traumatic intraabdominal hemorrhage? A) Admission to the ICU for observation is required B) Aggressive oxygenation and fluid resuscitation is needed C) Administration of blood or blood products will be necessary D) Rapid surgical intervention is often required Answer: D Diff: 1 Page Ref: 1979 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 7 10) The suspicion of blunt abdominal trauma should be based primarily on: A) the mechanism of injury. B) distension of the abdomen on palpation. C) the patient's complaint of abdominal pain. D) the presence of contusions. Answer: A Diff: 2 Page Ref: 1975 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 6

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11) Which of these is NOT a special consideration when managing the pregnant trauma patient? A) She is at increased risk for vomiting and aspiration. B) She may have a 30 percent blood volume loss before experiencing signs and symptoms of shock. C) Placing her supine may decrease cardiac output. D) There is an increased likelihood of head trauma in the pregnant female. Answer: D Diff: 1 Page Ref: 1977-1978 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 6 12) Your patient is a 17-year-old male driver of a vehicle that received a lateral impact at the driver's side door. There are no side-impact airbags, and there is about 8 inches of intrusion into the passenger compartment at the left door. Your patient is complaining of left shoulder pain and pain "in his left side." He has a contusion on the left shoulder and deformity of the left clavicle. He has erythema over the left lateral thorax from ribs 6 through 12 with crepitus on palpation. Which injuries should you suspect? 1. Blunt trauma to the spleen 2. Blunt trauma to the liver 3. Penetrating trauma to the spleen 4. Penetrating trauma to the liver 5. Left pneumothorax 6. Fracture of the left clavicle A) 1, 2, 6 B) 2, 4, 6 C) 1, 5, 6 D) 2, 5, 6 Answer: C Diff: 3 Page Ref: 1979-1981 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 7 13) Which guideline applies to prehospital fluid resuscitation of hypotensive patients with intraabdominal hemorrhage? A) In most cases, fluid administration should be limited to 2 liters. B) IV access should be obtained using a saline lock, but fluid resuscitation is contraindicated in the prehospital setting. C) Fluid administration rate should be titrated to maintain a systolic blood pressure of 60 mmHg. D) IV access is necessary only if the use of PASG fails to improve the patient's clinical condition. Answer: A Diff: 1 Page Ref: 1984 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 7

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14) Which organ is NOT part of the digestive system? A) Liver B) Spleen C) Stomach D) Pancreas Answer: B Diff: 1 Page Ref: 1972 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 3 15) Damage to which of the following organs is MOST likely to induce severe infection in the abdominal cavity? A) Urinary bladder B) Colon C) Stomach D) Ureter Answer: B Diff: 2 Page Ref: 1976 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 5 16) Your patient is an 18-year-old man who was slashed across the abdomen with a machete. He has a mass of omentum and small bowel protruding from the wound. What is your primary concern with this patient? A) Immediately covering the wound with an occlusive dressing, using your gloved hand if nothing else is available B) Irrigating the exposed organs with sterile saline to remove debris and gently tucking them back into the opening to keep them warm and moist and to prevent further contamination C) Covering the wound with a sterile, saline-moistened dressing covered by an occlusive dressing D) Having the patient hold the omentum and placing him on the stretcher in a position of comfort to transport rapidly Answer: C Diff: 2 Page Ref: 1984 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 7 17) Which of these will NOT affect the pattern of injury in abdominal trauma? A) A full-term uterus B) A full stomach C) A full bladder D) A concurrent abdominal infection Answer: D Diff: 1 Page Ref: 1979-1981 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 4 428 Copyright © 2023 Pearson Education, Inc.

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18) Which of these is TRUE of the epidemiology of abdominal trauma? A) Morbidity and mortality due to blunt trauma are decreasing, but morbidity and mortality due to penetrating trauma are increasing. B) Morbidity and mortality due to blunt trauma are increasing, but morbidity and mortality due to penetrating are decreasing. C) Morbidity and mortality due to blunt and penetrating trauma are both increasing. D) Mortality and morbidity due to blunt and penetrating trauma are both decreasing. Answer: A Diff: 2 Page Ref: 1968 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 2 19) Which of these organs is LEAST likely to be injured in penetrating trauma to the abdomen? A) Spleen B) Kidney C) Pancreas D) Small intestine Answer: C Diff: 1 Page Ref: 1974 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 4 20) The injury in which abdominal organs protrude through a large, deep laceration of the abdominal wall is best described as: A) disimpaction. B) a gutting injury. C) herniation. D) evisceration. Answer: D Diff: 1 Page Ref: 1975 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 1 21) Your patient is a 60-year-old female restrained driver involved in a moderate-speed frontal impact collision. When you arrive at the scene, she is sitting up in the driver's seat with a chief complaint of a burning sensation in her face. You note abrasions from deployment of the airbag. After transitioning the patient to the ambulance, you begin transport. During your detailed examination, the patient complains of developing right shoulder pain. What should you suspect? A) Myocardial contusion B) Intraabdominal bleeding C) Exacerbation of the patient's arthritis due to immobilization on the backboard D) Shoulder contusion or possible clavicle fracture due to restraint by the shoulder harness Answer: B Diff: 2 Page Ref: 1976 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 7 429 Copyright © 2023 Pearson Education, Inc.

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22) How much blood loss can occur in a third-trimester pregnant female before she will show signs or symptoms of hypovolemia? A) 30 percent B) 25 percent C) 40 percent D) 15 percent Answer: A Diff: 1 Page Ref: 1983 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 6 23) Which of the following is MOST likely to occur as a result of rapid deceleration without actual contact between the patient's body and the interior of the vehicle? A) Blunt trauma to the pancreas B) Rupture of the colon C) Kidney contusion D) Shearing injury of the liver Answer: D Diff: 2 Page Ref: 1976 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 4 24) Which of the following is TRUE of the patient with a suspected penetrating injury to or rupture of the diaphragm? A) This is the only abdominal injury for which removal of an impaled object is recommended. B) This is one of the primary indications for the use of PASG. C) Shallow respirations may be due to abdominal contents in the thorax. D) Breathing is not impaired unless abdominal organs migrate into the thoracic cavity. Answer: C Diff: 2 Page Ref: 1981 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 4 25) Which of these is NOT part of the prehospital examination of the patient with suspected abdominal trauma? A) Asking the patient about abdominal pain first, then palpating the abdomen in all four quadrants B) Checking for blood in the urine C) Checking for stability of the pelvis D) Assessment of the thorax for injury Answer: B Diff: 2 Page Ref: 1979-1983 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 6

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Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 60 Orthopedic Trauma 1) Which of these is NOT part of the axial skeleton? A) Sacrum B) Pubis C) Sternum D) Mandible Answer: B Diff: 2 Page Ref: 1992 Standard: Trauma (Orthopedic Trauma) Objective: 4 2) Your patient is a 27-year-old male ice skater whose left skate was planted when he was struck and knocked down by another skater. He is agitated and complaining of severe pain in his leg. Your examination reveals an open fracture 6 inches proximal to the ankle joint. Which describes the most appropriate management of this patient? A) Focused exam, oxygen, spinal immobilization, splint from the foot to above the knee, begin transport, start a large-bore IV, and request orders for analgesia B) Focused exam, cover the open wound, apply a lower extremity traction splint, begin transport, start an IV, and request orders for analgesia C) Focused exam, cover the open wound, splint from the foot to above the knee, begin transport, start an IV, and request orders for analgesia D) Rapid trauma exam, high-concentration oxygen, cervical spine immobilization, cover the open wound, use the long backboard for initial splinting, initiate transport, start a large-bore IV, perform a detailed examination, use padded board splints to immobilize from the ankle to above the knee, and reassess the patient every 5 minutes Answer: C Diff: 3 Page Ref: 2001 Standard: Trauma (Orthopedic Trauma) Objective: 9 3) Your patient is a football player who had his right foot planted and was tackled from the left rear, causing his body to rotate around the axis of his right lower extremity. This mechanism is most consistent with which type of fractures? A) Oblique B) Spiral C) Impacted D) Comminuted Answer: B Diff: 2 Page Ref: 2001-2002 Standard: Trauma (Orthopedic Trauma) Objective: 5

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4) Which of these is the highest priority when managing a patient with bilateral closed femur fractures? A) Assessing distal neurovascular function B) Anticipating hypovolemia C) Providing analgesia D) Anticipating pulmonary embolism as a complication Answer: B Diff: 2 Page Ref: 2006 Standard: Trauma (Orthopedic Trauma) Objective: 6 5) Upon assessing a patient with a hip injury, you find that his right lower extremity is moved away from the midline of the body. You should describe the right lower extremity as being: A) abducted. B) externally rotated. C) angulated. D) adducted. Answer: A Diff: 2 Page Ref: 1991 Standard: Trauma (Orthopedic Trauma) Objective: 1 6) Which of these is NOT a consideration in preventing an orthopedic injury? A) Proper footwear B) Well-designed railings C) Appropriate stepladder use D) Doing outside work on a weekend day Answer: D Diff: 1 Page Ref: 1988 Standard: Trauma (Orthopedic Trauma) Objective: 3 7) Your patient is a 20-year-old woman complaining of ankle pain after stepping off a curb. She states that she is concerned because she had a grade III sprain a year and a half ago that required extensive treatment and rehabilitation. Which answer most accurately describes the patient's previous injury? A) The ankle ligaments were stretched but not torn. B) The ankle ligaments had a minor tear. C) The ankle ligaments were torn but not all the way. D) The ankle ligaments were completely torn. Answer: D Diff: 1 Page Ref: 2000 Standard: Trauma (Orthopedic Trauma) Objective: 5

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8) Tendons connect what two structures? A) Muscles to bones B) Bones to bones C) Cartilage to bones D) Muscles to fascia Answer: A Diff: 1 Page Ref: 1998 Standard: Trauma (Orthopedic Trauma) Objective: 4 9) The use of a binder is indicated in the treatment in which of these musculoskeletal injuries? A) Bilateral tibia/fibula fractures B) Knee dislocation C) Lumbar vertebral compression fracture D) Pelvic fracture Answer: D Diff: 2 Page Ref: 2006 Standard: Trauma (Orthopedic Trauma) Objective: 8 10) Which of these supplies articular cartilage with oxygen and nutrients? A) Bursae B) Capillary beds C) Synovial fluid D) The Haversian system Answer: C Diff: 1 Page Ref: 1991 Standard: Trauma (Orthopedic Trauma) Objective: 4 11) A partial displacement of a bone end from its position in the joint is called a: A) sprain. B) dislocation. C) subluxation. D) contracture. Answer: C Diff: 1 Page Ref: 2000 Standard: Trauma (Orthopedic Trauma) Objective: 1

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12) A fracture in which significant energy exchange shatters or splinters bone, creating many fragments, is called a(n): A) impacted fracture. B) comminuted fracture. C) oblique fracture. D) spiral fracture. Answer: B Diff: 1 Page Ref: 2001 Standard: Trauma (Orthopedic Trauma) Objective: 5 13) Your patient is a seven-year-old boy with a fracture of the proximal tibia. Which of these is the MOST likely and serious complication of this injury? A) Juvenile onset arthritis B) Formation of a bone callus C) Disruption of the epiphyseal plate D) Fat embolism Answer: C Diff: 2 Page Ref: 2003 Standard: Trauma (Orthopedic Trauma) Objective: 5 14) What best describes the function of cancellous bone of the medullary canal? A) It produces erythrocytes. B) It acts as a growth plate in long bones. C) Its dense, compact structure is well adapted to weight bearing. D) It contains yellow bone marrow. Answer: A Diff: 1 Page Ref: 1990 Standard: Trauma (Orthopedic Trauma) Objective: 4 15) A dislocated knee is MOST likely to damage which vascular structures? A) Femoral vein B) Popliteal artery C) Femoral artery D) Great saphenous vein Answer: B Diff: 1 Page Ref: 2018 Standard: Trauma (Orthopedic Trauma) Objective: 5

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16) Which fracture type occurs in pediatric age groups but not in adults? A) Oblique B) Transverse C) Greenstick D) Impacted Answer: C Diff: 1 Page Ref: 2021 Standard: Trauma (Orthopedic Trauma) Objective: 2 17) Your patient is a 50-year-old motorcyclist who received a lateral impact from an automobile as he went through an intersection. He has an open right tibia/fibula fracture. He also has a fracture of his left forearm and some abrasions. He was wearing a helmet and suffered no loss of consciousness. He currently has a strong radial pulse of 100, his skin is warm and moist, and he has adequate respirations at 20 per minute. Assuming no significant findings during a rapid trauma exam and intact distal neurovascular status, which of these is the best way to manage this patient's lower extremity trauma? A) Use anatomical splinting provided by placing the patient on a long backboard. B) Secure padded long board splints laterally and medially. C) Place sand bags on either side of the injury and wrap it with cravats. D) Apply a traction splint. Answer: B Diff: 2 Page Ref: 2016 Standard: Trauma (Orthopedic Trauma) Objective: 7 18) Not considering other injuries, which of these musculoskeletal findings warrants immediate transport of your patient? A) Unstable pelvis B) Clavicle fracture C) Posterior shoulder dislocation D) Open fracture of the tibia and fibula Answer: A Diff: 1 Page Ref: 2014 Standard: Trauma (Orthopedic Trauma) Objective: 6

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19) Your patient is an 80-year-old woman who fractured a vertebra while coughing. This type of musculoskeletal injury is best described as what type of fracture? A) Pathological B) Greenstick C) Epiphyseal D) Comminuted Answer: A Diff: 1 Page Ref: 2003-2004 Standard: Trauma (Orthopedic Trauma) Objective: 5 20) When assessing a long bone injury, you should assume that you are dealing with a joint injury when the site of injury is within how many inch(es) of the joint? A) 3 B) 2 C) 1 D) 6 Answer: A Diff: 1 Page Ref: 2013 Standard: Trauma (Orthopedic Trauma) Objective: 6 21) One of the earliest indications that compartment syndrome is developing in an injured extremity is: A) burning pain. B) pallor of the overlying skin. C) loss of distal pulses. D) sensation of pressure in the limb. Answer: A Diff: 1 Page Ref: 1999 Standard: Trauma (Orthopedic Trauma) Objective: 6 22) A sprain is an injury best defined how? A) Bone ends not anatomically aligned B) Muscle fibers stretched and torn C) Partial or complete tearing of the ligaments of the joint capsule D) A violent muscle spasm that tears away a small piece of bone Answer: C Diff: 1 Page Ref: 2000 Standard: Trauma (Orthopedic Trauma) Objective: 1

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23) Your patient has an abrasion on the bony prominence on the inside of her right ankle. This abrasion should be described as being over which of these structures? A) Thenar eminence B) Medial malleolus C) Lateral malleolus D) Styloid process Answer: B Diff: 2 Page Ref: 1995 Standard: Trauma (Orthopedic Trauma) Objective: 4 24) The pain associated with skeletal fractures is transmitted by nerves in the: A) epiphysis. B) yellow bone marrow. C) osteoclasts. D) periosteum. Answer: D Diff: 1 Page Ref: 1990 Standard: Trauma (Orthopedic Trauma) Objective: 5 25) Your patient complains of elbow pain and states his doctor told him he had "the bursitis" in his elbow. The patient's condition is characterized by inflammation of the: A) articular cartilage. B) synovial sacs. C) tendons. D) bone. Answer: B Diff: 1 Page Ref: 1991 Standard: Trauma (Orthopedic Trauma) Objective: 5 26) Your patient is a 21-year-old football player who was struck in the lateral aspect of the left knee by another player's shoulder. The patient is in extreme pain, and the knee is significantly deformed and swollen. The pedal pulse is weak, but present, and capillary refill is less than 2 seconds. The patient is screaming at you to "fix" his knee. You are 10 minutes from the emergency department. You should: A) splint the knee as found, start an IV, consider narcotic analgesia. B) apply gentle axial traction and realign the limb, splint in alignment. C) flex the knee to a 45-degree angle, splint in position of function. D) start an IV, administer narcotic analgesia, apply firm axial traction until the pulse returns to normal or resistance is met, then splint. Answer: A Diff: 2 Page Ref: 2018 Standard: Trauma (Orthopedic Trauma) Objective: 9 437 Copyright © 2023 Pearson Education, Inc.

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27) What is the most common type of musculoskeletal injury encountered by the EMS practitioner? A) Fracture B) Strain C) Dislocation D) Open wound Answer: B Diff: 1 Page Ref: 1988 Standard: Trauma (Orthopedic Trauma) Objective: 2 28) What is the best strategy for avoiding a musculoskeletal injury? (Select the MOST correct answer.) A) Prevention strategies B) Helmet use C) Avoiding sporting activities D) Learning how to swim at an early age Answer: B Diff: 1 Page Ref: 1988 Standard: Trauma (Orthopedic Trauma) Objective: 3 29) Which of these is NOT recommended as something to use for skeletal trauma management? A) Rigid splint B) Air splint C) Vacuum splint D) Sand bag splint Answer: D Diff: 1 Page Ref: 2009 Standard: Trauma (Orthopedic Trauma) Objective: 7 30) What is the recommended immobilization technique for the most commonly fractured bone in the human body? A) Traction splint B) Sling and swath C) Board splint D) Long backboard Answer: B Diff: 3 Page Ref: 2016 Standard: Trauma (Orthopedic Trauma) Objective: 8 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine

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Chapter 61 Environmental Trauma 1) The difference in temperature between the environment and the body is known as the: A) thermal gradient. B) ambient temperature. C) thermal temperature. D) ambient gradient. Answer: A Diff: 2 Page Ref: 2025 Standard: Trauma (Environmental Emergencies) Objective: 1 2) Heat loss occurs in all these ways EXCEPT: A) conduction. B) evaporation. C) convection. D) ingestion. Answer: D Diff: 2 Page Ref: 2025 Standard: Trauma (Environmental Emergencies) Objective: 3 3) Although the hypothalamus plays a key role in body temperature regulation, there are two types of thermoreceptors elsewhere in the body. They are the: A) peripheral thermoreceptors and central thermoreceptors. B) appendicular thermoreceptors and axial thermoreceptors. C) internal thermoreceptors and external thermoreceptors. D) aortic thermoreceptors and carotid thermoreceptors. Answer: A Diff: 1 Page Ref: 2026 Standard: Trauma (Environmental Emergencies) Objective: 3

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4) You and your partner are working a day shift. It is a sunny day, and the temperature is 95°F. You are dispatched to the town soccer field for an 85-year-old woman complaining of cramping to her fingers. The patient denies any other complaint of dizziness, nausea, or vomiting. The patient tells you it feels like her arthritis but much worse. Her vital signs are all within normal limits, and her skin is warm and moist. What is the MOST likely problem this patient is experiencing? A) Heat stroke B) Heat exhaustion C) Heat cramps D) Arthritis Answer: C Diff: 1 Page Ref: 2029 Standard: Trauma (Environmental Emergencies) Objective: 4 5) Individuals working in hot environments will lose 1 to 2 liters of water an hour. Each liter of water lost will result in how much sodium loss? A) 20 to 50 milliequivalents B) 10 to 20 milliequivalents C) 20 to 50 milligrams D) 10 to 20 milligrams Answer: A Diff: 2 Page Ref: 2029 Standard: Trauma (Environmental Emergencies) Objective: 4 6) To treat for the excessive loss of sodium in patients with hyperthermic emergencies, the paramedic should: A) always administer salt tablets in all patients with heat emergency. B) never administer salt tablets under any circumstance. C) administer salt tablets only to patients experiencing heat exhaustion. D) administer salt tablets to patients only if they are conscious and alert. Answer: B Diff: 3 Page Ref: 2028 Standard: Trauma (Environmental Emergencies) Objective: 4 7) Pyrexia is another term for: A) fever. B) excessive thirst. C) heat emergency. D) sunburn. Answer: A Diff: 1 Page Ref: 2032 Standard: Trauma (Environmental Emergencies) Objective: 1 440 Copyright © 2023 Pearson Education, Inc.

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8) The pediatric dose of ibuprofen is: A) 10 mg. B) 15 mg. C) 10 mg/kg. D) 15 mg/kg. Answer: C Diff: 2 Page Ref: 2033 Standard: Trauma (Environmental Emergencies) Objective: 4 9) Patients are classified as hypothermic when their core temperature drops below: A) 40°C. B) 35°C. C) 30°C. D) None of the above Answer: B Diff: 1 Page Ref: 2033 Standard: Trauma (Environmental Emergencies) Objective: 5 10) All of these are signs of mild hypothermia EXCEPT: A) tachycardia. B) vasodilation. C) impaired judgment. D) fatigue. Answer: B Diff: 1 Page Ref: 2035 Standard: Trauma (Environmental Emergencies) Objective: 5 11) In which patient would you expect to see a subacute exposure to cold? A) A homeless person B) A mountain climber C) A chronically ill patient D) A patient who fell through ice into water Answer: B Diff: 1 Page Ref: 2034 Standard: Trauma (Environmental Emergencies) Objective: 2

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12) The most common arrhythmia seen in hypothermia is: A) ventricular fibrillation. B) ventricular tachycardia. C) atrial fibrillation. D) third-degree heart block. Answer: C Diff: 2 Page Ref: 2036 Standard: Trauma (Environmental Emergencies) Objective: 5 13) Active rewarming should not be attempted in the field unless the emergency department is more than how many minutes away? A) 10 B) 30 C) 45 D) 15 Answer: D Diff: 1 Page Ref: 2036 Standard: Trauma (Environmental Emergencies) Objective: 6 14) According to the American Heart Association, if a hypothermic patient who is in cardiac arrest does not respond to initial defibrillation and initial drug therapy, subsequent defibrillation and medication administration should be avoided until the patient's core temperature reaches how many degrees F? A) 86 B) 90 C) 96 D) 80 Answer: A Diff: 1 Page Ref: 2038 Standard: Trauma (Environmental Emergencies) Objective: 12 15) When providing fluid resuscitation to a hypothermic patient, the rate of infusion should be: A) 150 to 200 mL/hour. B) 500 to 600 mL/hour. C) 100 to 125 mL/hour. D) 250 to 275 mL/hour. Answer: A Diff: 2 Page Ref: 2038 Standard: Trauma (Environmental Emergencies) Objective: 12

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16) The portion of skin affected by superficial frostbite is which layer? A) Epidermal B) Subdural C) Intradural D) Subcutaneous Answer: A Diff: 1 Page Ref: 2039 Standard: Trauma (Environmental Emergencies) Objective: 5 17) You and your partner are treating a 25-year-old man with frostbite on the left hand. Your BLS unit is going to be delayed because of a severe winter storm that is occurring. You and your partner decide that you must rewarm the patient's hand while waiting for your BLS unit. You are in the patient's house, and there is no chance of the hand being refrozen. To rewarm the patient's hand, you are going to submerge the hand in water. You know that the water must be between and degrees F. A) 98; 102 B) 104; 108 C) 102; 104 D) 110; 112 Answer: A Diff: 2 Page Ref: 2039 Standard: Trauma (Environmental Emergencies) Objective: 5 18) What percentage of drowning victims are children under five years of age? A) 10 B) 20 C) 40 D) 60 Answer: C Diff: 3 Page Ref: 2039 Standard: Trauma (Environmental Emergencies) Objective: 2 19) What percentage of drowning victims are male? A) 85 B) 80 C) 90 D) 75 Answer: A Diff: 3 Page Ref: 2040 Standard: Trauma (Environmental Emergencies) Objective: 2

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20) Which of these is a predisposing factor to hypothermia? A) Age of the patient B) Overall health of the patient C) Medications the patient takes D) All of the above are predisposing factors. Answer: D Diff: 3 Page Ref: 2033 Standard: Trauma (Environmental Emergencies) Objective: 2 21) A reflex that occurs when a person dives into cold water in which his breathing is inhibited, his heart rate becomes bradycardic, and vasoconstriction occurs is known as the: A) diving reflex. B) mammalian diving reflex. C) submersion reflex. D) mammalian submersion reflex. Answer: B Diff: 2 Page Ref: 2040 Standard: Trauma (Environmental Emergencies) Objective: 1 22) The amount of fluid that enters the lungs in a drowning case is typically: A) < 30 mL. B) > 30 mL. C) < 20 mL. D) > 20 mL. Answer: A Diff: 1 Page Ref: 2041 Standard: Trauma (Environmental Emergencies) Objective: 7 23) The substance within the body that is responsible for preventing atelectasis is: A) alveolar fluid. B) surfactant. C) pleural fluid. D) atelectasis fluid. Answer: B Diff: 2 Page Ref: 2040 Standard: Trauma (Environmental Emergencies) Objective: 7

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24) All of these are part of the drowning sequence of a conscious person EXCEPT: A) attempted breath holding. B) violent swallowing efforts. C) PaCO2 in the blood falling below 50 mmHg. D) PaO2 in the blood falling below 50 mmHg. Answer: C Diff: 3 Page Ref: 2040 Standard: Trauma (Environmental Emergencies) Objective: 7 25) You and your partner are treating a drowning patient who had a submersion time of 10 minutes. Your partner wants to perform the abdominal thrusts; you should: A) advise your partner that the Heimlich maneuver should not be used for drowning victims. B) agree with your partner and begin performing the Heimlich maneuver. C) agree with your partner, as you know the Heimlich maneuver should be performed only on patients with a submersion time of less than 15 minutes. D) advise your partner that the Heimlich maneuver should be performed only on patients with a submersion time of more than 15 minutes. Answer: A Diff: 3 Page Ref: 2042 Standard: Trauma (Environmental Emergencies) Objective: 7 26) Boyle's law states that the pressure of a gas will A) decreasing; decrease B) decreasing; increase C) increasing; increase D) increasing; decrease Answer: D Diff: 1 Page Ref: 2043 Standard: Trauma (Environmental Emergencies) Objective: 8

its volume.

27) Which law of gases states that the amount of gas dissolved in a given volume of fluid is proportional to the pressure of the gas above it? A) Boyle's law B) Dalton's law C) Henry's law D) Winston's law Answer: C Diff: 2 Page Ref: 2043 Standard: Trauma (Environmental Emergencies) Objective: 8

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28) A diving injury commonly called "the squeeze" occurs during which phase of diving? A) Descent B) Ascent C) On the surface D) On the bottom Answer: A Diff: 2 Page Ref: 2044 Standard: Trauma (Environmental Emergencies) Objective: 9 29) Decompression sickness commonly occurs in divers who are diving below what level? A) 44 feet B) 33 feet C) 22 feet D) 11 feet Answer: B Diff: 3 Page Ref: 2044 Standard: Trauma (Environmental Emergencies) Objective: 9 30) When is hyperbaric therapy NOT usually necessary? A) Pulmonary overpressure accident B) Decompression sickness C) Acute mountain sickness D) HAPE Answer: A Diff: 3 Page Ref: 2046 Standard: Trauma (Environmental Emergencies) Objective: 10 31) You and your partner are treating a 35-year-old woman who is complaining of severe pain in her joints and abdomen. The patient tells you that she went diving approximately 12 hours prior to the onset of complaint. Which of these would be part of a correct course of treatment for this patient? A) Oxygen via nonrebreather mask to maintain SpO2 of > 96 percent, IV fluid replacement with lactated Ringer's, transport B) Oxygen via nasal cannula to maintain SpO2 of > 96 percent, fluid replacement with lactated Ringer's, transport C) Oxygen via nonrebreather mask regardless of SpO2 reading, IV fluid replacement with 5 percent dextrose, transport to hyperbaric chamber D) Oxygen via nonrebreather mask regardless of SpO2 reading, fluid replacement with lactated Ringer's, transport Answer: D Diff: 1 Page Ref: 2046 Standard: Trauma (Environmental Emergencies) Objective: 9 446 Copyright © 2023 Pearson Education, Inc.

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32) Field assessment/management for pnemomediastinum includes: A) administer high-flow oxygen. B) contact DAN. C) check for pneumothorax. D) all of the above. Answer: D Diff: 2 Page Ref: 2047 Standard: Trauma (Environmental Emergencies) Objective: 9 33) To eliminate the risk of altitude illness, climbers should climb below altitude illness starts to manifest. A) 8,000 feet B) 4,000 feet C) 6,000 feet D) 12,000 feet Answer: A Diff: 3 Page Ref: 2048 Standard: Trauma (Environmental Emergencies) Objective: 11

, where high-

34) What do the kidneys do during the hypoxic ventilatory response? A) Shut down B) Function normally C) Decrease the removal of bicarbonate D) Increase the removal of bicarbonate Answer: D Diff: 1 Page Ref: 2048-2049 Standard: Trauma (Environmental Emergencies) Objective: 11 35) Which of these is a medication used in the treatment of high-altitude conditions? A) Dextrose B) Methylprednisolone C) Atropine D) Diamox Answer: D Diff: 1 Page Ref: 2049 Standard: Trauma (Environmental Emergencies) Objective: 11

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36) What is TRUE regarding preventing a heat-related illness? A) Wait until you are thirsty to begin fluid replacement. B) Limit exposure to hot environments. C) Acclimatization decreases body fluid volume. D) Prepare to acclimatize rapidly. Answer: B Diff: 2 Page Ref: 2048 Standard: Trauma (Environmental Emergencies) Objective: 6 37) Which of these is NOT a strategy to prevent cold-related illness? A) Dress warmly. B) Get plenty of rest. C) Eat more fat than normal. D) Limit exposure to cold environments. Answer: C Diff: 2 Page Ref: 2033 Standard: Trauma (Environmental Emergencies) Objective: 6 38) You and your partner respond to an emergency call related to a diver who ascended rapidly because he was running out of air in his tank. When he reached the top, he complained of sharp pain in his abdomen. You suspect the diver has an arterial gas embolism, but you've never had to treat one before. What should you do? A) Call the Divers Alert Network. B) Start an IV of normal saline. C) Place the patient in Fowler's position. D) Give the patient fruit juice to drink. Answer: A Diff: 1 Page Ref: 2048 Standard: Trauma (Environmental Emergencies) Objective: 10 39) You are called to the scene of a diver who has a pressure disorder after a rapid ascent. Regardless of the type of pressure disorder, you should assess the patient for which condition? A) Pneumothorax B) Nitrogen narcosis C) Eardrum rupture D) Panic disorder Answer: A Diff: 1 Page Ref: 2047 Standard: Trauma (Environmental Emergencies) Objective: 9

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40) Which diagnostic test is important for the paramedic to include in the assessment of patients with a heat- or cold-related emergency? A) Blood glucose level B) Arterial blood gases C) Electrocardiogram D) Urine protein level Answer: C Diff: 1 Page Ref: 2035-2036 Standard: Trauma (Environmental Emergencies) Objective: 12 Paramedic Care: Principles and Practice, V. 1-2, 6e (Bledsoe) Volume 2 Paramedicine Chapter 62 Special Considerations in Trauma 1) Your patient is the 24-year-old male victim of a drive-by shooting. He is sitting on the ground on your arrival, with his legs stretched in front of him. You note that his sweatpants are bloody below the right knee. He is alert, though complaining of right leg pain, and has adequate ventilation, as well as a radial pulse of 88. To decide if this patient should be transported quickly to a trauma center, you should consider if he meets which of these? A) A Glasgow Coma Scale score of at least 15 B) CDC Guidelines for Field Triage of Injured Patients C) A revised trauma score of at least 20 D) All of the above Answer: B Diff: 2 Page Ref: 2067-2069 Standard: Trauma (Special Considerations in Trauma) Objective: 4 2) These are complications of hypothermia in the trauma patient EXCEPT: A) inhibited clotting cascade. B) release of anticoagulant agents. C) reduction in blood loss. D) increased energy use. Answer: C Diff: 3 Page Ref: 2074 Standard: Trauma (Special Considerations in Trauma) Objective: 6 3) Your patient is a 55-year-old man with a gunshot wound to the abdomen. Which of these does NOT have a bearing on the mechanism of injury analysis? A) The distance of the shooter from the victim at the time of injury B) The type of ammunition used C) Whether the shooter is right- or left-handed D) The type of firearm used 449 Copyright © 2023 Pearson Education, Inc.

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Answer: C Diff: 1 Page Ref: 2057 Standard: Trauma (Special Considerations in Trauma) Objective: 3

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4) Which of these best describes the appropriate timing of the rapid trauma assessment? A) After the focused history and assessment of the stable trauma patient B) After establishing airway, ventilation, and hemorrhage control in a critical trauma patient C) Upon making initial contact with the unresponsive trauma patient D) When considering accepting a refusal of treatment and transport from a stable trauma patient Answer: B Diff: 2 Page Ref: 2063 Standard: Trauma (Special Considerations in Trauma) Objective: 3 5) Your patient is the 40-year-old male driver of a vehicle that was struck in the driver's-side door by another vehicle at an intersection. The estimated speed of the vehicle that struck the patient's car is 30 miles per hour. The patient was restrained, but his vehicle lacks side-impact airbags. On your arrival, he is awake and complaining of head pain. He has a 4-cm laceration to the left posterior parietal area of the head. There was moderate bleeding before your arrival, but the bleeding is now minor. Witnesses state that there was no loss of consciousness, but immediately following the collision, the patient seemed confused and did not immediately understand that witnesses wanted him to unlock his door and use his cell phone to call for help. The patient's skin is warm and dry, his respirations are 16, and the radial pulse is strong at 88 per minute. He is now alert and oriented, and is complaining of head and neck pain. Which of these most accurately describes how to best remove the patient from the vehicle? A) Execute a rapid extrication technique. B) Use a "standing take-down" to place him on a long backboard after asking him to step out of the car. C) Ask him to self-extricate and walk to the ambulance so you can start rapid transport. D) Place a cervical collar, maintain manual stabilization of the cervical spine, and while allowing the patient to take several rest breaks, move him onto a long backboard. Answer: A Diff: 3 Page Ref: 2075 Standard: Trauma (Special Considerations in Trauma) Objective: 5 6) Which of these probably contributes to injury-related morbidity and mortality in the young male population (those aged 11 to 35 years)? A) The tendency to put small objects in the mouth B) Disregard for safety practices C) Poor physiological compensatory mechanisms D) None of the above Answer: B Diff: 1 Page Ref: 2055 Standard: Trauma (Special Considerations in Trauma) Objective: 2

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7) Paramedics should do everything possible to ensure that they are on the scene of a traumatic emergency for no more than how many minutes? A) 15 B) 20 C) 10 D) 25 Answer: C Diff: 2 Page Ref: 2075 Standard: Trauma (Special Considerations in Trauma) Objective: 5 8) Which of these offers a valuable model for EMS to consider when trying to reduce injuryrelated morbidity and mortality? A) The Pan American Health Organization B) American Society for Testing Materials (ASTM) C) The fire service D) Drug Abuse Resistance Education (DARE) Answer: C Diff: 1 Page Ref: 2054 Standard: Trauma (Special Considerations in Trauma) Objective: 2 9) The ongoing use of which of these techniques/interventions when caring for the trauma patient has been questioned by research? A) PASG B) Rapid isotonic fluid infusion C) Capillary refill as an indicator of tissue perfusion D) All of the above Answer: D Diff: 1 Page Ref: 2089-2090 Standard: Trauma (Special Considerations in Trauma) Objective: 2 10) The elderly patient in shock may be less likely to exhibit which of these expected manifestations of shock? A) Cardiac arrhythmias B) Hypothermia C) Altered mental status D) Tachycardia Answer: D Diff: 1 Page Ref: 2085 Standard: Trauma (Special Considerations in Trauma) Objective: 7

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11) Which statement about the pediatric pedestrian who is struck by a vehicle is NOT true? A) A child commonly turns toward the oncoming vehicle at the moment of impact. B) Smaller children are likely to suffer fractures of the tibia and fibula as a result of impact with the vehicle's bumper. C) A smaller child is more likely to be thrown to the ground following initial impact, versus being thrown onto the hood. D) Anatomically, the injuries caused by the initial impact of the vehicle will be higher on the body of a child than in an adult. Answer: B Diff: 2 Page Ref: 2076 Standard: Trauma (Special Considerations in Trauma) Objective: 7 12) Which of these best describes the significance of finding significant body abrasions during the prehospital assessment of the pediatric trauma patient as compared to an adult? A) Abrasions are superficial wounds and not of particular concern in the prehospital setting. B) There is a risk of infection. C) There is proportionally greater fluid loss when compared with an adult. D) It is a possible indication of more significant trauma beneath the abrasion. Answer: C Diff: 2 Page Ref: 2076 Standard: Trauma (Special Considerations in Trauma) Objective: 5 13) A thorough inspection of the trauma patient can be best performed if which of these guidelines is used? A) Assess for tenderness, the ability to move, and distal sensation and circulation. B) Assess for abnormalities in skin color, deformity of any part of the body, and any disruption of the skin. C) Assess for deformity, swelling, and angulation of any part of the body. D) Assess for pulse, paresthesia, pallor, and pain. Answer: B Diff: 2 Page Ref: 2064 Standard: Trauma (Special Considerations in Trauma) Objective: 3

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14) Your patient is the 24-year-old female driver of a vehicle in a motor vehicle collision. She rear-ended a vehicle stopped at a traffic light at about 25 miles per hour. She was restrained, and the front airbags deployed. She is 32 weeks pregnant. She is anxious because she has not felt the baby move since the impact, and she is complaining of constant pain on the left side of her abdomen. Palpation of the abdomen reveals unusual firmness over the left side of the abdomen. The patient has a pulse of 116, a blood pressure of 92/60, and respirations of 28. Her skin is cool but dry, and she has no other complaints. For which of the following should you have the highest index of suspicion? A) Placenta previa B) Placenta accreta C) Abruptio placentae D) Stress-induced onset of labor Answer: C Diff: 3 Page Ref: 2082 Standard: Trauma (Special Considerations in Trauma) Objective: 5 15) What has the greatest potential for reducing injury-related morbidity and mortality? A) Injury prevention activities B) Increased funding for rural EMS system development C) Increasing the scope of practice of paramedics to include such lifesaving procedures as pericardiocentesis and trephination of the skull to reduce intracranial pressure D) Using physicians and physician's assistants as prehospital care providers Answer: A Diff: 1 Page Ref: 2054 Standard: Trauma (Special Considerations in Trauma) Objective: 2 16) Your patient is the 23-year-old female victim of an attempted abduction at knifepoint. The assailant was interrupted and drew his knife across the victim's throat as he fled the scene. A first responder on the scene immediately applied direct pressure to the neck wound. Your assessment reveals a very agitated young woman with ongoing blood loss despite direct pressure to the wound. There appears to be both bright-red bleeding and slower but steady dark-red bleeding. It appears that the trachea has not been penetrated but that there is a hematoma around the laceration. Which of the following is the most appropriate sequence of intervention for this patient? A) Apply a pressure dressing to the wound, accompanied by pressure-point compression. B) Use rapid sequence intubation of the patient to protect the trachea from the expanding hematoma while maintaining direct pressure on the wound. C) Apply an occlusive dressing to the wound, and continue direct pressure. D) Apply direct pressure, and request an order from medical control to decompress the hematoma. Answer: B Diff: 3 Page Ref: 2071-2072 Standard: Trauma (Special Considerations in Trauma) Objective: 5 454 Copyright © 2023 Pearson Education, Inc.

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17) At a minimum, a critical trauma patient should be reassessed how often while en route to the trauma center? A) Every 5 minutes B) Every 10 minutes C) Every 15 minutes D) Every 3 minutes Answer: A Diff: 1 Page Ref: 2070 Standard: Trauma (Special Considerations in Trauma) Objective: 3 18) Assuming that none of the following patients has any neurologic deficits, which patient requires spinal motion restriction? A) A 19-year-old man who has a gunshot wound to the right thigh B) A 3-year-old girl who fell on the sidewalk while running and who has a bite injury to her tongue C) A 10-year-old male skateboarder who fell while skating down a hill and received abrasions to his hands, elbows, chest, and knees D) A 70-year-old woman involved in a moderate-speed, lateral-impact motor vehicle collision, who is complaining of left arm pain Answer: D Diff: 3 Page Ref: 2062 Standard: Trauma (Special Considerations in Trauma) Objective: 5 19) Which of the following best describes definitive care for the pregnant trauma patient with ongoing, significant hemorrhage? A) Invasive hemodynamic monitoring and serial hematocrits B) Administration of hypertonic crystalloid or colloid solution C) Immediate surgery D) Administration of blood or blood products Answer: C Diff: 2 Page Ref: 2075 Standard: Trauma (Special Considerations in Trauma) Objective: 7 20) Which of the following groups has the highest trauma morbidity and mortality rates? A) Males aged 11 to 35 years B) Males aged 45 to 70 C) Both genders aged 60 to 75 years D) Children aged 1 to 12 years Answer: A Diff: 1 Page Ref: 2055 Standard: Trauma (Special Considerations in Trauma) Objective: 2 455 Copyright © 2023 Pearson Education, Inc.

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21) During which part of your assessment would you note the need for additional resources? A) Scene size up B) Primary assessment C) Secondary assessment D) None of the above Answer: A Diff: 2 Page Ref: 2059 Standard: Trauma (Special Considerations in Trauma) Objective: 3 22) In which type of vehicle impact are patients afforded the most protection? A) Frontal impacts B) Side impacts C) Lateral impacts D) None of the above Answer: A Diff: 3 Page Ref: 2057 Standard: Trauma (Special Considerations in Trauma) Objective: 3 23) All of these are parameters assessed for when determining the revised trauma score, EXCEPT: A) Glasgow Coma Scale. B) systolic blood pressure. C) pulse rate. D) respiratory rate. Answer: C Diff: 3 Page Ref: 2068 Standard: Trauma (Special Considerations in Trauma) Objective: 4 24) What best explains the importance of determining the trauma patient's level of consciousness and orientation in the primary assessment? A) It determines whether the patient requires further assessment. B) It provides immediate information about the severity of the patient's injury. C) It immediately rules in or out the need for spinal immobilization. D) It serves as a baseline for determining improvement or deterioration in the patient's condition. Answer: D Diff: 2 Page Ref: 2061 Standard: Trauma (Special Considerations in Trauma) Objective: 3

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25) Which patient's mechanism of injury meets trauma triage criteria for transport to a trauma center? A) A 17-year-old man with a gunshot wound to the arm B) A 31-year-old man involved in a medium-velocity motor vehicle collision C) A 10-year-old male soccer player with a laceration over his right eye after colliding with another player's head D) A 9-year-old girl who fell 15 feet from the grandstand bleachers at a baseball game Answer: D Diff: 2 Page Ref: 2069 Standard: Trauma (Special Considerations in Trauma) Objective: 10 26) Your patient is a 19-year-old man who was thrown from a horse while riding in a rodeo. After throwing the patient off, the horse stepped on the patient's abdomen. When you reach the patient, you note that his face, neck, and shoulders are pale, cool, and diaphoretic but that the patient's skin is otherwise warm and dry. The patient has some movement and sensation in his forearms and hands but otherwise no movement or sensation below the shoulders. He is anxious and has a respiratory rate of 24, a heart rate of 68, and a blood pressure of 106/66. Which of the following should be the primary concern when determining this patient's transport priority? A) The potential for neurologic shock, requiring immediate surgery B) The potential for intraabdominal hemorrhage that may be masked by loss of nervous function C) The potential for traumatic brain injury D) The potential for respiratory failure secondary to paralysis of the diaphragm Answer: B Diff: 3 Page Ref: 2060, 2068 Standard: Trauma (Special Considerations in Trauma) Objective: 10 27) When administering fluid to a multisystem trauma patient with no signs of head injury but with signs of hypoperfusion, the paramedic should administer fluid only to maintain a systolic blood pressure equal to what level? A) 70 mmHg B) 80 mmHg C) 60 mmHg D) 100 mmHg Answer: B Diff: 2 Page Ref: 2070 Standard: Trauma (Multi-System Trauma) Objective: 5

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28) Which of the following should the paramedic assess when performing palpation during examination of a trauma patient? A) Discoloration, such as erythema or ecchymosis B) General muscle tone C) Hyporesonance or hyperresonance of the thorax and abdomen D) The depth of open wounds Answer: B Diff: 2 Page Ref: 2064 Standard: Trauma (Special Considerations in Trauma) Objective: 3 29) Your patient is a four-year-old child. He has received an accidental gunshot wound to the groin and has lost a significant amount of blood. He responds to painful stimuli and has a heart rate of 150 with no radial pulse. Respirations are 32 and shallow. What is the total amount of intravenous fluid you should administer to this patient per bolus, assuming that his condition does NOT improve with the previous intervention? A) 10 mL/kg B) 20 mL/kg C) 30 mL/kg D) 40 mL/kg Answer: B Diff: 3 Page Ref: 2044 Standard: Trauma (Special Considerations in Trauma) Objective: 7 30) Which of the following is NOT an element of the scene size up on a trauma response? A) Assessing for scene hazards B) Determining the number of patients C) Setting up an IV D) Evaluating the mechanism of injury Answer: C Diff: 1 Page Ref: 2056 Standard: Trauma (Special Considerations in Trauma) Objective: 3 31) Bariatric patients are at greater risk for all of the following, EXCEPT: A) arrhythmias. B) cardiac failure. C) systemic hypertension. D) bradycardia. Answer: D Diff: 3 Page Ref: 2083 Standard: Trauma (Special Considerations in Trauma) Objective: 7

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32) What is the bariatric trauma mortality likelihood as compared to normal weight patients? A) Two times higher B) Six times higher C) Three times higher D) Four times higher Answer: B Diff: 3 Page Ref: 2083 Standard: Trauma (Special Considerations in Trauma) Objective: 7 33) The blood pressure of the pregnant woman falls by 5 to 15 mmHg during which trimester? A) First B) Second C) Third D) Fourth Answer: B Diff: 3 Page Ref: 2081 Standard: Trauma (Special Considerations in Trauma) Objective: 7 34) What term is used to refer to a reduction in blood pressure (<90 mmHg) caused by cardiac, vascular, neurogenic, or volume problems, to a level that is lower than normal for the patient and insufficient to meet the metabolic needs of the body? A) Hypotension B) Hypovolemia C) Hypoperfusion D) Hypothermia Answer: A Diff: 2 Page Ref: 2071 Standard: Trauma (Special Considerations in Trauma) Objective: 1 35) Which of the following is NOT part of the key elements for the patient care report? A) Results of assessment B) Interventions C) Results of interventions D) Scene survey Answer: D Diff: 1 Page Ref: 2087 Standard: Trauma (Special Considerations in Trauma) Objective: 8

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36) What is a viable reason for use of air medical transport in the out-of-hospital setting? A) The patient has a low potential to require high-level life support available from an air medical helicopter, which is not available by ground transport. B) The patient has a significant potential to require a time-critical intervention, and an air medical helicopter will deliver the patient to an appropriate facility faster than ground transport. C) The patient is located in an area that would make ground transport viable or slightly delayed. D) Local EMS resources are acceptable. Answer: B Diff: 2 Page Ref: 2088-2089 Standard: Trauma (Special Considerations in Trauma) Objective: 9

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