TEST BANK for Paramedic Care: Principles and Practice, Volumes 1-5, 5th Edition by Bryan Bledsoe by ACADEMIAMILL

TEST BANK

Paramedic Care: Principles & Practice V. 1-5, 5e (Bledsoe) Volume 1 Introduction to Advanced Prehospital Care Chapter 1 Introduction to Paramedicine 1) What is one of the emerging roles and responsibilities of a paramedic in the 21st century? A) Third-party biller B) Managed health care C) Health promotion D) Internet education Answer: C Diff: 1 Page Ref: 4 Standard: Preparatory (EMS Systems) Objective: 4 2) Safety inspections, accident prevention, and medical screening of employees are some of the responsibilities for paramedics working in: A) industrial medicine. B) community clinics. C) correctional institutions. D) sports medicine. Answer: A Diff: 1 Page Ref: 8 Standard: Preparatory (EMS Systems) Objective: 5 3) Which of the following best describes the initial education program of the paramedic? A) It addresses everything one needs to know to practice paramedicine. B) It is a rite of passage, but information is inconsistent with how things really should be done. C) It is the base and beginning of one's professional education, not the end. D) Lectures prepare students, but all learning occurs on the job during the internship phase. Answer: C Diff: 1 Page Ref: 5 Standard: Preparatory (EMS Systems) Objective: 3 4) Which of the following best describes the paramedic's professional obligation? A) Acceptance and adherence to a code of professional ethics and etiquette B) Placing the system's well-being above that of the patient C) Absolute adherence to medical protocols D) Following long-standing traditions in practice Answer: A Diff: 2 Page Ref: 6 Standard: Preparatory (EMS Systems) Objective: 3 1 Copyright © 2017 Pearson Education, Inc.

5) A major advance in the education of out-of-hospital was the: A) formation of the National Association of Emergency Medical Technicians. B) 2009 publication National EMS Services Education Standards. C) passage of the Health Insurance Portability and Accountability Act (HIPAA). D) establishment of the National Registry computer-based certification exam. Answer: B Diff: 1 Page Ref: 5 Standard: Preparatory (EMS Systems) Objective: 4 6) Which of the following statements about a paramedic's skill competency is TRUE? A) High-frequency, low-criticality skills should be reviewed often. B) Low-frequency, high-criticality skills should be rarely reviewed. C) All skills should be reviewed equally, regardless of criticality. D) Frequent review of infrequently used skills is critical to ensure competency. Answer: D Diff: 1 Page Ref: 5 Standard: Preparatory (EMS Systems) Objective: 3 7) The paramedic's right to care for patients, administer medications, and perform other related tasks falls on the license of: A) the EMS system medical director. B) the state secretary of health. C) the receiving hospital personnel. D) the state medical director. Answer: A Diff: 1 Page Ref: 4 Standard: Preparatory (EMS Systems) Objective: 4 8) Many professional sports teams have found paramedics to be effective complements to their: A) team physicians. B) physical therapists. C) athletic trainers. D) rehabilitation programs. Answer: C Diff: 1 Page Ref: 8 Standard: Preparatory (EMS Systems) Objective: 5

9) Paramedics should always provide care: A) with the intent of transporting all patients. B) only when there is a legitimate patient complaint. C) without regard to a patient's ability to pay. D) with the goal of minimizing on-scene time. Answer: C Diff: 1 Page Ref: 4 Standard: Preparatory (EMS Systems) Objective: 4 10) The paramedic's role has expanded to include ________ because of the need to move ill/injured patients from one health care facility to another for specialized care. A) hospital emergency departments B) critical care transport C) corrections medicine D) helicopter EMS Answer: B Diff: 1 Page Ref: 6 Standard: Preparatory (EMS Systems) Objective: 4 11) Which of the following best characterizes the professional development of a paramedic? A) It is a career-long pursuit. B) It is focused on public education efforts. C) It is regulated by the system medical director and state agency. D) It is focused on illness and injury prevention. Answer: A Diff: 1 Page Ref: 5 Standard: Preparatory (EMS Systems) Objective: 3 12) Which of the following best describes the paramedic's expected level of functioning in the dynamic prehospital setting? A) Acts independently B) Under direct supervision of the medical director C) Under telephone or radio supervision by nursing personnel D) Under direct supervision of fire command Answer: A Diff: 1 Page Ref: 5 Standard: Preparatory (EMS Systems) Objective: 3

13) Which of the following aspects of the paramedic's work most appropriately falls into the category of public health? A) Administering care to a patient who has suffered a heart attack B) Providing life-saving measures after a traffic accident C) Educating the public on illness prevention D) Taking steps to prevent a terrorist attack Answer: C Diff: 1 Page Ref: 5 Standard: Preparatory (EMS Systems) Objective: 4 14) To legally function as a paramedic, one must: A) have successfully completed an accredited EMT education program. B) have fulfilled the specific requirements of an appropriate credentialing body. C) strive to maintain quality health care, regardless of cost or impact on one's EMS system. D) be able to function independently in a nonstructured, constantly changing environment. Answer: B Diff: 1 Page Ref: 4 Standard: Preparatory (EMS Systems) Objective: 3 15) Many traditional EMS treatments and practices have been abandoned or refined because of: A) research. B) patient complaints. C) legislation. D) lawsuits. Answer: A Diff: 1 Page Ref: 6 Standard: Preparatory (EMS Systems) Objective: 4 16) The highest level of prehospital care provider in the United States is a(n): A) emergency medical responder. B) paramedic. C) advanced EMT. D) emergency medical technician. Answer: B Diff: 1 Page Ref: 3 Standard: Preparatory (EMS Systems) Objective: 2

17) To practice, paramedics must be approved by a state or provincial agency and the: A) National Association of EMTs. B) National Registry of EMTs. C) EMS system's medical director. D) state medical director. Answer: C Diff: 1 Page Ref: 4 Standard: Preparatory (EMS Systems) Objective: 3 18) Which of the following is a desirable paramedic characteristic? A) The ability to give medical advice B) A commanding presence on the scene C) The ability to establish rapport with a wide variety of patients D) The ability to exactly follow protocols on each and every call Answer: C Diff: 1 Page Ref: 5 Standard: Preparatory (EMS Systems) Objective: 3 19) Which of the following agencies developed and published the 2009 EMS Instructional Guidelines? A) The National Registry of Emergency Medical Technicians B) The National Association of State EMS Training Coordinators C) The National Association of Emergency Medical Technicians D) The United States Department of Transportation Answer: D Diff: 1 Page Ref: 5 Standard: Preparatory (EMS Systems) Objective: 3 20) Where do many of the practices and techniques of tactical EMS come from? A) Police B) Firefighters C) Military D) Critical care medics Answer: C Diff: 1 Page Ref: 7 Standard: Preparatory (EMS Systems) Objective: 5

21) Which of these terms is a synonym of "mobile integrated health care?" A) industrial medicine B) illness prevention C) corrections medicine D) community paramedicine Answer: D Diff: 1 Page Ref: 4 Standard: Preparatory (EMS Systems) Objective: 1 Chapter 2 EMS Systems 1) Which of the following certification levels is currently NOT recognized by the National EMS Scope of Practice model? A) Paramedic B) Emergency Medical Responder C) Emergency Medical Technician D) Critical Care Paramedic Answer: D Diff: 1 Page Ref: 24 Standard: Preparatory (EMS Systems) Objective: 2 2) The rules or standards that govern the conduct of members of a particular group or profession are called: A) licensure. B) norms. C) protocols. D) ethics. Answer: D Diff: 1 Page Ref: 35 Standard: Preparatory (EMS Systems) Objective: 1 3) A physician not affiliated with the responding EMS system who takes part in patient care with system paramedics at an emergency scene is called a(n): A) surrogate medical director. B) volunteer physician. C) intervener physician. D) interloper physician. Answer: C Diff: 1 Page Ref: 25 Standard: Preparatory (EMS Systems) Objective: 1

4) The National EMS Education Instructional Guidelines are divided into three domains of learning. The affective domain refers to which of the following? A) Critical thinking and decision making B) Recall of basic facts and information C) Physical skills used for patient care D) Attitudes, values, and emotions Answer: D Diff: 1 Page Ref: 28 Standard: Preparatory (EMS Systems) Objective: 9 5) Which of the following National Highway Traffic Safety Administration (NHTSA) elements of EMS systems deals with issues of equal access to acceptable emergency care for all patients? A) Human resources and training B) Public information and education C) Resources management D) Trauma systems Answer: C Diff: 1 Page Ref: 19 Standard: Preparatory (EMS Systems) Objective: 5 6) Which of the following is NOT typically a role of the medical director in an EMS system? A) Participating in quality improvement B) Educating and training personnel C) Dispatching EMS personnel D) Participating in personnel and equipment selection Answer: C Diff: 1 Page Ref: 25 Standard: Preparatory (EMS Systems) Objective: 10 7) The person who is legally responsible for all clinical and patient care aspects of an EMS system is the: A) quality improvement coordinator. B) medical director. C) system administrator. D) battalion chief. Answer: B Diff: 1 Page Ref: 25 Standard: Preparatory (EMS Systems) Objective: 5

8) Medical policies, procedures, and practices that a system medical director has established in advance of a call are called: A) automated medical direction. B) off-line medical oversight. C) remote medical direction. D) on-line medical direction. Answer: B Diff: 1 Page Ref: 25 Standard: Preparatory (EMS Systems) Objective: 1 9) In 1980, the revision "KKK-A-1822A" involved: A) primarily addressing electrical systems, signage, and safety. B) guidelines to improve occupant protection in the patient compartment. C) changes based on the National Institute for Occupational Safety and Health standards. D) improving ambulance electrical systems by designing a low-amp lighting system to replace antiquated light bars and beacons. Answer: D Diff: 1 Page Ref: 32 Standard: Preparatory (EMS Systems) Objective: 12 10) What is the process by which an agency or association grants recognition to an individual who has the proper qualifications? A) Registration B) Qualification C) Certification D) Authorization Answer: C Diff: 1 Page Ref: 29 Standard: Preparatory (EMS Systems) Objective: 1 11) Paramedics carry out their tasks in the prehospital setting as designated agents of the: A) EMS system director. B) EMS system medical director. C) EMS program director. D) hospital nursing director. Answer: B Diff: 1 Page Ref: 25 Standard: Preparatory (EMS Systems) Objective: 10

12) The process by which a governmental agency grants permission to engage in a given occupation to an applicant who has attained the degree of competency required to ensure the public's protection is called: A) reciprocity. B) licensure. C) registration. D) certification. Answer: B Diff: 1 Page Ref: 29 Standard: Preparatory (EMS Systems) Objective: 1 13) Which of the following elements of an EMS system is NOT needed to ensure the best possible patient care? A) Resources management B) Medical direction C) Ambulance billing D) Public information Answer: C Diff: 1 Page Ref: 19-20 Standard: Preparatory (EMS Systems) Objective: 2 14) Which of the following best describes the practice of evidence-based medicine? A) Basing all treatments on the patient's signs and symptoms B) Combining clinical expertise with the best available clinical evidence C) Using clinical judgment to know when you should deviate from protocols D) Using published reports of research to change practice Answer: B Diff: 1 Page Ref: 37 Standard: Preparatory (EMS Systems) Objective: 17 15) Which of the following situations is NOT typically addressed by EMS system protocols? A) Triage B) EMS system financing C) Transfer to appropriate facilities D) Mode of patient transportation Answer: B Diff: 1 Page Ref: 26 Standard: Preparatory (EMS Systems) Objective: 10

16) Few areas of the United States provided adequate prehospital care until: A) after World War II. B) after the Gulf War. C) the late 1960s. D) the mid-1950s. Answer: C Diff: 1 Page Ref: 18-19 Standard: Preparatory (EMS Systems) Objective: 3 17) The process by which an agency in one state grants automatic certification or licensing to a paramedic who is certified or licensed by an agency in another state is called: A) professional courtesy. B) immunity. C) recertification. D) reciprocity. Answer: D Diff: 1 Page Ref: 29 Standard: Preparatory (EMS Systems) Objective: 1 18) Direct access to medical consultation is a feature of: A) a tiered response system. B) off-line medical oversight. C) the incident command system. D) on-line medical direction. Answer: D Diff: 1 Page Ref: 25 Standard: Preparatory (EMS Systems) Objective: 2 19) In which of the following ways can paramedics play a significant part in EMS research? A) Collecting data accurately and completely B) Changing patient care practices based on unique research outcomes C) Volunteering their patients for drug trials D) Experimenting with different ways of managing patients Answer: A Diff: 1 Page Ref: 37 Standard: Preparatory (EMS Systems) Objective: 16

20) Components of a paramedic's education include all of the following, EXCEPT: A) refresher courses. B) continuing education. C) initial education. D) disciplinary action. Answer: D Diff: 1 Page Ref: 28-29 Standard: Preparatory (EMS Systems) Objective: 9 21) Guidelines developed by the National Highway Traffic Safety Administration (NHTSA) for quality improvement in EMS systems include all of the following, EXCEPT: A) regulation and policy. B) financial auditing. C) communications. D) human resources training. Answer: B Diff: 1 Page Ref: 19-20 Standard: Preparatory (EMS Systems) Objective: 14 22) Key events in the historical development of EMS include all of the following, EXCEPT the: A) 1973 EMS Systems Act. B) 1988 Statewide EMS Technical Assistance Program. C) 1975 Cater-Benson Reform Act. D) 1981 COBRA Act. Answer: C Diff: 1 Page Ref: 16 Standard: Preparatory (EMS Systems) Objective: 3 23) Which of the following is the publication that first focused attention on the deficiencies in prehospital emergency care? A) KKK-A-1822 B) Injury in America: A Continuing Public Health Problem C) Accidental Death and Disability: The Neglected Disease of Modern Society D) A Leadership Guide to Quality Improvement for Emergency Medical Services Systems Answer: C Diff: 1 Page Ref: 18 Standard: Preparatory (EMS Systems) Objective: 4

24) Which of the following pieces of legislation had a significant NEGATIVE impact on EMS funding? A) The Emergency Medical Services Systems Act B) The National Highway Safety Act C) The Consolidated Omnibus Budget Reconciliation Act (COBRA) D) The Emergency Medical Treatment and Active Labor Act (EMTALA) Answer: C Diff: 1 Page Ref: 19 Standard: Preparatory (EMS Systems) Objective: 3 25) No EMS system should be without which of the following items? A) An independent communication system B) One reserve ambulance for every active ambulance in the fleet C) A large network of volunteers D) A disaster plan Answer: D Diff: 1 Page Ref: 33 Standard: Preparatory (EMS Systems) Objective: 10 26) As a rule, which of the following services should be present in trauma systems within an EMS system? A) Trauma center B) Burn center C) Pediatrics D) Orthopedics Answer: A Diff: 1 Page Ref: 20 Standard: Preparatory (EMS Systems) Objective: 10 27) When you complete your paramedic course and pass the National Registry examination, you will: A) be certified to practice as a paramedic in your state. B) be certified to practice as a paramedic in any state. C) be licensed to practice as a paramedic in your state. D) still need to complete your state's certification or licensure process. Answer: D Diff: 1 Page Ref: 29 Standard: Preparatory (EMS Systems) Objective: 9

28) The future enhancement of EMS is strongly dependent on: A) the ability to outline the logistics affecting research. B) obtaining approval for patient consent procedures. C) availability of quality research. D) the collection of raw data. Answer: C Diff: 1 Page Ref: 37 Standard: Preparatory (EMS Systems) Objective: 16 29) Paramedics can improve their knowledge and skills through an evaluation by others of equal rank and skills, known as: A) tenure tracking. B) debriefing. C) peer review. D) performance appraisal. Answer: C Diff: 1 Page Ref: 35 Standard: Preparatory (EMS Systems) Objective: 1 30) Which of the following best describes the purpose of the KKK specifications? A) To standardize EMS dispatching terminology B) To specify quality improvement procedures C) To state the physical standards required of paramedics D) To standardize the design of ambulances Answer: D Diff: 1 Page Ref: 32 Standard: Preparatory (EMS Systems) Objective: 12 31) Entering a person's name and relevant information in a particular record maintained by an organization is best described as: A) registration. B) reciprocity. C) certification. D) licensure. Answer: A Diff: 1 Page Ref: 29 Standard: Preparatory (EMS Systems) Objective: 1

32) As defined by the National Highway Transportation Safety Agency (NHTSA), which of the following is NOT a component of an EMS system? A) System of quality improvement B) Public information and education C) Human resources and training D) A public advisory council Answer: D Diff: 1 Page Ref: 33-34 Standard: Preparatory (EMS Systems) Objective: 5 33) Which of the following best describes a comprehensive network of personnel, equipment, and resources established to deliver aid and emergency medical care to the community? A) Trauma system B) EMS system C) Medical direction D) ALS system Answer: B Diff: 1 Page Ref: 14 Standard: Preparatory (EMS Systems) Objective: 1 34) Although termed certification by many states, the governmental agency's permission to engage in a profession actually constitutes: A) registration. B) licensure. C) authorization. D) reciprocity. Answer: B Diff: 1 Page Ref: 29 Standard: Preparatory (EMS Systems) Objective: 1 35) The established policies and procedures of an EMS system that provide a standardized approach to common patient problems and a consistent level of medical care are known as: A) codes of action and response. B) clinical protocols. C) standard operating procedures. D) standing orders. Answer: B Diff: 1 Page Ref: 25 Standard: Preparatory (EMS Systems) Objective: 1

36) One area of EMS that will rely especially heavily on research is: A) communications. B) transportation. C) human resources. D) funding. Answer: D Diff: 1 Page Ref: 37 Standard: Preparatory (EMS Systems) Objective: 16 37) Which of the following choices best explains the difference between an EMT-Intermediate and an EMT-Paramedic? A) Licensure versus certification B) Scope of knowledge C) The legal requirement for medical direction D) Scope of practice Answer: D Diff: 1 Page Ref: 24 Standard: Preparatory (EMS Systems) Objective: 9 38) Reasons to be involved with a professional membership organization include all of the following, EXCEPT to: A) stay abreast of changes within the profession. B) share ideas with other providers. C) interact with members from other parts of the country. D) conform to National Institute for Occupational Safety and Health (NIOSH) standards. Answer: D Diff: 1 Page Ref: 30 Standard: Preparatory (EMS Systems) Objective: 11 39) With regard to medical authorization, which of the following best describes the role of a paramedic in providing prehospital care? A) He relies on the delegated practice of a licensed physician medical director. B) He relies on the delegated practice of any licensed health care practitioners, such as physician assistants, nurse practitioners, nurses, and dentists. C) He relies on the delegated practice of a licensed nurse. D) He relies on the autonomous medical practitioner. Answer: A Diff: 1 Page Ref: 25 Standard: Preparatory (EMS Systems) Objective: 8

40) Which of the following are likely subjects of standing orders or protocols? A) How to handle DNR orders B) Procedures that can be done only with a direct order C) When to use air transport versus ground transport D) All of the above Answer: D Diff: 2 Page Ref: 26 Standard: Preparatory (EMS Systems) Objective: 10 41) Which of the following is NOT one of the three basic elements of citizen involvement in EMS? A) Recognizing an emergency B) Providing financial support for EMS agencies C) Initiating basic life support procedures D) Accessing the EMS system Answer: B Diff: 1 Page Ref: 26 Standard: Preparatory (EMS Systems) Objective: 2 42) The first use of a prehospital system of triage and transport took place: A) in large cities in the 19th-century United States. B) during the U.S. Civil War. C) during the Napoleonic Wars. D) in ancient Mesopotamia. Answer: C Diff: 1 Page Ref: 17 Standard: Preparatory (EMS Systems) Objective: 3 43) An example of a quality improvement activity in EMS is: A) peer review of patient care. B) displaying the "Star of Life" symbol. C) disciplinary action for patient care issues. D) using a Type II or III ambulance. Answer: A Diff: 2 Page Ref: 25, 35 Standard: Preparatory (EMS Systems) Objective: 14

44) The Institute of Medicine published Emergency Medical Services for Children in: A) 1993. B) 1984. C) 1969. D) 1977. Answer: A Diff: 1 Page Ref: 20 Standard: Preparatory (EMS Systems) Objective: 3 45) Sending multiple levels of emergency care personnel to the same incident is called a: A) mass casualty incident. B) helicopter EMS. C) tiered response. D) chain of survival. Answer: C Diff: 1 Page Ref: 14 Standard: Preparatory (EMS Systems) Objective: 1 46) An occupation in which the practitioners have a competence in a specialized body of knowledge or skills that has been recognized by some organization or agency is called a: A) profession. B) career. C) vocation. D) trade. Answer: A Diff: 1 Page Ref: 29 Standard: Preparatory (EMS Systems) Objective: 1 47) Which of these documents recommended that EMS of the future should have the ability to identify and modify illness and injury risks, provide acute illness and injury care and follow-up, and contribute to treatment of chronic conditions and community health monitoring? A) Injury in America: A Continuing Public Health Problem B) The EMS Agenda for the Future C) Emergency Medical Services: At the Crossroads D) The Ontario Prehospital Advanced Life Support (OPALS) study Answer: B Diff: 1 Page Ref: 20 Standard: Preparatory (EMS Systems) Objective: 6

48) Which of these is NOT an issue facing EMS providers, according to Emergency Medical Services: At the Crossroads? A) Insufficient coordination B) Disparities in response times C) Limited evidence base D) Medical malpractice Answer: D Diff: 1 Page Ref: 21 Standard: Preparatory (EMS Systems) Objective: 7 49) Categorization of EMS-receiving hospitals was initially developed to identify which of the following? A) trauma care capability B) stroke care capability C) burn care capability D) chest pain care capability Answer: A Diff: 1 Page Ref: 33 Standard: Preparatory (EMS Systems) Objective: 13 50) Which of the following is a knowledge-based failure of patient safety? A) A stressed EMS provider applies the wrong rule, resulting in patient injury. B) A distracted paramedic fails to perform a routine skill correctly. C) A tired EMS provider fails to follow a relevant rule, resulting in patient injury. D) A narcissistic paramedic makes a bad decision based on insufficient information. Answer: C Diff: 1 Page Ref: 35 Standard: Preparatory (EMS Systems) Objective: 15 Chapter 3 Roles and Responsibilities of the Paramedic 1) Which of the following professional characteristics is required for patients to trust paramedics to be in their homes and have access to their property and personal information? A) Patient advocacy B) Integrity C) Empathy D) Leadership Answer: B Diff: 2 Page Ref: 53 Standard: Preparatory (EMS Systems) Objective: 5

2) When en route to a call, one of the paramedic's chief responsibilities is: A) assessing the patient's responsiveness. B) preparing the ambulance to accept the patient. C) identifying the mechanism of injury or nature of illness. D) anticipating scene risks and needs based on dispatch information. Answer: D Diff: 2 Page Ref: 44 Standard: Preparatory (EMS Systems) Objective: 2 3) Your patient is a 24-year-old man with a severe closed head injury. He is unresponsive, and his vital signs are unstable. Which of the following is the appropriate receiving facility for this patient? A) A Level I trauma center B) A Level III trauma center C) A Level IV trauma center D) A Level II trauma center Answer: A Diff: 1 Page Ref: 47 Standard: Preparatory (EMS Systems) Objective: 2 4) Defending patients, protecting them, and, in general, acting in their best interests are all examples of: A) leadership. B) empathy. C) patient advocacy. D) integrity. Answer: C Diff: 2 Page Ref: 55 Standard: Preparatory (EMS Systems) Objective: 5 5) During the return to service, one of the paramedic's chief responsibilities is: A) decontaminating the ambulance. B) correcting the patient care report. C) giving a verbal report to the receiving facility personnel. D) taking care of personal matters before the next call. Answer: A Diff: 2 Page Ref: 49 Standard: Preparatory (EMS Systems) Objective: 2

6) The EMT Code of Ethics was established by which of the following groups? A) National Association of EMTs (NAEMT) B) American College of Emergency Physicians (ACEP) C) National Registry of EMTs (NREMT) D) National Association of EMS Educators (NAEMSE) Answer: A Diff: 1 Page Ref: 51 Standard: Preparatory (EMS Systems) Objective: 4 7) The paramedic is responsible for determining the mechanism of injury or nature of the illness when carrying out which of the primary responsibilities? A) Scene size-up B) Patient management C) Patient assessment D) Response Answer: A Diff: 2 Page Ref: 44-45 Standard: Preparatory (EMS Systems) Objective: 2 8) Which of the following is NOT one of the paramedic's primary responsibilities? A) Patient follow-up B) Response C) Returning to service after a call D) Medical treatment Answer: A Diff: 1 Page Ref: 43-44 Standard: Preparatory (EMS Systems) Objective: 2 9) Consoling and offering emotional support to a person who has just seen a loved one die is an example of the professional attribute of: A) patient advocacy. B) leadership. C) empathy. D) integrity. Answer: C Diff: 2 Page Ref: 53 Standard: Preparatory (EMS Systems) Objective: 5

10) Close attention to detail during patient care reflects which of the following professional attributes? A) Self-motivation B) Patient advocacy C) Empathy D) Careful delivery of service Answer: D Diff: 2 Page Ref: 55 Standard: Preparatory (EMS Systems) Objective: 5 11) Which of the following is one of the paramedic's primary responsibilities? A) Accident reconstruction B) Crowd control C) Patient disposition D) Public relations Answer: C Diff: 2 Page Ref: 43-44 Standard: Preparatory (EMS Systems) Objective: 2 12) Respecting the opinions offered by peers on a call is an example of which professional characteristic? A) Advocacy B) Diplomacy C) Communication D) Leadership Answer: B Diff: 2 Page Ref: 54 Standard: Preparatory (EMS Systems) Objective: 4 13) Which of the following is an example of professional development? A) Participating in mentoring activities B) Reading professional publications C) Attending refresher and continuing education classes D) All of the above Answer: D Diff: 2 Page Ref: 50 Standard: Preparatory (EMS Systems) Objective: 4

14) Knowing ________ is NOT part of the paramedic's responsibility prior to an EMS call. A) the nature of illness B) what resources are available C) medical protocols D) how to use communication technology Answer: A Diff: 1 Page Ref: 43-44 Standard: Preparatory (EMS Systems) Objective: 2 15) Which of the following is NOT part of a paramedic's administrative duties? A) Recordkeeping B) Station duties C) Developing interagency relationships D) Promoting community health Answer: D Diff: 2 Page Ref: 49 Standard: Preparatory (EMS Systems) Objective: 3 16) Which of the following professional characteristics is displayed in a paramedic's selfconfidence, inner strength, ability to communicate, and willingness to make a decision? A) Integrity B) Respect C) Empathy D) Leadership Answer: D Diff: 2 Page Ref: 52 Standard: Preparatory (EMS Systems) Objective: 5 17) Which of the following is an example of how paramedics support primary care when carrying out their out-of-hospital functions? A) Transporting all patients to the emergency department B) Determining the appropriateness of treating on the scene and releasing the patient C) Refusing to transport patients who do not have potentially life-threatening conditions D) Transporting to the patient's physician's office, rather than the emergency department Answer: B Diff: 2 Page Ref: 48 Standard: Preparatory (EMS Systems) Objective: 2

18) Maintaining paramedic certification through seeking and reporting continuing education is the responsibility of the: A) state EMS office. B) paramedic. C) EMS system. D) training officer. Answer: B Diff: 1 Page Ref: 50 Standard: Preparatory (EMS Systems) Objective: 3 19) Which of the following is NOT an example of the paramedic's responsibility for community involvement? A) Teaching the public BLS classes B) Conducting illness and injury risk surveys C) Allowing citizens to vote on EMS protocols D) Helping the public learn how to recognize an emergency Answer: C Diff: 1 Page Ref: 49-50 Standard: Preparatory (EMS Systems) Objective: 3 20) The paramedic who routinely fails to complete duties and paperwork in a timely manner is most likely lacking which of the following professional attributes? A) Self-confidence B) Self-motivation C) Leadership D) Integrity Answer: B Diff: 2 Page Ref: 53 Standard: Preparatory (EMS Systems) Objective: 5 21) A way for paramedics to determine appropriate injury prevention programs for their community is by using: A) community self-reports. B) injury risk surveys. C) National Science Foundation guidelines. D) Centers for Disease Control and Prevention guidelines. Answer: B Diff: 1 Page Ref: 49-50 Standard: Preparatory (EMS Systems) Objective: 3

22) Which of the following is NOT considered an allied health profession? A) Nursing B) Paramedicine C) Respiratory therapy D) Physical therapy Answer: A Diff: 1 Page Ref: 51 Standard: Preparatory (EMS Systems) Objective: 1 Chapter 4 Workforce Safety and Wellness 1) The stage of the stress response in which the pituitary gland releases a flood of adrenocorticotropic hormones is: A) exhaustion. B) resistance. C) withdrawal. D) alarm. Answer: D Diff: 1 Page Ref: 75 Standard: Preparatory (Workforce Safety and Wellness) Objective: 8 2) Which of the following statements about Kübler-Ross's five stages of grief is most accurate? A) These stages are only experienced by patients actually undergoing the dying process. B) Dying patients experience these stages in their own unique ways. C) Although people have unique experiences along the way, they do experience all five stages. D) Health care providers typically experience one to three of the stages when grieving the death of a patient. Answer: B Diff: 2 Page Ref: 72 Standard: Preparatory (Workforce Safety and Wellness) Objective: 7 3) Which of the following best describes those in an ambulance who should use seat belts? A) All persons on board (care providers, patients, and family) B) Only the patient, because the requirements of medical care take priority C) Only those riding in the back D) Only those seated in the front Answer: A Diff: 1 Page Ref: 80 Standard: Preparatory (Workforce Safety and Wellness) Objective: 11

4) Of the following, which is NOT generally used on scene to minimize hazards? A) Helmets B) Body armor C) Reflective tape D) Surgical scrubs Answer: D Diff: 2 Page Ref: 79 Standard: Preparatory (Workforce Safety and Wellness) Objective: 2 5) One of the principles of proper lifting is to: A) hold your breath while lifting. B) position the load close to your body. C) pull rather than push when possible. D) bend at the waist to use the strong muscles of the back. Answer: B Diff: 1 Page Ref: 64-65 Standard: Preparatory (Workforce Safety and Wellness) Objective: 5 6) Which of the Kübler-Ross stages of grief would be suspected if a cancer patient said to you, "This frustrates me so much. I never saw it coming, and now my family will have to go on without me"? A) Bargaining B) Hopelessness C) Anger D) Denial Answer: C Diff: 1 Page Ref: 72 Standard: Preparatory (Workforce Safety and Wellness) Objective: 7 7) Which of the following is an important factor in reducing the risk of infection? A) Stress management B) Adequate rest C) Good nutrition D) All of the above Answer: D Diff: 1 Page Ref: 65 Standard: Preparatory (Workforce Safety and Wellness) Objective: 2

8) To minimize the stress of shift work, on their days off paramedics should sleep: A) at the times they sleep on workdays. B) after a heavy meal or strenuous exercise. C) at least 12 hours to catch up on lost sleep. D) at night, regardless of when they sleep on workdays. Answer: A Diff: 1 Page Ref: 76 Standard: Preparatory (Workforce Safety and Wellness) Objective: 11 9) Which of the following is NOT one of the core elements of physical fitness? A) Muscular strength B) Speed C) Cardiovascular endurance D) Flexibility Answer: B Diff: 1 Page Ref: 60-61 Standard: Preparatory (Workforce Safety and Wellness) Objective: 3 10) When coping mechanisms can no longer buffer job stressors, the likely result is: A) withdrawal. B) burnout. C) eustress. D) fugue state. Answer: B Diff: 1 Page Ref: 76 Standard: Preparatory (Workforce Safety and Wellness) Objective: 8 11) Which of the following causes the greatest hazard for EMS personnel? A) Motor vehicle collisions B) Violence C) Suicide D) Communicable diseases Answer: A Diff: 1 Page Ref: 79 Standard: Preparatory (Workforce Safety and Wellness) Objective: 11

12) What is the minimum number of times you should exercise weekly to build cardiovascular endurance? A) 2 B) 5 C) 3 D) 10 Answer: C Diff: 1 Page Ref: 61 Standard: Preparatory (Workforce Safety and Wellness) Objective: 3 13) Good nutrition habits include: A) drinking 2-3 cups of coffee a day. B) eating 1-2 servings of grains or breads daily. C) enjoying charcoal-cooked foods. D) bringing low-calorie snacks to work. Answer: D Diff: 1 Page Ref: 62 Standard: Preparatory (Workforce Safety and Wellness) Objective: 3 14) You are on a scene at which you have requested and received orders for field termination of resuscitative measures. Which of the following terms should you use when informing the family of the patient's status? A) Gone B) Expired C) Dead D) Passed Answer: C Diff: 1 Page Ref: 73 Standard: Preparatory (Workforce Safety and Wellness) Objective: 7 15) At which of the following times should you wash your hands? A) Before meals B) When your hands are visibly soiled C) After every patient contact and/or decontamination procedure D) All of the above Answer: D Diff: 1 Page Ref: 68 Standard: Preparatory (Workforce Safety and Wellness) Objective: 2

16) The minimum recommended PPE for prehospital providers is all of the following, EXCEPT: A) reusable equipment. B) HEPA respirator. C) protective gloves. D) protective eyewear. Answer: A Diff: 1 Page Ref: 66-67 Standard: Preparatory (Workforce Safety and Wellness) Objective: 6 17) When operating an emergency vehicle, the paramedic should show due regard for the safety of: A) the patient. B) the EMS crew members. C) the general public. D) all of the above. Answer: D Diff: 1 Page Ref: 80 Standard: Preparatory (Workforce Safety and Wellness) Objective: 11 18) Which of the following is NOT a recommended vaccination for EMS providers? A) Tuberculosis B) Hepatitis B C) Measles/mumps/rubella D) Influenza Answer: A Diff: 1 Page Ref: 70 Standard: Preparatory (Workforce Safety and Wellness) Objective: 2 19) The most important Standard Precaution the EMS provider can employ as an infection control practice is to: A) avoid direct patient contact. B) sterilize all contaminated equipment. C) wash hands frequently. D) receive all recommended vaccinations. Answer: C Diff: 1 Page Ref: 68 Standard: Preparatory (Workforce Safety and Wellness) Objective: 6

20) A type of exercise in which muscles are worked through their full ranges of motion to develop muscular strength is called: A) iatrogenic. B) isotonic. C) isolateral. D) isometric. Answer: B Diff: 1 Page Ref: 61 Standard: Preparatory (Workforce Safety and Wellness) Objective: 1 21) A patient with suspected or known ________ makes it necessary for the care provider to don a HEPA or an N-95 respirator. A) pneumonia B) HIV C) viral meningitis D) tuberculosis Answer: D Diff: 2 Page Ref: 67 Standard: Preparatory (Workforce Safety and Wellness) Objective: 6 22) In addition to gloves, what personal protective equipment should you wear when assisting with childbirth? A) Protective eyewear and gown B) Mask, gown, and protective eyewear C) Mask D) Protective eyewear and N-95 respirator Answer: B Diff: 2 Page Ref: 67 Standard: Preparatory (Workforce Safety and Wellness) Objective: 6 23) What can be done to minimize the possibility of developing cancer? A) Eating broccoli and high-fiber foods B) Wearing sunblock C) Risk-assessment screening D) All of the above Answer: D Diff: 1 Page Ref: 63 Standard: Preparatory (Workforce Safety and Wellness) Objective: 3

24) Which of the following procedures would you use for dealing with a backboard contaminated with blood? A) Sterilization B) Cleaning C) Disinfection D) Disposal Answer: C Diff: 1 Page Ref: 70 Standard: Preparatory (Workforce Safety and Wellness) Objective: 6 25) Your EMS partner has been through some hard times lately. He broke up with his wife a few months ago, and his father died last month. After not smoking for years, he's taken it up again and now chain-smokes. He's sometimes rude to patients, and when you try to talk with him about this, he cuts you off. Your partner is using stress management techniques best described as: A) normal. B) defensive. C) detrimental. D) neutral. Answer: C Diff: 2 Page Ref: 77 Standard: Preparatory (Workforce Safety and Wellness) Objective: 9 26) Which of the following increases the risk of motor vehicle collision? A) Poor weather conditions B) Multiple vehicle responses C) The use of an ambulance escort D) All of the above Answer: D Diff: 1 Page Ref: 80 Standard: Preparatory (Workforce Safety and Wellness) Objective: 11

27) You are responding to a call for a "person slumped behind the wheel of a car" on a quiet side street at 1 AM. How should you approach this car? A) Pull up in front of the car, turn on all lights and the siren, and move quickly toward the vehicle. B) Pull up in front of the car, turn on all lights, and stay in the ambulance to determine scene safety. C) Pull up behind the car, use spotlights to "blind" the occupant, and approach cautiously until you perceive that there is no hostile intent. D) Park behind the car at a safe distance, remain in the ambulance, and wait for law enforcement to arrive and ensure scene safety. Answer: C Diff: 2 Page Ref: 80 Standard: Preparatory (Workforce Safety and Wellness) Objective: 11 28) When you are in a stressful situation and find yourself thinking, "I can't do this," one effective strategy is to: A) withdraw. B) deny. C) project. D) reframe. Answer: D Diff: 1 Page Ref: 77 Standard: Preparatory (Workforce Safety and Wellness) Objective: 9 29) Which of the following normally occurs as part of the "fight-or-flight" response? A) Pupils dilate. B) Heart rate decreases. C) Blood pressure decreases. D) Digestion speeds up. Answer: A Diff: 1 Page Ref: 75 Standard: Preparatory (Workforce Safety and Wellness) Objective: 8 30) One way to prevent a potentially hostile situation is to: A) assert your authority. B) move into bystanders' personal space. C) communicate effectively. D) maintain a closed stance. Answer: C Diff: 1 Page Ref: 79 Standard: Preparatory (Workforce Safety and Wellness) Objective: 11

31) Your ambulance arrives at a scene where a car has run into a ditch alongside a two-lane country highway. You should park the ambulance: A) in front of the car on the same side of the street. B) behind the car on the same side of the street. C) behind the car on the opposite side of the street. D) in front of the car on the opposite side of the street. Answer: A Diff: 2 Page Ref: 80 Standard: Preparatory (Workforce Safety and Wellness) Objective: 11 32) The stress management technique of controlled breathing works by: A) reducing adrenaline levels. B) increasing blood pressure. C) increasing ACTH levels. D) speeding digestion. Answer: A Diff: 1 Page Ref: 77 Standard: Preparatory (Workforce Safety and Wellness) Objective: 9 33) Which of the following can increase the risk of back injury? A) Smoking B) Weak abdominal muscles C) Poor nutrition D) All of the above Answer: D Diff: 1 Page Ref: 64 Standard: Preparatory (Workforce Safety and Wellness) Objective: 5 34) You are providing end-of-life care to a patient in the last stages of a terminal illness. She appears to be at peace and speaks animatedly about her upcoming funeral. She is in which stage of loss? A) Acceptance B) Denial C) Bargaining D) Depression Answer: A Diff: 1 Page Ref: 72 Standard: Preparatory (Workforce Safety and Wellness) Objective: 7

35) Which of the following is a benefit of good nutritional habits? A) Proper body weight B) Reduced risk of cardiovascular disease C) Reduced cancer risk D) All of the above Answer: D Diff: 1 Page Ref: 62-63 Standard: Preparatory (Workforce Safety and Wellness) Objective: 3 36) Eating habits that contribute to good nutrition include which of the following? A) Consuming no more than 10 percent of calories from carbohydrates B) Eating a variety of foods from the major food groups daily C) Eating primarily high-protein foods D) Consuming 8 to 10 glasses of fruit juice per day Answer: B Diff: 1 Page Ref: 62 Standard: Preparatory (Workforce Safety and Wellness) Objective: 3 37) Which of the following practices, when done regularly, can help reduce back injuries during lifting? A) Gaining body weight to "anchor" the lift B) Keeping the palms up when possible while lifting the cot C) Using traditional sit-ups to strengthen lower back muscles during exercise routines D) Counterbalance the lift by moving your center of gravity away from the load Answer: B Diff: 1 Page Ref: 64 Standard: Preparatory (Workforce Safety and Wellness) Objective: 5 38) Which of the following Standard Precautions should paramedics use with every patient? A) Disposable gloves B) Surgical gown and mask C) Mask and protective eyewear D) HEPA mask Answer: A Diff: 1 Page Ref: 66 Standard: Preparatory (Workforce Safety and Wellness) Objective: 6

39) Shift work, down time between calls, and inadequate pay are all examples of ________ stressors. A) emotional B) administrative C) environmental D) physical Answer: B Diff: 2 Page Ref: 74 Standard: Preparatory (Workforce Safety and Wellness) Objective: 8 40) Standard Precautions are used on the assumption that: A) the blood and body fluids of all patients are potentially infectious. B) hemorrhage is likely in most patients who call EMS. C) paramedics are threatened mainly by airborne pathogens. D) patients who look healthy are not contagious. Answer: A Diff: 1 Page Ref: 65 Standard: Preparatory (Workforce Safety and Wellness) Objective: 6 41) You just sustained an accidental needle stick with a contaminated intravenous needle. You should immediately: A) request a tetanus shot. B) contact your supervisor. C) wash the affected area with soap and water. D) ask the patient about lifestyle risk factors for HIV. Answer: C Diff: 1 Page Ref: 71-72 Standard: Preparatory (Workforce Safety and Wellness) Objective: 2 42) Which of the following is part of good handwashing technique? A) Use the hottest water that can be tolerated. B) Use only antibacterial bar soap, avoiding liquid soaps when possible. C) Thoroughly lather your hands with soap, front and back, for at least 15 seconds. D) Use an ethanol-based, waterless hand sanitizer instead of soap when possible. Answer: C Diff: 1 Page Ref: 68 Standard: Preparatory (Workforce Safety and Wellness) Objective: 6

43) Which of the following is NOT a common warning sign of cancer? A) Change in mole size or appearance B) Weight gain C) Unexplained chronic fatigue D) Abnormal lumps Answer: B Diff: 1 Page Ref: 63 Standard: Preparatory (Workforce Safety and Wellness) Objective: 2 44) Which of the following is a physiological benefit of achieving and maintaining physical fitness? A) Increased resting blood pressure B) Increased metabolic rate C) Decreased oxygen-carrying capacity D) Increased resting heart rate Answer: B Diff: 1 Page Ref: 60 Standard: Preparatory (Workforce Safety and Wellness) Objective: 3 45) Which of the following is a bloodborne disease? A) Hepatitis B B) Rubella C) Tuberculosis D) Influenza Answer: A Diff: 1 Page Ref: 65 Standard: Preparatory (Workforce Safety and Wellness) Objective: 2 46) The long spine board on which you transported a patient directly contacted the patient's unbroken skin. How would you clean the board? A) Wash it with soap and water. B) Discard it. C) Sterilize it with an EPA-approved solution. D) Disinfect it with a solution of 1 part bleach to 10 parts of water. Answer: D Diff: 1 Page Ref: 70 Standard: Preparatory (Workforce Safety and Wellness) Objective: 6

47) Any occurrence in which blood or body fluids contact non-intact skin or mucous membranes is considered a(n): A) contamination. B) exposure. C) incident. D) infection. Answer: B Diff: 1 Page Ref: 70 Standard: Preparatory (Workforce Safety and Wellness) Objective: 1 48) As part of a healthy diet to control weight, you should: A) eat low-calorie snacks. B) cut back on fluids. C) eat quickly. D) eat less than the serving size on the food label. Answer: A Diff: 1 Page Ref: 62 Standard: Preparatory (Workforce Safety and Wellness) Objective: 3 49) A supervisor senses that an EMS crew that has just conducted a very dramatic, but unsuccessful, rescue of a drowned child may be experiencing very intense emotions about the incident. Which of the following is an appropriate supervisory action? A) Do nothing unless the providers become obviously distressed. B) Refer all crew members to psychiatric help at the end of the shift. C) Minimize any effects by keeping a low-key attitude about the incident. D) Initiate a "resiliency based care" program to care for the mental health of the crew. Answer: D Diff: 2 Page Ref: 78-79 Standard: Preparatory (Workforce Safety and Wellness) Objective: 10 50) When physically preparing yourself to work safely as a paramedic, you should: A) exercise your cardiovascular system at least three times a week. B) read as much as you can about physical fitness. C) perform as many traditional sit-ups as you can to promote abdominal strength. D) do as little as possible to preserve your strength for emergency duty. Answer: A Diff: 1 Page Ref: 61 Standard: Preparatory (Workforce Safety and Wellness) Objective: 3

51) When evaluating a patient with tuberculosis, paramedics should protect themselves by: A) placing a HEPA respirator on the patient. B) wearing surgical masks. C) wearing HEPA respirators. D) placing nonrebreather masks on their patients. Answer: C Diff: 1 Page Ref: 67 Standard: Preparatory (Workforce Safety and Wellness) Objective: 2 52) Which of the following is NOT a benefit of physical fitness? A) Back safety B) Improved self-image C) Enhanced quality of life D) Maintenance of motor skills Answer: A Diff: 1 Page Ref: 60 Standard: Preparatory (Workforce Safety and Wellness) Objective: 3 53) Which of the following is NOT a common approach to managing addiction? A) aversion therapy B) behavior modification C) hypnotism D) enhancement therapy Answer: D Diff: 1 Page Ref: 63 Standard: Preparatory (Workforce Safety and Wellness) Objective: 4 Chapter 5 EMS Research 1) ________ describes phenomena in numbers. A) Prospective research B) Qualitative research C) Mixed research D) Quantitative research Answer: D Diff: 1 Page Ref: 88 Standard: Preparatory (Research) Objective: 1

2) Which type of research can help determine whether a procedure, drug, treatment, or similar strategy actually improves patient outcomes? A) Bench B) Outcomes-based C) Mixed D) Qualitative Answer: B Diff: 1 Page Ref: 86 Standard: Preparatory (Research) Objective: 1 3) The person who is overseeing a study and is familiar with requirements for informed consent is the: A) controller. B) institutional review foreman. C) principal investigator. D) abstract editor. Answer: C Diff: 1 Page Ref: 102 Standard: Preparatory (Research) Objective: 1 4) The difference between mean and median is which of the following? A) Mean is calculated by adding values, then dividing the sum by the number of values involved; median is calculated by putting the values into numerical order and finding the middle value. B) Mean is a representation of the standard deviation within a study, and median is the value of the variance. C) Median is calculated by adding values, then dividing the sum by the number of values involved; mean is calculated by putting the values into numerical order and finding the middle value. D) Mean is the value of the variance within a study, and median is a representation of the standard deviation. Answer: A Diff: 2 Page Ref: 94 Standard: Preparatory (Research) Objective: 1 5) A group of subjects who do not have manipulation of the independent variable is called the: A) subject group. B) experimental group. C) treatment group. D) control group. Answer: D Diff: 1 Page Ref: 89 Standard: Preparatory (Research) Objective: 1 38 Copyright © 2017 Pearson Education, Inc.

6) The acronym ANOVA stands for: A) an over-variable analog. B) a novel analysis. C) analysis of variance. D) abstract null overaction. Answer: C Diff: 1 Page Ref: 95 Standard: Preparatory (Research) Objective: 1 7) A specific question that a research study sets out to answer is called the: A) hypothesis. B) experiment. C) meta-analysis. D) odds ratio. Answer: A Diff: 1 Page Ref: 87 Standard: Preparatory (Research) Objective: 1 8) How well a study supports the conclusions is referred to as: A) variance. B) validity. C) bias. D) ordinal data. Answer: B Diff: 1 Page Ref: 95 Standard: Preparatory (Research) Objective: 1 9) A type of study that does not allow the subjects or the experimenters to know who is in the control group is: A) quasi-experimental. B) cross-sectional. C) double blind D) single blind. Answer: C Diff: 1 Page Ref: 90 Standard: Preparatory (Research) Objective: 1

10) The statistic that reflects only the odds of seeing the results of a particular piece of research if the study hypothesis is TRUE is the: A) nominal data. B) P value. C) chi square test. D) t test. Answer: B Diff: 1 Page Ref: 100 Standard: Preparatory (Research) Objective: 1 11) Which of the following is a common measure of dispersion? A) Standard deviation B) Confidence interval C) Inferential statistics D) Ordinal data Answer: A Diff: 1 Page Ref: 95 Standard: Preparatory (Research) Objective: 1 12) The process by which scientists endeavor to construct an accurate representation of the world that is reliable, consistent, and non-arbitrary is the: A) case series. B) random sampling. C) iterative process. D) scientific method. Answer: D Diff: 1 Page Ref: 87 Standard: Preparatory (Research) Objective: 1 13) The ________ is a brief paragraph that summarizes the need for the study, the research methods used, and the results encountered. A) abstract B) mode C) hypothesis D) parameter Answer: A Diff: 1 Page Ref: 97 Standard: Preparatory (Research) Objective: 1

14) What is the first step of the scientific method? A) Observe and ask questions. B) Construct a hypothesis. C) Conduct research and collect data. D) Test the hypothesis. Answer: A Diff: 1 Page Ref: 87 Standard: Preparatory (Research) Objective: 4 15) Where are the results of a scientific study published, regardless of the outcome of the study? A) In a medical director paper B) In an EMS trade magazine C) In a university-based magazine D) In a peer-reviewed journal Answer: D Diff: 1 Page Ref: 88 Standard: Preparatory (Research) Objective: 4 16) What is the difference between qualitative and quantitative research? A) Quantitative research uses a control group; qualitative research does not use a control group. B) Quantitative research is designed to determine the relationship between one thing and another and describe it with numbers; qualitative research primarily relies on collection of nonnumeric data. C) Quantitative research does not use a control group; qualitative research does use a control group. D) Qualitative research is designed to determine the relationship between one thing and another and describe it with numbers; quantitative research primarily relies on collection of nonnumeric data. Answer: B Diff: 1 Page Ref: 88 Standard: Preparatory (Research) Objective: 5 17) When comparing and contrasting between a retrospective and prospective study, which of the following is a TRUE statement? A) Prospective studies are generally less expensive than retrospective methodologies. B) There is more chance for the introduction of bias in the data gathering for prospective studies. C) Prospective studies have greater validity than retrospective studies. D) Retrospective studies use a research form or instrument specifically designed for the study. Answer: C Diff: 1 Page Ref: 88-89 Standard: Preparatory (Research) Objective: 5

18) In a(n) ________ study, subjects are randomized into either the treatment group or the control group; this type is considered among the most valid of studies. A) experimental B) quasi-experimental C) observational D) retrospective Answer: A Diff: 1 Page Ref: 89 Standard: Preparatory (Research) Objective: 6 19) In many situations it is unethical to withhold treatment from a group simply for the purposes of experimentation. As a result, a(n) ________ study must be done. A) observational B) quasi-experimental C) retrospective D) prospective Answer: A Diff: 1 Page Ref: 90 Standard: Preparatory (Research) Objective: 7 20) The most valid of all the specific study types is: A) cross-sectional study. B) meta-analysis of randomized controlled trials. C) expert opinions, editorials, rational conjecture. D) In vivo research. Answer: B Diff: 1 Page Ref: 90 Standard: Preparatory (Research) Objective: 6 21) This type of study has less validity than an RCT, but it has utility in some circumstances. The problem in this study design is that there is an increased chance that the study groups will be different. A) Cohort study B) Nonrandomized controlled trial C) Cross-sectional study D) Case series Answer: B Diff: 1 Page Ref: 91 Standard: Preparatory (Research) Objective: 5

22) The mean is especially useful when the data are what statisticians call "normally distributed." This means: A) if you graphed the data, it would form a shape similar to a bell curve. B) values are placed into numerical order, and the middle value is determined. C) the data falls within the "fiftieth percentile." D) the distribution of a group is how spread out it is, or how dispersed the data are. Answer: A Diff: 2 Page Ref: 94 Standard: Preparatory (Research) Objective: 8 23) ________ are very important in interpreting the value of the research results. A) Measures of central tendency B) Standard deviations C) Qualitative statistics D) Confidence intervals Answer: D Diff: 1 Page Ref: 95 Standard: Preparatory (Research) Objective: 8 24) Which section of a research paper describes exactly how the authors conducted the study, including what population they wished to study, how subjects were selected (and excluded), and what intervention was performed? A) Introduction B) Discussion C) Methods D) Results Answer: C Diff: 1 Page Ref: 97 Standard: Preparatory (Research) Objective: 9 25) The ________ section of a research paper is where the authors interpret their findings and describe their significance. A) summary B) results C) methods D) discussion Answer: D Diff: 1 Page Ref: 97 Standard: Preparatory (Research) Objective: 9

26) The first thing to appear after the title and names of the authors of a research paper is the: A) introduction. B) summary. C) abstract. D) results. Answer: C Diff: 1 Page Ref: 97 Standard: Preparatory (Research) Objective: 9 27) All of the following are questions to ask when reviewing a study, EXCEPT: A) Was the study type appropriate? B) Was the research peer reviewed? C) Were the results reported properly? D) What control group were the researchers studying? Answer: D Diff: 1 Page Ref: 100-101 Standard: Preparatory (Research) Objective: 10 28) What type of confidence interval would be appropriate for a research study that is potentially going to change EMS practice? A) 80 percent B) 85 percent C) 90 percent D) 95 percent Answer: D Diff: 1 Page Ref: 95 Standard: Preparatory (Research) Objective: 8 29) A ________ is undertaken first to find unforeseen obstacles to data gathering during participation in a research study. A) null hypothesis B) pilot trial C) principal investigation D) data analysis Answer: B Diff: 1 Page Ref: 102 Standard: Preparatory (Research) Objective: 9

30) Telling participants the inclusion and exclusion criteria for enrolling patients in the study, the effect of the study on patient care in general, and the risks and potential benefits to patients in the study helps to: A) gain informed consent. B) get EMS concessions. C) identify the PI. D) determine how to publish. Answer: A Diff: 2 Page Ref: 102 Standard: Preparatory (Research) Objective: 7 31) Which of these is an EMS technique that has been proven through research to be less effective than once thought? A) tiered response B) modified Valsalva maneuver C) endotracheal intubation D) evidence-based practice Answer: C Diff: 1 Page Ref: 86 Standard: Preparatory (Research) Objective: 2 32) Which of these conclusions did the 2001 National EMS Research Agenda NOT reach? A) Develop a cadre of EMS researchers and support them early in their careers. B) Publicize research that supports the consensus of EMS medical directors. C) Establish an alternate funding source for EMS research outside of government. D) View research as necessary for the improvement of patient care. Answer: B Diff: 1 Page Ref: 86 Standard: Preparatory (Research) Objective: 3 33) Which of these is not necessarily a step EMS providers should take when conducting a research study? A) Implement a cohort study model. B) Determine how to obtain informed consent from study subjects. C) Prepare a null hypothesis and research hypothesis. D) Define the population to be studied. Answer: A Diff: 1 Page Ref: 101 Standard: Preparatory (Research) Objective: 11

Chapter 6 Public Health 1) The science and practice of protecting and improving the health of a community through the use of preventive medicine is known as: A) public health. B) epidemiology. C) primary prevention. D) injury risk. Answer: A Diff: 1 Page Ref: 107 Standard: Public Health Objective: 1 2) The branch of medicine that deals with the incidence and prevalence of disease in large populations is known as: A) tertiary prevention. B) injury surveillance. C) epidemiology. D) field investigation. Answer: C Diff: 1 Page Ref: 108 Standard: Public Health Objective: 1 3) Rehabilition activities that help prevent further injury are called: A) quaternary prevention. B) secondary prevention. C) primary prevention. D) tertiary prevention. Answer: D Diff: 1 Page Ref: 109 Standard: Public Health Objective: 1 4) A(n) ________ is the ongoing systematic collection, analysis, and interpretation of injury data essential to the planning, implementation, and evaluation of public health practice. A) injury surveillance program B) primary prevention program C) injury risk program D) epidemiological program Answer: A Diff: 1 Page Ref: 109 Standard: Public Health Objective: 1

5) Which one of the following roles does EMS have in public health when providing health care screenings and vaccinations, providing health education, and targeting high-risk populations in an effort to ensure that they are receiving needed medical care? A) Disease surveillance B) Disaster management C) Injury prevention D) Health promotion Answer: D Diff: 2 Page Ref: 110 Standard: Public Health Objective: 2 6) Common strategies that include child safety seat classes, bicycle safety training, drunk driving education programs, smoking prevention, and swimming pool safety programs fall under which public health role of EMS? A) Health promotion B) Injury prevention C) Policy development D) Disease surveillance Answer: B Diff: 2 Page Ref: 114 Standard: Public Health Objective: 2 7) Which of the following is NOT a category within public health laws? A) Laws that give public health officials the necessary legal tools to perform their jobs B) Laws allowing public health entities to act in the general interest of the public C) Laws that deal with the incidence and prevalence of disease in large populations D) Laws giving public health agencies power to use epidemiological tools to analyze legal issues Answer: C Diff: 2 Page Ref: 108 Standard: Public Health Objective: 3 8) How has public health improved both the quality of life and the life span of humankind? A) Through research B) Through epidemiology C) Through surveillance D) All of the above Answer: D Diff: 1 Page Ref: 107 Standard: Public Health Objective: 3

9) In order to link its EMS and public health systems, a community must have which of the following in place? A) Strong medical oversight over just the EMS system B) Stakeholders having a role in the planning process C) Disaster plans that are drilled and developed at the state level D) A desire to educate public health providers about field investigation. Answer: B Diff: 2 Page Ref: 107 Standard: Public Health Objective: 5 10) A calculation made by subtracting the age at death from 65 is one concept of: A) analytic studies. B) illness prevention. C) epidemiology. D) linkage. Answer: C Diff: 2 Page Ref: 109 Standard: Public Health Objective: 4 11) Which of the following is NOT a category of intentional injury? A) Acquaintance rape B) Suicide by hanging C) Household accident D) Elder abuse Answer: C Diff: 2 Page Ref: 109 Standard: Public Health Objective: 4 12) A(n) ________ occurs shortly after an injury and is when a patient may be more receptive to learning about how a similar injury can be prevented in the future. A) teachable moment B) injury surveillance C) field investigation D) analytic study Answer: A Diff: 1 Page Ref: 109 Standard: Public Health Objective: 5

13) Epidemiologically speaking, an ongoing process that determines the effectiveness, efficiency, and impact of activities related to public health initiatives is called: A) linkage. B) evaluation. C) policy development. D) field evaluation. Answer: B Diff: 1 Page Ref: 109 Standard: Public Health Objective: 4 14) A(n) ________ program must also include a component for the timely dissemination of data to those who need to know. A) injury surveillance B) primary prevention C) field investigation D) unintentional injury Answer: A Diff: 1 Page Ref: 109 Standard: Public Health Objective: 4 15) Which of the following is an example of how EMS providers can be involved in community injury prevention? A) Transporting an unconscious trauma patient to a Level I trauma center B) Performing CPR on an elderly patient in cardiac arrest C) Participating in a high school drunk driving crash scenario D) Being an advocate to attain the latest technology and equipment Answer: C Diff: 2 Page Ref: 111 Standard: Public Health Objective: 5 16) What is required from EMS providers at every level for any prevention program to succeed? A) They must instruct others in the fundamentals of primary prevention. B) They must understand the need for involvement in prevention activities. C) They must participate in all continuing education activities offered in their system. D) They must know all the different types of on-scene survival techniques. Answer: B Diff: 2 Page Ref: 111 Standard: Public Health Objective: 5

17) When developing and measuring the success of prevention programs, each EMS agency should contribute data to all of the following agencies, EXCEPT: A) local. B) international. C) federal. D) state. Answer: B Diff: 1 Page Ref: 111 Standard: Public Health Objective: 5 18) The ultimate factor in achieving success in an EMS prevention program lies in the hands of: A) frontline personnel. B) EMS managers. C) medical directors. D) community leaders. Answer: A Diff: 1 Page Ref: 111 Standard: Public Health Objective: 5 19) The ________ guidelines outline how employers and employees share responsibility for ensuring that Standard Precautions are used to assist in preventing contamination from blood and other bodily fluids. A) HIPAA B) AHA C) AMA D) OSHA Answer: D Diff: 2 Page Ref: 112 Standard: Public Health Objective: 6 20) Which of the following is NOT part of the commitment that an EMS provider needs to have to prevent illness and injury? A) Parking the unit in the safest place to load the patient, then directing traffic B) Being familiar with local and state traffic laws and obeying them C) Consistently incorporating exercise and a health-minded attitude into his life D) Knowing his limits and taking time out to relax when necessary Answer: A Diff: 2 Page Ref: 112-113 Standard: Public Health Objective: 6

21) What tends to be the first body part that is injured in a pediatric patient during a motor vehicle collision? A) Chest B) Head C) Abdomen D) Neck Answer: B Diff: 1 Page Ref: 114 Standard: Public Health Objective: 7 22) What is the most common mechanism of injury for children younger than 6 years old? A) Firearms B) Abuse and assault C) Motor vehicle collision D) Falls Answer: D Diff: 1 Page Ref: 114 Standard: Public Health Objective: 7 23) What is the biggest preventable injury in the geriatric population? A) Falls B) Firearms C) Accidental overdose D) Abuse Answer: A Diff: 1 Page Ref: 114 Standard: Public Health Objective: 7 24) Almost one-half of public workplace injuries occur to all of the following EXCEPT: A) the back. B) the eyes. C) the feet. D) the hands. Answer: C Diff: 1 Page Ref: 115 Standard: Public Health Objective: 7

25) Which of the following can lead to a medication-related illness/injury? A) Following the medication directions of the pharmacist B) Taking only 7 of the 10 prescribed antibiotic pills C) Seeking prescriptions only from an urgent care facility D) Refilling a medication prescription two days prior to the expiration date Answer: B Diff: 2 Page Ref: 115 Standard: Public Health Objective: 7 26) A community issue that may require EMS assistance in developing a prevention program is: A) epidemiological research. B) financial support. C) recognizing scene hazards. D) early discharge of a patient. Answer: C Diff: 1 Page Ref: 115 Standard: Public Health Objective: 7 27) A hazardous or potentially hazardous situation that puts people in danger of sustaining injury best defines which of the following? A) Injury risk B) Injury surveillance C) Injury D) Accident Answer: A Diff: 1 Page Ref: 109 Standard: Public Health Objective: 1 28) Certain situations, such as epidemics and disasters, call for which of the following actions? A) Public health law research program B) Epidemiological research C) Public health agency police powers D) Illness and prevention laws Answer: C Diff: 1 Page Ref: 108 Standard: Public Health Objective: 2

29) Which of the following is one of the components that must be in place for EMS and public health to work together? A) Strong medical oversight B) Legislative doctrines C) Educating the community about EMS D) Passive pursuit of finances Answer: A Diff: 1 Page Ref: 107 Standard: Public Health Objective: 5 30) Which of the following is NOT a prevention strategy that EMS personnel should be able to implement? A) Preserving the safety of the response team B) Policing powers C) Document findings D) Knowing the community resources Answer: B Diff: 1 Page Ref: 115-117 Standard: Public Health Objective: 6 Chapter 7 Medical—Legal Aspects of Out-of-Hospital Care 1) A paramedic who transports patients without their consent or other legal authority would most likely be subject to charges of: A) false imprisonment. B) abandonment. C) defamation. D) negligence. Answer: A Diff: 1 Page Ref: 135 Standard: Preparatory (Medical/Legal and Ethics) Objective: 13 2) A document that is signed by a physician and that outlines the life-sustaining measures that may or may not be taken when a patient's heart and respiratory functions have ceased is a: A) DNR order. B) power of attorney. C) living will. D) statement of last rites. Answer: A Diff: 1 Page Ref: 137 Standard: Preparatory (Medical/Legal and Ethics) Objective: 1

3) Injuring a person's name or character through malicious spoken statements is called: A) misfeasance. B) perjury. C) libel. D) slander. Answer: D Diff: 1 Page Ref: 129-130 Standard: Preparatory (Medical/Legal and Ethics) Objective: 1 4) Your patient is a 16-year-old male with a reported history of ingesting 8 to 10 beers over the preceding 2 hours. He fell while jumping on a trampoline, striking his head on the metal framing of the trampoline. There was no reported loss of consciousness, but the patient has a laceration to the occipital area of the head. The patient is alert and oriented to person, time, and place but fails to show appropriate concern for his injury and has slurred speech. The parents are unavailable. Which of the following is the best course of action? A) Treat the patient under the doctrine of implied consent of the parents. B) Treat the patient as an emancipated minor and allow him to decide whether he wants treatment and transport. C) Have the patient arrested for underage drinking, and obtain the consent of law enforcement to treat the patient. D) Use the doctrine of res ipsa loquitur to support your decision to either treat and release or treat and transport. Answer: A Diff: 3 Page Ref: 131 Standard: Preparatory (Medical/Legal and Ethics) Objective: 11 5) A civil wrong committed by one individual against another is a: A) breach of duty. B) misdemeanor. C) felony. D) tort. Answer: D Diff: 1 Page Ref: 122 Standard: Preparatory (Medical/Legal and Ethics) Objective: 1

6) Which of the following is NOT a valid reason for releasing confidential patient information? A) A judge signs a court order requesting the information. B) A newspaper reporter promises not to reveal his source. C) The patient's other medical care providers have a need to know. D) The patient's insurance company needs the information for filing and reimbursement purposes. Answer: B Diff: 2 Page Ref: 128-129 Standard: Preparatory (Medical/Legal and Ethics) Objective: 9 7) EMT-P Smith came to work feeling very tired and decided to nap before doing his equipment and vehicle checklist. After about 45 minutes the tones went off, and EMT-P Smith and his EMT-B partner, Jones, were dispatched for a seizure. The patient was still actively seizing when they arrived at the scene. Smith discovered that the previous shift had used all the Valium and failed to replace it. As a result, Smith could administer no medication to stop the seizure. Ultimately, the patient stopped seizing and suffered no apparent adverse consequences. Which of the following elements to establish negligence is missing in this case? A) Consent B) Breach of duty C) Actual damages D) Duty to act Answer: C Diff: 2 Page Ref: 126 Standard: Preparatory (Medical/Legal and Ethics) Objective: 6 8) The granting of permission by a governmental body for a qualified individual to engage in a particular profession or occupation is known as: A) licensure. B) registration. C) reciprocity. D) certification. Answer: A Diff: 1 Page Ref: 124 Standard: Preparatory (Medical/Legal and Ethics) Objective: 5 9) Malfeasance, misfeasance, and nonfeasance are three types of: A) aggravated assault. B) breach of duty. C) negligence. D) criminal acts. Answer: B Diff: 1 Page Ref: 126 Standard: Preparatory (Medical/Legal and Ethics) Objective: 8 55 Copyright © 2017 Pearson Education, Inc.

10) ________ often occurs in patients who have used CNS depressants and results from the patient being in a physical position that interferes with his airway or with ventilation. A) Res ipsa loquitur B) Excited delirium C) Restraint asphyxia D) Defamation Answer: C Diff: 2 Page Ref: 128 Standard: Preparatory (Medical/Legal and Ethics) Objective: 13 11) The principle of law that prohibits the release of medical or other personal information about a patient without the patient's permission is known as: A) primum non nocere. B) privilege. C) confidentiality. D) privacy. Answer: C Diff: 2 Page Ref: 128 Standard: Preparatory (Medical/Legal and Ethics) Objective: 1 12) You are called to a scene for a report of "an unconscious man." When you arrive at the scene, the patient is conscious and alert, sitting on the front stairs with neighbors around him. He says he doesn't know what happened but is "Okay now, just a little woozy." You ask if you can assess him, but he refuses. You make several attempts to get him to change his mind, pointing out possible causes of the problem and possible consequences of refusing. He still says no, and you ask the neighbors if they can help the patient change his mind. Finally, you get the patient to sign a release from liability form and have it witnessed by one of the neighbors. As you leave, you document the call and your efforts to convince the patient to accept assessment/care. What else should you have done with this patient before leaving the scene? A) Consulted with medical direction online B) Advised the patient that he could call EMS again if the problem recurs C) Urged the patient's neighbors to stay with him D) All of the above Answer: D Diff: 2 Page Ref: 132 Standard: Preparatory (Medical/Legal and Ethics) Objective: 11

13) The category of law that deals with issues involving conflicts between two or more parties, such as personal injury cases, contract disputes, and matrimonial issues, is ________ law. A) criminal B) civil C) common D) magistrate Answer: B Diff: 1 Page Ref: 122 Standard: Preparatory (Medical/Legal and Ethics) Objective: 3 14) When faced with unruly or violent patients who pose threats to themselves, paramedics, or others, the paramedic may control the patients by using: A) reasonable physical force. B) pepper spray. C) handcuffs. D) a Taser. Answer: A Diff: 1 Page Ref: 135 Standard: Preparatory (Medical/Legal and Ethics) Objective: 13 15) When a court orders that a prisoner receive treatment the prisoner does not want, the treatment is based on ________ consent. A) involuntary B) expressed C) proximate D) ex parte Answer: A Diff: 1 Page Ref: 131 Standard: Preparatory (Medical/Legal and Ethics) Objective: 11 16) Which of the following laws is designed to allow the paramedic who has been potentially exposed to an infectious disease access to the medical records of the patient to whom the paramedic was exposed? A) The Ryan White CARE Act B) EMTALA C) HIPAA D) Good Samaritan laws Answer: A Diff: 1 Page Ref: 141 Standard: Preparatory (Medical/Legal and Ethics) Objective: 17

17) There are ethical and societal limits to the interactions between paramedics or other health care personnel and the patients they serve. These are called: A) employment laws. B) professional boundaries. C) scope of practice. D) standard of care. Answer: B Diff: 1 Page Ref: 134 Standard: Preparatory (Medical/Legal and Ethics) Objective: 12 18) Which of the following occurrences is LEAST likely to require mandatory legal reporting by the paramedic? A) Public intoxication B) Abuse of the elderly C) Child endangerment D) Spousal battery Answer: A Diff: 2 Page Ref: 139-140 Standard: Preparatory (Medical/Legal and Ethics) Objective: 16 19) A patient has been treated by paramedics for a sprained wrist. En route to the hospital, she suffers a stroke. What is the likely outcome of a negligence lawsuit brought by the patient? A) The suit would succeed because this was a foreseeable event. B) The suit would fail because the plaintiff could not demonstrate that the paramedics' actions were the proximate cause of the stroke. C) The suit would succeed because the paramedics had a duty to act and the patient suffered actual damages. D) The suit would fail because the plaintiff failed to demonstrate malice on the part of the plaintiffs. Answer: B Diff: 2 Page Ref: 125-126 Standard: Preparatory (Medical/Legal and Ethics) Objective: 7 20) When a paramedic treats an unconscious patient, the provision of treatment is based on ________ consent. A) implied B) expressed C) res ipsa loquitur D) primum non nocere Answer: A Diff: 1 Page Ref: 131 Standard: Preparatory (Medical/Legal and Ethics) Objective: 11 58 Copyright © 2017 Pearson Education, Inc.

21) When a patient care report is found to be incomplete or inaccurate, the paramedic should: A) erase or white out the incorrect information and write in the correct facts. B) add a dated and signed written amendment to the original report. C) file a completely new report with the correct information. D) cross out the incorrect information so that it cannot be read and add the correct information to the bottom of the report, dating and signing it. Answer: B Diff: 1 Page Ref: 140 Standard: Preparatory (Medical/Legal and Ethics) Objective: 16 22) The unilateral termination of the paramedic-patient relationship by the paramedic without assurance that an equal or greater level of care will continue is known as: A) misfeasance. B) abandonment. C) assault. D) battery. Answer: B Diff: 1 Page Ref: 134 Standard: Preparatory (Medical/Legal and Ethics) Objective: 1 23) The degree of care, skill, and judgment that would be expected of any similarly trained, reasonable paramedic acting under similar circumstances is called the: A) test of prudent actions. B) standard of care. C) duty to act. D) scope of practice. Answer: B Diff: 1 Page Ref: 126 Standard: Preparatory (Medical/Legal and Ethics) Objective: 1 24) DNR orders, durable powers of attorney, and living wills are forms of: A) standards of care. B) protocols. C) advance directives. D) medical orders. Answer: C Diff: 1 Page Ref: 136-138 Standard: Preparatory (Medical/Legal and Ethics) Objective: 14

25) Which of the following statements about civil suits regarding torts is generally TRUE? A) The burden of proof rests on the defendant. B) The plaintiff seeks to recover damages from the defendant. C) Guilt must be proven beyond a shadow of a reasonable doubt. D) Intent to harm must be proven. Answer: B Diff: 1 Page Ref: 123 Standard: Preparatory (Medical/Legal and Ethics) Objective: 3 26) A physician has ordered you to give a medication that you believe will harm your patient. Which of the following should you do? A) Question the physician but carry out the order if the physician insists. B) Contact a supervisor in the EMS system and request a second opinion. C) Carry out the ordered treatment but note your objection in the patient care report. D) Question the physician, refuse to carry out the order if the physician insists you do so, and document the incident. Answer: D Diff: 2 Page Ref: 123 Standard: Preparatory (Medical/Legal and Ethics) Objective: 8 27) You have responded to a physician's office for a terminal cancer patient in cardiac arrest. The physician says, "This is a chemical code only. Just give the meds, but don't intubate or do CPR." Which of the following should you do? A) Tell the physician you are bound to treat the patient according to protocol. If the physician would like you to do something different, she must take complete responsibility for patient care. B) Comply with her orders on the scene to avoid a confrontation, but initiate appropriate care once you are in the back of the ambulance. C) Tell the physician you cannot comply with her orders under any circumstances, and then file a report with the state medical licensing board about her negligence in this case. D) Because this is the patient's personal physician, you must comply with her orders. Answer: A Diff: 3 Page Ref: 138-139 Standard: Preparatory (Medical/Legal and Ethics) Objective: 14 28) Protecting those at risk is an example of a paramedic's ________ duty. A) legal B) medical-legal C) ethical D) moral Answer: C Diff: 2 Page Ref: 139 Standard: Preparatory (Medical/Legal and Ethics) Objective: 1 60 Copyright © 2017 Pearson Education, Inc.

29) Which of the following is best described as the unlawful touching of another individual without the individual's consent? A) Battery B) Malpractice C) Negligence D) Assault Answer: A Diff: 1 Page Ref: 134 Standard: Preparatory (Medical/Legal and Ethics) Objective: 1 30) Paramedic Davis and his partner, EMT-I Smothers, are eating lunch in the hospital cafeteria and discussing the details of a call they ran last week on well-known news anchor Adam Best. Unbeknownst to Davis and Smothers, Mr. Best's co-anchor is sitting directly behind them listening to the details. Which of the following best describes the actions of Davis and Smothers? A) Slander B) Breach of confidentiality C) Negligence D) Libel Answer: B Diff: 2 Page Ref: 129 Standard: Preparatory (Medical/Legal and Ethics) Objective: 10 31) Which of the following is an example of good documentation? A) Vital information is kept secret between you and your partner. B) You use as many abbreviations as possible. C) It is done prior to patient care. D) It is thorough. Answer: D Diff: 1 Page Ref: 140 Standard: Preparatory (Medical/Legal and Ethics) Objective: 16 32) An action or inaction by a paramedic that causes or worsens damages suffered by a patient is called the ________ of the damages. A) precipitating agent B) potential agent C) primary cause D) proximate cause Answer: D Diff: 1 Page Ref: 126 Standard: Preparatory (Medical/Legal and Ethics) Objective: 1

33) Most of the laws that OSHA can use to enact regulations and statutes are ________ laws. A) constitutional B) legislative C) administrative D) common Answer: C Diff: 1 Page Ref: 122 Standard: Preparatory (Medical/Legal and Ethics) Objective: 2 34) All of the following are matters of civil law, EXCEPT: A) homicide. B) marriage. C) malpractice. D) negligence. Answer: A Diff: 1 Page Ref: 122 Standard: Preparatory (Medical/Legal and Ethics) Objective: 3 35) The four elements needed to sustain a charge of negligence against a paramedic are: A) duty to act, actual damages, malicious intent, and significant harm. B) breach of duty, actual damages, malicious intent, and reckless disregard of results. C) duty to act, breach of that duty, actual damages, and proximate cause. D) breach of duty, violation of EMS codes, proximate cause, and failure to document the action. Answer: C Diff: 2 Page Ref: 125-126 Standard: Preparatory (Medical/Legal and Ethics) Objective: 6 36) Legal responsibility for a situation is known as: A) liability. B) primum non nocere. C) negligence. D) res ipsa loquitur. Answer: A Diff: 1 Page Ref: 121 Standard: Preparatory (Medical/Legal and Ethics) Objective: 1

37) Which of the following is TRUE in the event that off-duty paramedics provide advanced lifesupport interventions at an emergency scene? A) They are protected by Good Samaritan laws in all states. B) It is permissible as long as they have valid certification or licensure in that state. C) They will be granted immunity from negligence as long as they follow the standard of care. D) They may be charged with practicing medicine without a license. Answer: D Diff: 2 Page Ref: 128 Standard: Preparatory (Medical/Legal and Ethics) Objective: 5 38) "Case" law and "judge-made" law are other names for ________ law. A) constitutional B) common C) legislative D) administrative Answer: B Diff: 1 Page Ref: 122 Standard: Preparatory (Medical/Legal and Ethics) Objective: 2 39) A paramedic performs an intervention on a patient that is contrary to current practices. The patient suffers an injury as a result of that intervention. This is an example of: A) malfeasance. B) misfeasance. C) nonfeasance. D) antifeasance. Answer: A Diff: 2 Page Ref: 126 Standard: Preparatory (Medical/Legal and Ethics) Objective: 8 40) A written statement of a patient's preference for future medical care is a(n): A) power of attorney. B) patient narrative. C) deposition. D) advance directive. Answer: D Diff: 1 Page Ref: 136 Standard: Preparatory (Medical/Legal and Ethics) Objective: 14

41) OSHA's development of requirements to be followed at hazardous materials emergencies is an example of ________ law. A) legislative B) constitutional C) common D) administrative Answer: D Diff: 2 Page Ref: 122 Standard: Preparatory (Medical/Legal and Ethics) Objective: 2 42) In a lawsuit in which a paramedic has been charged with negligence, the paramedic is called the: A) suspect B) plaintiff C) defendant D) magistrate Answer: C Diff: 1 Page Ref: 123 Standard: Preparatory (Medical/Legal and Ethics) Objective: 1 43) The duties and skills paramedics are allowed and expected to perform while carrying out their jobs are called the: A) National Standard Curriculum. B) standing orders. C) scope of practice. D) treatment guidelines. Answer: C Diff: 1 Page Ref: 123 Standard: Preparatory (Medical/Legal and Ethics) Objective: 1 44) Which of the following is NOT one of the common elements of Good Samaritan laws offering protection to people who assist at scenes of medical emergencies? A) The person acted in good faith. B) The person was not grossly negligent. C) The person accepted no payment for his services. D) The person attempted to contact qualified emergency personnel. Answer: D Diff: 1 Page Ref: 124 Standard: Preparatory (Medical/Legal and Ethics) Objective: 5

45) The type of consent that must be obtained from a conscious, competent adult patient before a paramedic can begin treatment is called ________ consent. A) implied B) voluntary C) ex officio D) informed Answer: D Diff: 1 Page Ref: 130 Standard: Preparatory (Medical/Legal and Ethics) Objective: 11 46) Your patient is a competent adult who has given permission for treatment and transport. You have loaded the patient into the ambulance, but just before you are ready to leave the scene, she changes her mind and says she does not want to go to the hospital. Which of the following statements about this situation is TRUE? A) You must obtain an emergency detention order to continue treatment. B) She cannot withdraw consent after having given it. C) She can now be treated using implied consent. D) She can withdraw consent. Answer: D Diff: 2 Page Ref: 131 Standard: Preparatory (Medical/Legal and Ethics) Objective: 11 47) A patient is involved in a car crash. When the paramedics arrive, he complains of neck pain but refuses to let the paramedics immobilize his spine. The paramedics explain the risks of refusing treatment and have the patient sign a release-from-liability form. The patient suffers minor neurological damage and later sues, charging negligence on the part of the paramedics. Which of the following best explains why the patient is NOT likely to be awarded damages? A) There was contributory negligence on the part of the patient. B) The paramedics did not have a duty to act. C) There was no violation of the standard of care. D) A monetary award cannot be assigned to the damages. Answer: A Diff: 2 Page Ref: 127 Standard: Preparatory (Medical/Legal and Ethics) Objective: 7

48) A paramedic may treat an unconscious diabetic patient by relying on: A) res ipsa loquitur. B) implied consent. C) primum non nocere. D) informed consent. Answer: B Diff: 1 Page Ref: 131 Standard: Preparatory (Medical/Legal and Ethics) Objective: 11 49) Which of the following is NOT a component of a civil suit? A) Imprisonment B) Incident C) Investigation D) Discovery Answer: A Diff: 1 Page Ref: 122-123 Standard: Preparatory (Medical/Legal and Ethics) Objective: 4 50) Injuring a person's name or character through false written statements is known as: A) misfeasance. B) libel. C) slander. D) perjury. Answer: B Diff: 1 Page Ref: 129 Standard: Preparatory (Medical/Legal and Ethics) Objective: 1 51) You are treating a patient who you think needs an IV of lactated Ringer's. The patient, however, says he is frightened of needles and refuses to give his consent. If you display the IV catheter and bring it toward the patient, you may be charged with: A) negligence. B) assault. C) battery. D) libel. Answer: B Diff: 2 Page Ref: 134 Standard: Preparatory (Medical/Legal and Ethics) Objective: 13

52) Generally, a patient under age 18 can be considered an emancipated minor in all of the following situations EXCEPT when the patient is a: A) 16-year-old female who is the parent of a 1-year-old child. B) 16-year-old living in foster care. C) 17-year-old who is in the military. D) 16-year-old female who is pregnant. Answer: B Diff: 2 Page Ref: 131 Standard: Preparatory (Medical/Legal and Ethics) Objective: 1 53) Which of the following is NOT an important action to take when preserving physical evidence at a crime scene? A) Once a crime scene has been deemed safe, initiate patient contact and medical care. B) Do not move or touch anything at a crime scene unless it is necessary to do so for patient care. C) Above all, protect yourself and the safety of other EMS personnel. D) Report suspected child or elder abuse to the proper authorities. Answer: D Diff: 1 Page Ref: 139 Standard: Preparatory (Medical/Legal and Ethics) Objective: 15 Chapter 8 Ethics in Paramedicine 1) State laws requiring the reporting of births, deaths, certain infectious diseases, and child and elder abuse and neglect may require the paramedic to breach the obligation to protect the patient's: A) right to self-determination. B) First Amendment rights. C) confidentiality. D) autonomy. Answer: C Diff: 1 Page Ref: 154 Standard: Preparatory (Medical/Legal and Ethics) Objective: 5 2) The four fundamental principles or values used to resolve problems in bioethics today include all of the following EXCEPT: A) beneficence. B) maleficence. C) autonomy. D) egalitarianism. Answer: D Diff: 1 Page Ref: 149 Standard: Preparatory (Medical/Legal and Ethics) Objective: 5 67 Copyright © 2017 Pearson Education, Inc.

3) The obligation of a paramedic to treat all patients fairly is an example of the principle of: A) beneficence. B) democracy. C) sovereignty. D) justice. Answer: D Diff: 1 Page Ref: 149 Standard: Preparatory (Medical/Legal and Ethics) Objective: 5 4) Your paramedic partner is telling you about a situation in which he resuscitated a patient with a DNR, even though the DNR was present and available to him at the time he began resuscitation. He tells you he is justified because the patient survived for a year after the incident and suffered no ill effects from the cardiac arrest or the resuscitation efforts. Which of the following best describes the ethical approach used by your partner? A) Deontologicalism B) Consequentialism C) Ethical relativism D) Self-determination Answer: B Diff: 2 Page Ref: 148 Standard: Preparatory (Medical/Legal and Ethics) Objective: 3 5) The idea that each person must decide how to behave and that whatever decision that person makes is acceptable is known as: A) consequentialism. B) the deontological method. C) ethical relativism. D) moral positivism. Answer: C Diff: 1 Page Ref: 147 Standard: Preparatory (Medical/Legal and Ethics) Objective: 3 6) When analyzing an ethical problem, the method in which you ask whether you would want an action performed in all relevantly similar circumstances is known as the: A) impartiality test. B) interpersonal justifiability test. C) universalizability test. D) rationalization test. Answer: C Diff: 1 Page Ref: 152 Standard: Preparatory (Medical/Legal and Ethics) Objective: 6 68 Copyright © 2017 Pearson Education, Inc.

7) The most common situations involving allocation of scarce resources that paramedics will usually face are those involving: A) administering expensive medications. B) deciding whether to terminate resuscitative efforts. C) triage in mass-casualty incidents. D) transporting patients to high-quality versus low-quality hospitals. Answer: C Diff: 1 Page Ref: 155 Standard: Preparatory (Medical/Legal and Ethics) Objective: 6 8) When analyzing an ethical problem, the method in which you ask yourself whether you can vindicate your actions to others is known as the: A) interpersonal justifiability test. B) rationalization test. C) impartiality test. D) universalizability test. Answer: A Diff: 1 Page Ref: 152 Standard: Preparatory (Medical/Legal and Ethics) Objective: 3 9) If you receive a copy of a valid DNR order after you have begun resuscitation attempts, you are ethically obligated to: A) cease resuscitation efforts. B) check the patient's breathing and pulse before ceasing resuscitation efforts. C) continue resuscitation until ordered to stop by medical direction. D) continue resuscitation attempts until the patient is transported to an emergency department. Answer: A Diff: 1 Page Ref: 153 Standard: Preparatory (Medical/Legal and Ethics) Objective: 2 10) Enforced racial segregation in the United States before the 1960s can best be described as: A) illegal, but ethical. B) legal, but unethical. C) illegal and unethical. D) legal and ethical. Answer: B Diff: 2 Page Ref: 147 Standard: Preparatory (Medical/Legal and Ethics) Objective: 2

11) Rules or standards that govern the conduct of members of a particular group or profession are called: A) regulations. B) ethics. C) morals. D) statutes. Answer: B Diff: 1 Page Ref: 147 Standard: Preparatory (Medical/Legal and Ethics) Objective: 1 12) You are on the scene where an 80-year-old woman is unresponsive and has shallow, snoring respirations. The patient's husband wants you to do nothing for the patient, but her daughter is crying and pleading with you to do something to help her mother. The patient lacks a DNR. The husband insists that his wife would not want to be "kept alive by machines." Which of the following is the most ethical course of action? A) Follow the husband's wishes, because he has the legal authority to make the decision while the daughter does not. B) Explain to the husband that you do not yet know what is wrong with his wife, that it may be something readily treatable, and that without a written order from her physician you cannot withhold treatment. C) Consider how you would feel if it was your spouse or parent, and ask yourself what you would want done. D) Find out more about the patient's medical history in an attempt to determine if resuscitative measures would be futile. Answer: B Diff: 3 Page Ref: 152-153 Standard: Preparatory (Medical/Legal and Ethics) Objective: 6 13) Social, religious, or personal standards of right and wrong are called: A) morals. B) culture. C) common laws. D) ethics. Answer: A Diff: 1 Page Ref: 146 Standard: Preparatory (Medical/Legal and Ethics) Objective: 1

14) When analyzing an ethical problem, the method in which you ask yourself whether you would be willing to undergo a procedure or action if you were in the patient's place is known as the: A) universalizability test. B) rationalization test. C) impartiality test. D) interpersonal justifiability test. Answer: C Diff: 1 Page Ref: 152 Standard: Preparatory (Medical/Legal and Ethics) Objective: 3 15) Which of the following questions should guide the paramedic in ethical decision making? A) "Have I consulted with medical direction?" B) "What legal liability will I face as a result of this action?" C) "What is in the patient's best interest?" D) "What do the system protocols say?" Answer: C Diff: 1 Page Ref: 148 Standard: Preparatory (Medical/Legal and Ethics) Objective: 3 16) Your patient is a 49-year-old woman with terminal cancer. She has a DNR order, but her family has called 911 because the patient is having difficulty breathing and seems to be very uncomfortable. Making the patient as comfortable as possible demonstrates the ethical principle of: A) beneficence. B) autonomy. C) justice. D) malfeasance. Answer: A Diff: 2 Page Ref: 149 Standard: Preparatory (Medical/Legal and Ethics) Objective: 5

17) When students are working with patients under a preceptor in an EMS system, at what point should the preceptor inform the patients that their care, or part of it, is being performed by a student? A) This information should not be revealed to the patient. B) The patient should be informed after the procedure but only if there are no complications from the procedure. C) The patient should be informed if he asks what the caregiver's qualifications are. D) The patient should be informed before procedures are performed, and the student should be allowed to proceed only with the patient's consent. Answer: D Diff: 2 Page Ref: 156 Standard: Preparatory (Medical/Legal and Ethics) Objective: 6 18) The right of competent people to determine what happens to their bodies is one example of the principle of: A) autonomy. B) libertarianism. C) democracy. D) agency. Answer: A Diff: 1 Page Ref: 149 Standard: Preparatory (Medical/Legal and Ethics) Objective: 1 19) You are driving home late one night from a state-to-state interhospital transport. You are still in the other state driving home at 0200 hours when you come upon a single-vehicle MVC on a deserted stretch of the highway. You stop your ambulance, and you and your partner assess the scene and find out there is only one occupant of the vehicle and that the victim is unresponsive. If you initiate care and transport the patient to a hospital without summoning local EMS or fire, your actions could be considered: A) illegal. B) unethical. C) inappropriate. D) unnecessary. Answer: A Diff: 1 Page Ref: 155 Standard: Preparatory (Medical/Legal and Ethics) Objective: 2

20) Failure to stop and render assistance could be perceived by the patient's family or other EMS providers as being: A) illegal. B) unethical. C) appropriate. D) unnecessary. Answer: B Diff: 1 Page Ref: 155 Standard: Preparatory (Medical/Legal and Ethics) Objective: 2 21) Which of the following is not typically addressed in a code of ethics? A) nondiscrimination B) fitness requirements C) social responsibility D) responsible publication Answer: B Diff: 1 Page Ref: 148 Standard: Preparatory (Medical/Legal and Ethics) Objective: 4 Chapter 9 EMS System Communications 1) A(n) ________ system uses a computer to route transmissions to the first available frequency. A) repeater B) digital C) encrypted D) trunked Answer: D Diff: 1 Page Ref: 174 Standard: Preparatory (EMS Systems) Objective: 1 2) Which of the following is most effective in helping the dispatcher get information from distressed callers? A) Having supervisors get on the line with the callers B) A standard set of medically approved questions C) Empathetic pauses to allow the callers to collect their thoughts D) Transferring callers to a consulting-nurse advice line Answer: B Diff: 1 Page Ref: 169 Standard: Preparatory (EMS Systems) Objective: 6

3) The type of communication system that works like a telephone is: A) ultrasimplex. B) multiplex. C) simplex. D) duplex. Answer: D Diff: 1 Page Ref: 174 Standard: Preparatory (EMS Systems) Objective: 8 4) Which of the following is NOT a guideline for effective radio use? A) Press the transmit button for one second before speaking. B) Use codes that are part of the international EMS system. C) Speak in a normal pitch, keeping your voice free of emotion. D) Do not waste airtime with unnecessary information. Answer: B Diff: 1 Page Ref: 164-165 Standard: Preparatory (EMS Systems) Objective: 3 5) Paramedics and other EMTs becoming affordable in rural communities and also helping to fill gaps in primary health care services is a concept of: A) community paramedicine. B) creation of ad hoc databases. C) medical quality video. D) public safety answering points. Answer: A Diff: 1 Page Ref: 177-178 Standard: Preparatory (EMS Systems) Objective: 3 6) The acronym PSAP stands for: A) paramedic system answering point. B) prehospital safety and prevention. C) public safety answering point. D) public safety agency paramedics. Answer: C Diff: 1 Page Ref: 167 Standard: Preparatory (EMS Systems) Objective: 1

7) Cellular telephone systems use ________ to transmit communications. A) shortwave technology B) underground cables C) satellite technology D) regional radio base stations Answer: D Diff: 1 Page Ref: 175 Standard: Preparatory (EMS Systems) Objective: 8 8) The dispatcher's directions to the caller for appropriate emergency measures are known as: A) enhanced 911 service. B) priority dispatching. C) prearrival instructions. D) call coordination. Answer: C Diff: 1 Page Ref: 169 Standard: Preparatory (EMS Systems) Objective: 6 9) Without formal transfer of care to the receiving hospital, paramedics could be charged with: A) malpractice. B) abuse. C) abandonment. D) neglect. Answer: C Diff: 1 Page Ref: 171 Standard: Preparatory (EMS Systems) Objective: 10 10) Because only the necessary resources are sent on each call, priority dispatching has which of the following benefits? A) Minimizes responder responsibilities B) Saves time and money C) Reduces patient anxiety D) Keeps dispatchers alert Answer: B Diff: 1 Page Ref: 169 Standard: Preparatory (EMS Systems) Objective: 6

11) Which of the following is the key link in the chain that results in the best possible patient outcome? A) Conceptualization B) Communication C) Coordination D) Confrontation Answer: B Diff: 1 Page Ref: 162 Standard: Preparatory (EMS Systems) Objective: 10 12) In terms of written communication, a neat and complete PCR is a good indicator of which of the following paramedic traits? A) Professionalism B) Compassion C) Promotion suitability D) Education level Answer: A Diff: 1 Page Ref: 165 Standard: Preparatory (EMS Systems) Objective: 5 13) How can AACN improve outcomes with seriously injured patients? A) Assisting with field triage destination and transportation decisions B) Increasing response times by prehospital care providers C) Predicting the unlikelihood of serious injury among vehicle occupants D) Increasing the time it takes for patients to receive definitive trauma care Answer: A Diff: 1 Page Ref: 168 Standard: Preparatory (EMS Systems) Objective: 7 14) Multiplex systems transmit: A) voice simultaneously in two ways. B) on the same frequency as they receive. C) using digital encryption technology. D) voice and data simultaneously. Answer: D Diff: 1 Page Ref: 174 Standard: Preparatory (EMS Systems) Objective: 8

15) The prehospital care report is all of the following EXCEPT a(n): A) legal record of the incident. B) public record. C) indicator of professionalism. D) part of the patient's permanent medical record. Answer: B Diff: 1 Page Ref: 165 Standard: Preparatory (EMS Systems) Objective: 5 16) What is the last step in the sequence of communications during an EMS response? A) Calling 911 B) Transferring communications C) Emergency medical dispatch D) Citizen detection and access Answer: B Diff: 1 Page Ref: 170-171 Standard: Preparatory (EMS Systems) Objective: 6 17) The emergency medical dispatcher has just finished interrogating a caller. The next step would be for the dispatcher to: A) follow established guidelines to determine the appropriate level of response. B) call the patient's insurance company for preapproval. C) transfer care of the patient to the receiving facility with a hand-off report. D) send a first responder engine company and paramedics. Answer: A Diff: 1 Page Ref: 169 Standard: Preparatory (EMS Systems) Objective: 2 18) Systems that transmit and receive on the same frequency are ________ systems. A) multiplex B) duplex C) simplex D) trunked Answer: C Diff: 1 Page Ref: 173 Standard: Preparatory (EMS Systems) Objective: 1

19) All of the following are other technology applications with broadband implications that the national EMS communications initiatives have suggested, EXCEPT: A) patient multi-vital-signs monitoring. B) infrared crowd disease detection. C) wire-based speech-to-monitor transcription. D) creation of ad hoc multicomponent patient databases. Answer: C Diff: 1 Page Ref: 178-179 Standard: Preparatory (EMS Systems) Objective: 7 20) Which of the following radio waves can penetrate through concrete and steel? A) UHF B) VHF C) ICT D) GIS Answer: A Diff: 1 Page Ref: 173 Standard: Preparatory (EMS Systems) Objective: 8 21) You are giving a report to the base physician. After stating the patient's age, sex, and weight, you should next: A) give the patient's chief complaint. B) give the hospital the ETA. C) relay treatments already rendered D) request specific orders. Answer: A Diff: 1 Page Ref: 164 Standard: Preparatory (EMS Systems) Objective: 4 22) Without proper terminology and verbal communications skills, the receiver will be unable to ________ the message. A) decode B) resend C) encode D) receive Answer: A Diff: 1 Page Ref: 163-164 Standard: Preparatory (EMS Systems) Objective: 2

23) Immediate repetition of medical orders received during radio communications is known as the: A) verification protocol. B) echo procedure. C) standard format. D) response algorithm. Answer: B Diff: 1 Page Ref: 165 Standard: Preparatory (EMS Systems) Objective: 1 24) Regulation of communications at the federal level includes all of the following, EXCEPT: A) licensing technical personnel. B) establishing technical standards. C) establishing terminology. D) allocating radio frequencies. Answer: C Diff: 1 Page Ref: 180 Standard: Preparatory (EMS Systems) Objective: 9 25) Information on the prehospital care reports may be used by which of the following in certain circumstances? A) Hospital staff B) Insurance claims departments C) Attorneys D) All of the above Answer: D Diff: 1 Page Ref: 165 Standard: Preparatory (EMS Systems) Objective: 5 26) The main duties of the dispatcher, after sending the responders and providing prearrival instructions, include: A) transferring communications. B) discussing medical direction. C) directing the crew to an appropriate receiving facility. D) supporting and coordinating. Answer: D Diff: 1 Page Ref: 169-170 Standard: Preparatory (EMS Systems) Objective: 6

27) What is semantics? A) A standard format for delivering information B) The meaning of words C) Effective communications D) Process of exchanging information between individuals Answer: B Diff: 1 Page Ref: 163 Standard: Preparatory (EMS Systems) Objective: 1 28) The practice of notifying a receiving hospital of an ambulance's impending arrival began in the: A) 1960s. B) 1970s. C) 1980s. D) 1990s. Answer: B Diff: 1 Page Ref: 171 Standard: Preparatory (EMS Systems) Objective: 2 29) Which of the following best explains the reason for the need to communicate effectively with other responders? A) To coordinate and implement the treatment plan B) To summon EMS through a PSAP C) To make sure you can recover your equipment afterward D) To exchange career information Answer: A Diff: 1 Page Ref: 162 Standard: Preparatory (EMS Systems) Objective: 10 30) Medical audits, research, and policy changes can improve patient care through information collected from: A) prehospital care reports. B) crew activity logs. C) vehicle maintenance logs. D) disciplinary action records. Answer: A Diff: 1 Page Ref: 165 Standard: Preparatory (EMS Systems) Objective: 5

31) The verbal report to the receiving hospital should always include vital information, chief complaint, and: A) personal physician's information. B) treatments rendered. C) next-of-kin name and telephone number. D) EMS unit status. Answer: B Diff: 1 Page Ref: 170 Standard: Preparatory (EMS Systems) Objective: 4 32) In addition to giving emergency instruction to the caller, a dispatcher can also use prearrival instructions to: 1. comfort a distressed caller. 2. elicit additional information. 3. provide emotional support. 4. coordinate responders. A) 1 and 2 only B) 1, 3, and 4 C) 1, 2, and 3 D) All of the above Answer: C Diff: 1 Page Ref: 169 Standard: Preparatory (EMS Systems) Objective: 6 33) In addition to being a part of your patient's medical record, a written report can also be used as: A) a representation of the care you provided. B) a legal record. C) a document used for continuous quality improvement. D) all of the above. Answer: D Diff: 1 Page Ref: 165 Standard: Preparatory (EMS Systems) Objective: 5 34) ________ communications are condensed and ease the overcrowding of radio frequencies. A) Cellular B) Analog C) Digital D) Telephone Answer: C Diff: 1 Page Ref: 174-175 Standard: Preparatory (EMS Systems) Objective: 7 81 Copyright © 2017 Pearson Education, Inc.

35) The first part of the EMS response to an incident is: A) discussion with medical direction. B) prearrival instructions. C) detection and citizen access. D) call coordination. Answer: C Diff: 1 Page Ref: 166 Standard: Preparatory (EMS Systems) Objective: 6 36) In most systems, 911 callers are first routed to the ________, which then sends the call to ________. A) EMS-C; PSAP B) PSAP; base station C) EMD; PAAP D) PSAP; EMD Answer: D Diff: 1 Page Ref: 167 Standard: Preparatory (EMS Systems) Objective: 10 37) The federal agency that controls and regulates nongovernmental communications is the: A) FCC. B) FAC. C) FCA. D) FAA. Answer: A Diff: 1 Page Ref: 180 Standard: Preparatory (EMS Systems) Objective: 9 38) Specialized terms for radio use enhance communications by: A) lengthening airtime and transmitting thoughts quickly. B) shortening airtime and transmitting thoughts quickly. C) rationing airtime and transmitting thoughts reasonably accurately. D) shortening airtime and transmitting thoughts reasonably accurately. Answer: B Diff: 1 Page Ref: 166 Standard: Preparatory (EMS Systems) Objective: 3

39) The ________, the public's first contact with the EMS system, plays a crucial role in every EMS response. A) emergency medical technician B) emergency medical dispatcher C) paramedic D) first responder Answer: B Diff: 1 Page Ref: 169 Standard: Preparatory (EMS Systems) Objective: 2 40) The transfer of care to the receiving facility staff should always include: A) physician examination of the report. B) a formal verbal briefing. C) a nurse signature on the prehospital chart. D) immediate notification to the dispatcher that the unit is back in service. Answer: B Diff: 1 Page Ref: 170 Standard: Preparatory (EMS Systems) Objective: 4 41) The prehospital care report (PCR) is a written record of events that includes administrative and ________ information. A) weather B) medical C) vehicle maintenance D) extraneous Answer: B Diff: 1 Page Ref: 165 Standard: Preparatory (EMS Systems) Objective: 5 42) The process of interrogating callers with medical questions to elicit information and then determine the proper level of response is known as: A) telephone triage. B) acuity assignment. C) call queueing. D) priority dispatching. Answer: D Diff: 1 Page Ref: 169 Standard: Preparatory (EMS Systems) Objective: 1

43) How do reports to the base physician differ for trauma and medical patients? A) It is less important to include ETA for medical patients. B) Only trauma patients require a description of the scene. C) Medical reports describe a chief complaint, whereas trauma reports do not. D) Medical reports emphasize history; trauma reports emphasize injuries and exam findings. Answer: D Diff: 2 Page Ref: 164 Standard: Preparatory (EMS Systems) Objective: 2 44) Using terminology widely accepted by the emergency services and medical community when giving a report to emergency department personnel is important because: A) semantics enhance effective communication. B) the receiver must be able to decode the message. C) verbal communication is the preferred medium. D) "10-codes" are meaningless to physicians. Answer: B Diff: 1 Page Ref: 163-164 Standard: Preparatory (EMS Systems) Objective: 10 45) One of the first bits of information to be transmitted to the base physician is the: A) estimated time of arrival to the hospital. B) request for specific orders. C) unit and provider information. D) treatments already rendered. Answer: C Diff: 1 Page Ref: 164 Standard: Preparatory (EMS Systems) Objective: 4 46) Health organizations are responding to the rise of VOIP phones and the ability to send photos, videos, and text messages from mobile devices via the Internet with: A) an initiative called Next Generation 911 (NG-911). B) advanced automatic crash notification (AACN). C) a coordinated system known as priority dispatching. D) computerized hand-off reports. Answer: A Diff: 1 Page Ref: 168 Standard: Preparatory (Medical/Legal and Ethics) Objective: 6

Chapter 10 Documentation 1) The subjective narrative includes information that is elicited: A) during history taking. B) from public records. C) by observing the patient's actions. D) from dispatch information. Answer: A Diff: 1 Page Ref: 197 Standard: Preparatory (Documentation) Objective: 5 2) The best method for completing the narrative section of the PCR is: A) dependent on the nature of the call. B) the CHART format. C) the patient management format. D) the SOAP format. Answer: A Diff: 1 Page Ref: 197 Standard: Preparatory (Documentation) Objective: 5 3) An addition or a supplement to an original report is called a(n): A) supplement. B) add-on. C) addendum. D) appendix. Answer: C Diff: 1 Page Ref: 196 Standard: Preparatory (Documentation) Objective: 1 4) When your patient refuses care and transportation, even though you have communicated to the patient that you feel it is necessary, the patient is refusing: A) against medical control (AMC). B) with impaired decision-making (WID). C) with informed consent (WIC). D) against medical advice (AMA). Answer: D Diff: 1 Page Ref: 201 Standard: Preparatory (Documentation) Objective: 6

5) The paramedic's general impression is documented in the: A) subjective narrative. B) assessment/management plan. C) objective narrative. D) diagnosis section. Answer: C Diff: 1 Page Ref: 197 Standard: Preparatory (Documentation) Objective: 5 6) Which of the following refers to the time between dispatch of a unit and its arrival on the scene? A) On-scene B) Response C) Dispatch D) Transport Answer: B Diff: 1 Page Ref: 185 Standard: Preparatory (Documentation) Objective: 1 7) What is the problem with the treatment in the following narrative? The pt. complained of chest pain x 2 days before calling EMS and is now also c/o SOB. Vitals BP 90/50, HR 40, labored with retractions. Treated with O2 and atropine. Upon arrival the pt. felt better. A) No dosages are stated. B) The patient should have received transcutaneous pacing. C) Nothing documented supports the treatment given. D) A and C are both problematic. Answer: D Diff: 2 Page Ref: 194 Standard: Preparatory (Documentation) Objective: 4 8) The format that uses a chronological account from the time of arrival on scene to the time of transfer of care is known as: A) patient management. B) body systems. C) head-to-toe. D) SOAP. Answer: A Diff: 1 Page Ref: 200 Standard: Preparatory (Documentation) Objective: 4

9) The only truly factual record of the events on an EMS call is the: A) emergency department chart. B) prehospital care report. C) communications center report. D) medical control report. Answer: B Diff: 1 Page Ref: 184 Standard: Preparatory (Documentation) Objective: 2 10) Pertinent clinical information should be documented in the: A) subjective narrative. B) objective narrative. C) treatment section. D) clinical narrative. Answer: B Diff: 1 Page Ref: 197 Standard: Preparatory (Documentation) Objective: 5 11) An essential component of good documentation is the appropriate use of: A) subjective opinions. B) administrative research. C) medical terminology. D) medical metaphors. Answer: C Diff: 1 Page Ref: 186 Standard: Preparatory (Documentation) Objective: 4 12) Which of the following documents containing vital information is affixed to the patient during large-scale incidents with multiple patients? A) MedicAlert tags B) PCRs C) MCI narratives D) Triage tags Answer: D Diff: 1 Page Ref: 202-203 Standard: Preparatory (Documentation) Objective: 6

13) What is the correct abbreviation for potassium? A) K++ B) KC) K+ D) K Answer: C Diff: 1 Page Ref: 190 Standard: Preparatory (Documentation) Objective: 3 14) Which of the following allows you to increase the amount of information you can quickly and efficiently write on your PCR? A) Acronyms and abbreviations B) Pertinent negatives C) Time stamps D) Medical terms Answer: A Diff: 1 Page Ref: 188 Standard: Preparatory (Documentation) Objective: 3 15) Which of the following types of records provides the basis for continuous improvement of patient care in the EMS system? A) EMS supervisor administrative reports B) Medical control radio logs C) Prehospital care reports D) The dispatch center log Answer: C Diff: 1 Page Ref: 186 Standard: Preparatory (Documentation) Objective: 2 16) The prehospital care report should document all of the following, EXCEPT: A) objective observations. B) treatments provided. C) pertinent negatives. D) subjective opinions. Answer: D Diff: 1 Page Ref: 186 Standard: Preparatory (Documentation) Objective: 2

17) You are completing your PCR and cannot remember the correct spelling of a medical term. You should: A) try to spell the word, even if you are wrong. B) make up an abbreviation for the word. C) cross out the sentence and indicate an error. D) use plain English instead. Answer: D Diff: 1 Page Ref: 188 Standard: Preparatory (Documentation) Objective: 3 18) The abbreviation Hgb stands for: A) millimeters of mercury. B) hematocrit. C) history. D) hemoglobin. Answer: D Diff: 1 Page Ref: 191 Standard: Preparatory (Documentation) Objective: 3 19) What is one of the common problems with documenting times? A) Medical terminology B) Abbreviations and acronyms C) Inconsistencies between dispatch and ambulance clocks D) Check boxes Answer: C Diff: 1 Page Ref: 188 Standard: Preparatory (Documentation) Objective: 8 20) Confidentiality of a patient's prehospital care report is: A) forfeited by the patient when he consents to treatment. B) not applicable to patients who are not expected to survive. C) not applicable to noncitizens. D) the patient's legal right. Answer: D Diff: 1 Page Ref: 205 Standard: Preparatory (Documentation) Objective: 2

21) Which of the following individuals may make changes and additions to the original chart? A) The medical direction physician B) The original author's partner C) The original author D) All of the above Answer: C Diff: 1 Page Ref: 196 Standard: Preparatory (Documentation) Objective: 4 22) Missing information, inaccurate data, and illegible documentation all give the impression of a(n): A) incompetent provider. B) busy shift. C) typical EMS patient care report. D) practiced paramedic whose reputation speaks for itself. Answer: A Diff: 1 Page Ref: 204 Standard: Preparatory (Documentation) Objective: 7 23) You respond to a call and the police and fire departments are on the scene, as well as a physician. Which of the following should you mention in your PCR? A) Fire department only B) Fire department and the physician only C) Police, fire, and the physician D) Police only Answer: C Diff: 1 Page Ref: 194 Standard: Preparatory (Documentation) Objective: 4 24) A well-written prehospital care report is: 1. accurate. 2. legible. 3. without alterations. 4. professional. A) 1 and 2 only B) 1, 2, and 4 C) All of the above D) None of the above Answer: C Diff: 1 Page Ref: 204 Standard: Preparatory (Documentation) Objective: 4

25) When using direct patient statements, you should: A) identify the quote with quotation marks. B) have your partner or another witness initial the statement. C) use the SOAP format. D) have the patient initial his agreement with them, if his condition permits. Answer: A Diff: 1 Page Ref: 194 Standard: Preparatory (Documentation) Objective: 4 26) When possible, who should be asked to read and review the PCR before you submit it as complete? A) Only you and your partner B) Only you C) Only you, your partner, and the patient D) All EMS providers participating in patient care on the call Answer: D Diff: 1 Page Ref: 194 Standard: Preparatory (Documentation) Objective: 4 27) What is the chief complaint in the following narrative? The pt. stated he had chest pain x 2 days before calling EMS. Pt. denies SOB. Vitals: BP 90/50, respirations labored with retractions, HR 44. Rx: O2 and atropine 0.5 mg IVP. Upon arrival, the pt. reported feeling better. A) Chest pain B) Hypotension C) Labored respirations D) Shortness of breath Answer: A Diff: 1 Page Ref: 199 Standard: Preparatory (Documentation) Objective: 4 28) The narrative approach that focuses only on the areas involved in the current illness or injury is the ________ approach. A) body systems B) toe-to-head C) focused exam D) head-to-toe Answer: A Diff: 1 Page Ref: 198 Standard: Preparatory (Documentation) Objective: 5

29) "The 45-year-old patient had CP and was complaining of leg and arm pains." In this example, the abbreviation CP stands for: A) cerebral palsy. B) cerebral perfusion. C) chest pain. D) unable to determine. Answer: C Diff: 1 Page Ref: 189 Standard: Preparatory (Documentation) Objective: 3 30) Which of the following situations poses an even greater risk of liability to the paramedic than patient refusal of care? A) Denying transport to an apparently stable patient who insists he needs an ambulance B) Transporting minors, with or without their consent C) Transporting a mentally incompetent individual against his wishes D) Having the patient who wants to refuse speak directly with a medical control physician Answer: A Diff: 1 Page Ref: 201 Standard: Preparatory (Documentation) Objective: 6 31) In filling out your prehospital care report, you want to document that your patient had a laceration to his right hand secondary to a fall. How would you abbreviate "secondary to?" A) 2° B) 2/ C) 2@ D) 2nd Answer: A Diff: 1 Page Ref: 192 Standard: Preparatory (Documentation) Objective: 3 32) Which is the most important reason for NOT trying to complete the PCR during the ride to the hospital? A) Your time is better spent performing ongoing assessments. B) You must communicate with the medical control physician. C) There is an increased chance of error. D) The ride is bumpy and the chart will be illegible. Answer: A Diff: 1 Page Ref: 196 Standard: Preparatory (Documentation) Objective: 8

33) Instead of using the words heart attack, the paramedic could use the abbreviation: A) AMI. B) CP. C) AHA. D) HA. Answer: A Diff: 1 Page Ref: 189 Standard: Preparatory (Documentation) Objective: 3 34) Which words are spelled incorrectly in the following narrative? Pt. is a 53 y/o male with pain to the upper thoracks and neck 2- to past history. Pt. has a history of a heart attack and takes KCl, HCTZ, and aspirin. 1. Thoracks 2. Heart attack 3. Aspirin 4. History A) 1 only B) 1 and 3 only C) 3 only D) None of the above Answer: A Diff: 1 Page Ref: 188 Standard: Preparatory (Documentation) Objective: 3 35) An accurate prehospital care report includes all of the following, EXCEPT: A) proper acronyms. B) approved abbreviations. C) addenda from supervisors. D) proper spelling. Answer: C Diff: 1 Page Ref: 196 Standard: Preparatory (Documentation) Objective: 3 36) All of the following are part of the standard patient documentation narrative, EXCEPT a(n): A) assessment/management plan. B) subjective narrative. C) financial assessment. D) objective narrative. Answer: C Diff: 1 Page Ref: 197 Standard: Preparatory (Documentation) Objective: 5

37) The narrative format that focuses on immediate management of a variety of patient problems is called: A) body systems. B) SOAP. C) patient management. D) objective-subjective. Answer: C Diff: 1 Page Ref: 200 Standard: Preparatory (Documentation) Objective: 5 38) Writing false or malicious words intended to damage a person's character is called: A) character assassination. B) bad faith. C) slander. D) libel. Answer: D Diff: 1 Page Ref: 197 Standard: Preparatory (Documentation) Objective: 1 39) The call incident approach for narrative writing emphasizes all of the following, EXCEPT: A) how the incident occurred. B) absolute chronological order. C) surrounding circumstances. D) mechanism of injury. Answer: B Diff: 1 Page Ref: 200 Standard: Preparatory (Documentation) Objective: 5 40) Which of the following would be most useful for paramedics to carry with them as an aid to proper documentation? A) Pocket-sized thesaurus B) Copy of previous charts C) Pocket-sized medical dictionary D) Quality assurance policy Answer: C Diff: 1 Page Ref: 188 Standard: Preparatory (Documentation) Objective: 3

41) Why do patient refusals warrant more thorough documentation than typical EMS calls? A) Additional witnesses must be quoted. B) The patient is usually not competent. C) There is more time available before the next assignment. D) The potential for abandonment charges is greater. Answer: D Diff: 1 Page Ref: 201 Standard: Preparatory (Documentation) Objective: 6 42) Why should the PCR be completed immediately after the call? A) The medical control physician must sign it. B) You must get back in service. C) The information is fresh in your mind. D) The receiving facility demands it. Answer: C Diff: 1 Page Ref: 196 Standard: Preparatory (Documentation) Objective: 2 43) Which of the following statements is inappropriate for a prehospital care report? A) The patient had trouble walking. B) The patient's appearance indicated a lack of self-care. C) The patient was intoxicated. D) The patient stated, "I feel fine." Answer: C Diff: 2 Page Ref: 186 Standard: Preparatory (Documentation) Objective: 7 44) You are allowed to share the information in patient charts with all of the following, EXCEPT: A) law enforcement officials, in specific situations. B) third-party billing companies. C) medical professionals providing continuing care. D) other paramedics not on the call. Answer: D Diff: 1 Page Ref: 205 Standard: Preparatory (Documentation) Objective: 2

45) To correct an error on the PCR, the paramedic should: A) make it a habit to use erasable ink so mistakes can be completely erased. B) cross it out with one line and initial it. C) block it out completely. D) use correction fluid matching the paper color of each copy of the PCR. Answer: B Diff: 1 Page Ref: 196 Standard: Preparatory (Documentation) Objective: 4 46) Use of prehospital care reports for quality improvement is an example of their ________ use. A) medical B) administrative C) patient care D) legal Answer: B Diff: 1 Page Ref: 185 Standard: Preparatory (Documentation) Objective: 2 47) Which of the following is the paramedic's interpretation of the patient's problem? A) Chief complaint B) Subjective opinion C) Patient complaints D) Field diagnosis Answer: D Diff: 1 Page Ref: 198 Standard: Preparatory (Documentation) Objective: 1 48) Seeking and recording pertinent negatives demonstrates which of the following? A) Charting by exception B) Thoroughness of your examination C) Thoughtfulness of your care D) Use of the PERT-NEG format Answer: B Diff: 1 Page Ref: 193-194 Standard: Preparatory (Documentation) Objective: 4

49) The standard charting abbreviation for nitroglycerin is: A) NTG. B) NGT. C) Nitro. D) N2O. Answer: A Diff: 1 Page Ref: 190 Standard: Preparatory (Documentation) Objective: 3 50) What is the patient's heart rate in the following narrative? The pt. complained of CP x 2 days before calling EMS and is now also c/o SOB. Vitals BP 90/50, labored with retractions. Treated with O2 and atropine. Upon arrival, the pt. reported feeling better. A) 50 B) 90 C) 40 D) Cannot be determined Answer: D Diff: 1 Page Ref: 194 Standard: Preparatory (Documentation) Objective: 4 51) Which of the following best describes why abbreviations and acronyms can cause confusion and problems? A) They are not universally accepted by all EMS agencies. B) Nursing uses a different set of abbreviations and acronyms. C) Some abbreviations and acronyms can have multiple meanings. D) Physicians use a different set of abbreviations and acronyms. Answer: C Diff: 1 Page Ref: 196 Standard: Preparatory (Documentation) Objective: 3 52) The ultimate responsibility for documentation belongs to the: A) agency's administration. B) paramedic writing the PCR. C) medical control physician. D) receiving nurse. Answer: B Diff: 1 Page Ref: 185 Standard: Preparatory (Documentation) Objective: 2

53) One common pattern for organizing a narrative report is identified by the mnemonic: A) CHART. B) OPRST. C) SAMPLE. D) DCHART-E. Answer: A Diff: 1 Page Ref: 199-200 Standard: Preparatory (Documentation) Objective: 5 54) Careful, thorough documentation has the effect of ________ frivolous lawsuits. A) eliminating B) defeating C) discouraging D) encouraging Answer: C Diff: 1 Page Ref: 204 Standard: Preparatory (Documentation) Objective: 4 55) Under what circumstances should paramedics try to hide charting errors? A) Always B) When directed to by a supervisor or superior officer C) When a lawsuit is probable D) Never Answer: D Diff: 1 Page Ref: 196 Standard: Preparatory (Documentation) Objective: 4 56) The objective narrative portion of documentation contains information on the: A) history of the present illness. B) current health status. C) chief complaint. D) physical exam. Answer: D Diff: 1 Page Ref: 197 Standard: Preparatory (Documentation) Objective: 5

57) The unofficial language used by a particular group or profession is known as ________ and can be confusing when included on a PCR. A) terminology B) semantics C) slang D) jargon Answer: D Diff: 1 Page Ref: 197 Standard: Preparatory (Documentation) Objective: 1 58) Which of the following words is an example of proper medical terminology? A) Belly B) Thorax C) Jawbone D) Chest Answer: B Diff: 1 Page Ref: 196-198 Standard: Preparatory (Documentation) Objective: 3 59) Why is it important for billing companies to have complete PCRs? A) They can decide what to bill for. B) They require all information for accurate billing. C) They provide quality assurance audits as part of their service. D) They are required by law to collect the complete PCR. Answer: B Diff: 1 Page Ref: 185 Standard: Preparatory (Documentation) Objective: 2 60) Who would be held MOST responsible if poor prehospital documentation results in inappropriate continuing medical care? A) The patient, if he was uncooperative B) The paramedic who wrote the document C) The paramedic agency and its medical director D) The physician who ordered the continuing medical care Answer: B Diff: 1 Page Ref: 204 Standard: Preparatory (Documentation) Objective: 7

61) If a legal case is brought against you, your best defense in court is usually: A) the dispatch log. B) your immediate recollection of events. C) a complete and accurate PCR. D) your partner's corroborating testimony. Answer: C Diff: 1 Page Ref: 186 Standard: Preparatory (Documentation) Objective: 2 62) Your patient is complaining of respiratory distress. In ruling out congestive heart failure, the absence of swollen ankles would be a: A) false positive finding. B) false negative finding. C) pertinent negative finding. D) true positive finding. Answer: C Diff: 1 Page Ref: 193-194 Standard: Preparatory (Documentation) Objective: 4 63) The standard charting abbreviation for Tylenol is: A) ASA. B) Acet. C) APAP. D) Amp. Answer: C Diff: 1 Page Ref: 190 Standard: Preparatory (Documentation) Objective: 3 64) When using a prehospital care report for research or quality assurance, you should block out the: A) patient's identifying information. B) vital signs. C) paramedics' names. D) treatments rendered. Answer: A Diff: 1 Page Ref: 205 Standard: Preparatory (Documentation) Objective: 2

65) Patient and bystander quotes belong in the ________ section. A) objective narrative B) subjective narrative C) assessment/management plan D) quotation Answer: B Diff: 1 Page Ref: 197 Standard: Preparatory (Documentation) Objective: 5 Chapter 11 Human Life Span Development 1) A major concern of psychosocial development for many adults in middle adulthood is: A) awareness that the time in which they can accomplish their life's goals is becoming shorter. B) finding love and having children. C) a sense of self-worth. D) the development of a personal code of ethics. Answer: A Diff: 1 Page Ref: 218 Standard: Life Span Development Objective: 6 2) When infants are uncertain about whether their caregivers will be responsive when needed, they may develop ________ attachment. A) mistrusting B) insecure C) anxious resistant D) anxious avoidant Answer: C Diff: 1 Page Ref: 213 Standard: Life Span Development Objective: 1 3) To which of the following conditions are infants especially susceptible? A) Nasal congestion B) Dehydration C) Fatigue due to increased respiratory effort D) All of the above Answer: D Diff: 2 Page Ref: 211-212 Standard: Life Span Development Objective: 2

4) The highest levels of job stress typically occur in the ________ years. A) early adult B) adolescent C) middle adult D) late adult Answer: A Diff: 1 Page Ref: 218 Standard: Life Span Development Objective: 6 5) By the age of 80, cardiac vessel elasticity has decreased by approximately ________ percent. A) 30 B) 40 C) 50 D) 60 Answer: C Diff: 1 Page Ref: 219 Standard: Life Span Development Objective: 7 6) The normal heart rate of a toddler ranges from ________ to ________ beats per minute. A) 120; 180 B) 100; 120 C) 80; 110 D) 60; 80 Answer: C Diff: 1 Page Ref: 210 Standard: Life Span Development Objective: 3 7) Preconventional reasoning is characterized by an orientation toward: A) concern with community rights. B) punishment and obedience. C) concern with interpersonal norms. D) concern with universal ethical principles. Answer: B Diff: 1 Page Ref: 216 Standard: Life Span Development Objective: 1

8) Which of the following describes the Moro reflex in the infant? A) When the infant's cheek is stroked, he turns his head in that direction. B) When the infant's lips are touched, he makes sucking motions. C) When startled, the infant throws his arms out wide, then grasps with the fingers and arms. D) The infant's hand grasps an object placed in the palm of the hand. Answer: C Diff: 2 Page Ref: 211-212 Standard: Life Span Development Objective: 2 9) Infants and children learn by building on what they have already learned, a technique known as: A) cognition. B) scaffolding. C) attachment. D) bonding. Answer: B Diff: 1 Page Ref: 213 Standard: Life Span Development Objective: 2 10) Which of the following fluids helps the newborn infant's lungs remain open by reducing surface tension of the alveoli? A) Amniotic fluid B) Vernix caseosa C) Surfactant D) Meconium Answer: C Diff: 1 Page Ref: 211 Standard: Life Span Development Objective: 2 11) Which of the following best describes an authoritarian parent? A) Responsive to the needs and wishes of the children B) Expectant that the partner will discipline the children C) Demanding and desiring instant obedience D) Tolerant, with an accepting view of his children's behavior Answer: C Diff: 2 Page Ref: 215 Standard: Life Span Development Objective: 1

12) Which of the following guidelines applies when interviewing an adolescent patient? A) Try to have a parent or peer stay with the patient. B) Conduct the interview in private. C) Remember that, although they look grown up, adolescents still want to be treated like children. D) Avoid asking questions about sensitive topics such as substance abuse and sexual activity. Answer: B Diff: 1 Page Ref: 217 Standard: Life Span Development Objective: 5 13) Which of the following statements about the physiological changes associated with aging is TRUE? A) There is a 25 to 30 percent increase in kidney mass due to hypertrophy. B) Impaired insulin use and glucose metabolism result in weight loss. C) Decreased elasticity of the lung tissue results in a smaller lung volume. D) Blood vessel walls thicken, reducing blood flow to end organs and causing blood pressure to rise. Answer: D Diff: 2 Page Ref: 219 Standard: Life Span Development Objective: 7 14) Which of the following best describes the development of the sensory portion of the nervous system in infants? A) They can feel pain but cannot isolate the sensation. B) They both feel pain and can localize the sensation. C) They have not yet developed an acute sense of pain. D) None of the above is accurate. Answer: A Diff: 2 Page Ref: 211 Standard: Life Span Development Objective: 2 15) Which of the following serves as a guideline for the expected weight of a 4- to 6-month-old child? A) Increased birth weight by 2 to 3 pounds B) Tripled his birth weight C) Gained at least 5 pounds D) Doubled his birth weight Answer: D Diff: 1 Page Ref: 210 Standard: Life Span Development Objective: 2

16) The normal birth weight of a full-term newborn infant is ________ kg. A) 2.0 to 2.5 B) 4.0 to 4.5 C) 1.0 to 1.5 D) 3.0 to 3.5 Answer: D Diff: 1 Page Ref: 210 Standard: Life Span Development Objective: 2 17) A child's hearing reaches maturity at: A) 12 to 18 months. B) 2 to 3 years. C) 3 to 4 years. D) 5 to 6 years. Answer: C Diff: 1 Page Ref: 214 Standard: Life Span Development Objective: 3 18) A newborn typically sleeps ________ hours in a 24-hour period. A) 8 to 10 B) 12 to 16 C) 16 to 18 D) 18 to 22 Answer: C Diff: 2 Page Ref: 212 Standard: Life Span Development Objective: 2 19) Psychological readiness for toilet training generally occurs at age ________ months. A) 12 to 15 B) 15 to 24 C) 18 to 30 D) 24 to 36 Answer: A Diff: 2 Page Ref: 214 Standard: Life Span Development Objective: 3

20) When palpating the head of a 12-month-old infant, it would be normal to feel the ________ fontanelle. A) occipital B) sphenoid C) anterior D) posterior Answer: C Diff: 1 Page Ref: 212 Standard: Life Span Development Objective: 2 21) An infant's ventilatory rate generally is too fast to sustain adequate tidal volume when the rate is over ________ breaths per minute. A) 60 B) 50 C) 40 D) 30 Answer: A Diff: 2 Page Ref: 211 Standard: Life Span Development Objective: 2 22) "Magical thinking" begins at age ________ months. A) 12 to 18 B) 18 to 24 C) 24 to 36 D) 36 to 48 Answer: C Diff: 1 Page Ref: 214 Standard: Life Span Development Objective: 3 23) School-age children usually develop all of the following, EXCEPT: A) an extreme sense of privacy. B) decision-making skills. C) self-concept. D) self-esteem. Answer: A Diff: 1 Page Ref: 216 Standard: Life Span Development Objective: 4

24) Infants should typically be able to sit up in a high chair and make one-syllable sounds by the age of ________ months. A) 3 B) 4 C) 6 D) 9 Answer: C Diff: 1 Page Ref: 212 Standard: Life Span Development Objective: 2 25) In the early-adulthood age bracket, what is the leading cause of death? A) Cardiovascular disease B) Accidental trauma C) Diabetes mellitus D) Seizure disorders Answer: B Diff: 1 Page Ref: 218 Standard: Life Span Development Objective: 6 26) At what stage does exploratory behavior accelerate playing simple games, following basic rules, and displaying early signs of competitiveness? A) Preschooler B) Toddler C) School age D) Adolescent Answer: A Diff: 1 Page Ref: 214 Standard: Life Span Development Objective: 3 27) ________ parents take a tolerant, accepting view of their children's behavior, including aggressive behavior and sexual behavior. A) Permissive B) Authoritative C) Authoritarian D) Divorced Answer: A Diff: 1 Page Ref: 215 Standard: Life Span Development Objective: 1

28) ________ take "time out" to experiment with a variety of identities, knowing that they do NOT have to assume responsibility for the consequences of those identities. A) Adolescents B) Preschoolers C) Toddlers D) School agers Answer: A Diff: 1 Page Ref: 217 Standard: Life Span Development Objective: 5 29) Adults in this age group are more concerned with the "social clock" and become more task oriented as they see the time for accomplishing their lifetime goals recede. A) Middle adulthood B) Early adulthood C) Late adulthood D) Adolescents Answer: A Diff: 1 Page Ref: 218 Standard: Life Span Development Objective: 6 30) What is the theoretical, species-specific, longest duration of life, excluding premature or "unnatural" death called? A) Maximum life span B) Life expectancy C) Maximum duration D) Theoretical duration Answer: A Diff: 1 Page Ref: 219 Standard: Life Span Development Objective: 1 31) In which stage of development do the trachea and large airways increase in diameter and enlargement of the end units of the airway results in a decreased surface area of the lungs? A) Late adulthood B) Middle adulthood C) Early adulthood D) Adolescence Answer: A Diff: 1 Page Ref: 219 Standard: Life Span Development Objective: 7

32) A decrease in cognitive functioning over a five-year period prior to death is termed: A) terminal drop. B) postconventional reasoning. C) slow-to-warm-up effect. D) scaffolding. Answer: A Diff: 1 Page Ref: 220 Standard: Life Span Development Objective: 1 33) What is one of the major challenges for the older adult? A) Maintaining a sense of self-worth B) Staying in peak physical conditioning C) Keeping up with daily chores and routines D) Maintaining an accurate account of savings for retirement Answer: A Diff: 1 Page Ref: 221 Standard: Life Span Development Objective: 7 34) A(n) ________ airway is shorter, narrower, less stable, and more easily obstructed than at any other stage in life. A) infant's B) toddler's C) preschooler's D) school ager's Answer: A Diff: 1 Page Ref: 211 Standard: Life Span Development Objective: 2 Chapter 12 Pathophysiology 1) The most abundant cation in the intracellular fluid is: A) potassium. B) sodium. C) magnesium. D) calcium. Answer: A Diff: 1 Page Ref: 264 Standard: Pathophysiology Objective: 11

2) Which type of shock is differentiated from other types by the presence of laryngeal edema? A) Anaphylactic B) Septic C) Cardiogenic D) Hypovolemic Answer: A Diff: 1 Page Ref: 311 Standard: Pathophysiology Objective: 20 3) One of the primary functions of cortisol as it is released during the stress response is to: A) inhibit lipolysis. B) promote the release of beta-endorphins. C) potentiate serotonin. D) stimulate gluconeogenesis. Answer: D Diff: 1 Page Ref: 345 Standard: Pathophysiology Objective: 27 4) Mast cells activate the inflammatory response through: A) degranulation and synthesis. B) granulation and synthesis. C) degranulation and agglutination. D) granulation and agglutination. Answer: A Diff: 1 Page Ref: 328 Standard: Pathophysiology Objective: 25 5) The study of the ways in which diseases interfere with normal body functions is called: A) pathophysiology. B) epidemiology. C) immunology. D) pathology. Answer: A Diff: 1 Page Ref: 229 Standard: Pathophysiology Objective: 1

6) The type of blood that may be administered to all people in an emergency, regardless of their blood type, is: A) O negative. B) AB positive. C) AB negative. D) O positive. Answer: A Diff: 1 Page Ref: 269 Standard: Pathophysiology Objective: 12 7) Which of the following is NOT part of the body's response in secondary multiple organ dysfunction syndrome (MODS)? A) Inflammatory mediators enter the system. B) Plasma protein systems are activated. C) Endorphin release contributes to vasodilation. D) Catecholamine release is inhibited. Answer: D Diff: 1 Page Ref: 313 Standard: Pathophysiology Objective: 21 8) Which of the following is NOT one of the body's three chief lines of defense against infection and injury? A) Homeopathic secretions B) Inflammatory response C) Anatomic barriers D) Immune response Answer: A Diff: 1 Page Ref: 316-317 Standard: Pathophysiology Objective: 23 9) Which of the following barriers provides the greatest degree of specificity when eliminating foreign substances from the body? A) Apocrine secretions B) Inflammation C) Anatomical barriers D) Immunity Answer: D Diff: 2 Page Ref: 317 Standard: Pathophysiology Objective: 24

10) Which of the following factors may contribute to the development of disease in geriatric patients? A) Genetic predisposition B) Preexisting disease(s) C) Inadequate nutrition D) All of the above Answer: D Diff: 1 Page Ref: 296-297 Standard: Pathophysiology Objective: 3 11) B lymphocytes are primarily responsible for: A) neutralizing antigens. B) producing antibodies. C) directly attacking antigens. D) producing antigens. Answer: B Diff: 1 Page Ref: 317 Standard: Pathophysiology Objective: 24 12) Which of the following terms refers to the movement of a substance from an area of higher concentration to an area of lower concentration without the use of energy? A) Diffusion B) Facilitation C) Osmosis D) Active transport Answer: A Diff: 1 Page Ref: 256 Standard: Pathophysiology Objective: 1 13) Poisons released from bacterial cells when they die are known as: A) endotoxins. B) epitoxins. C) exotoxins. D) ectotoxins. Answer: A Diff: 1 Page Ref: 315 Standard: Pathophysiology Objective: 1

14) The process in which the size of a cell decreases as a result of a decreasing workload is known as: A) hypertrophy. B) metaplasia. C) atrophy. D) hyperplasia. Answer: C Diff: 1 Page Ref: 281 Standard: Pathophysiology Objective: 1 15) The excess elimination of hydrogen ions, as may occur in vomiting, can result in: A) metabolic alkalosis. B) respiratory alkalosis. C) metabolic acidosis. D) respiratory acidosis. Answer: A Diff: 1 Page Ref: 254 Standard: Pathophysiology Objective: 1 16) Which of the following is TRUE of anaerobic metabolism? A) It occurs only in pathological conditions. B) It occurs only during very strenuous exercise. C) It is a normal part of cellular metabolism. D) It occurs only in the presence of oxygen. Answer: C Diff: 1 Page Ref: 307 Standard: Pathophysiology Objective: 15 17) Which of the following is NOT an acute inflammatory response? A) Increased vascular permeability B) Vasodilation C) Cellular infiltration D) Thrombolysis Answer: D Diff: 1 Page Ref: 328 Standard: Pathophysiology Objective: 25

18) Which of the following pH values indicates acidosis in the human body? A) 7.35 B) 7.30 C) 7.40 D) 7.45 Answer: B Diff: 1 Page Ref: 252 Standard: Pathophysiology Objective: 8 19) The attraction of leukocytes to the site of inflammation during degranulation is called: A) apoptosis. B) histocompatibility. C) chemotaxis. D) catabolism. Answer: C Diff: 1 Page Ref: 329 Standard: Pathophysiology Objective: 1 20) The shift of intravascular fluid to the interstitial spaces is commonly called: A) diuresis. B) third-space fluid loss. C) insensible water loss. D) turgor. Answer: B Diff: 1 Page Ref: 263-264 Standard: Pathophysiology Objective: 11 21) The activation of several body systems' baroreceptors to reestablish a normal blood pressure is a process known as: A) compensation. B) positive feedback. C) inflammatory. D) pathological. Answer: A Diff: 2 Page Ref: 306 Standard: Pathophysiology Objective: 1

22) Oncotic force is related to the amount of ________ in a solution. A) electrolytes B) water C) anions D) protein Answer: D Diff: 1 Page Ref: 267 Standard: Pathophysiology Objective: 7 23) As blood volume is lost due to a traumatic injury, the body's response is to: A) decrease heart rate and vasoconstrict major veins. B) increase heart rate and decrease systemic vascular resistance. C) decrease heart rate and promote peripheral vasoconstriction. D) increase heart rate and close precapillary arterioles. Answer: D Diff: 1 Page Ref: 301 Standard: Pathophysiology Objective: 20 24) Which of the following is considered the body's "first line of defense" when preventing infection and injury? A) Chemotactic reactions B) Anatomic barriers C) Immune response D) Inflammatory response Answer: B Diff: 1 Page Ref: 316 Standard: Pathophysiology Objective: 23 25) Hemolytic disease of the newborn is most likely when an Rh ________ mother has previously given birth to an Rh ________ infant and is now pregnant with an Rh ________ fetus. A) negative; positive; positive B) positive; negative; positive C) negative; positive; negative D) positive; negative; negative Answer: A Diff: 2 Page Ref: 320 Standard: Pathophysiology Objective: 12

26) Adequate perfusion depends on: A) the presence of oxygen in the blood. B) adequate production of carbon dioxide. C) adequate blood pressure. D) intact pump, intact container and fluid. Answer: D Diff: 1 Page Ref: 299-300 Standard: Pathophysiology Objective: 19 27) On average, the human body weight is about ________ percent water. A) 50 B) 70 C) 60 D) 80 Answer: C Diff: 1 Page Ref: 261 Standard: Pathophysiology Objective: 7 28) Blood pressure is represented by: A) cardiac output multiplied by peripheral vascular resistance. B) the difference between preload and afterload. C) stroke volume multiplied by heart rate. D) the difference between cardiac contractile force and peripheral vascular resistance. Answer: A Diff: 1 Page Ref: 300 Standard: Pathophysiology Objective: 19 29) Which of the following is TRUE of leukotrienes? A) They are released by B lymphocytes. B) They inhibit vascular permeability. C) They promote faster effects than histamines. D) They are known as SRS-As. Answer: D Diff: 1 Page Ref: 330 Standard: Pathophysiology Objective: 25

30) Which of the following best describes an antibody? A) A toxin released when cells die B) A cell that engulfs and destroys invading pathogens C) A substance secreted by apocrine glands D) A substance produced by B lymphocytes that binds with an antigen Answer: D Diff: 1 Page Ref: 321 Standard: Pathophysiology Objective: 1 31) Pulmonary edema is characteristic of which of the following types of shock? A) Hypovolemic B) Septic C) Cardiogenic D) Neurogenic Answer: C Diff: 1 Page Ref: 307 Standard: Pathophysiology Objective: 20 32) T lymphocytes are primarily responsible for: A) directly attacking antigens. B) producing antibodies. C) neutralizing antigens. D) producing antigens. Answer: A Diff: 1 Page Ref: 318 Standard: Pathophysiology Objective: 24 33) The term pH is a measure of: A) hydrogen ion concentration. B) sodium bicarbonate concentration. C) carbonic acid concentration. D) sodium hydroxide concentration. Answer: A Diff: 1 Page Ref: 249 Standard: Pathophysiology Objective: 8

34) Which of the following processes is used when glucose enters a body cell? A) Diffusion B) Facilitated diffusion C) Active transport D) Hydrostatic pressure Answer: B Diff: 1 Page Ref: 258 Standard: Pathophysiology Objective: 10 35) What is the primary constituent of plasma? A) Clotting factors B) Water C) Proteins D) Electrolytes Answer: B Diff: 1 Page Ref: 268 Standard: Pathophysiology Objective: 12 36) What is the name of the level of structural organization that consists of groups of tissues working together? A) Organ B) Organism C) Organ system D) Organelle Answer: A Diff: 1 Page Ref: 229 Standard: Pathophysiology Objective: 1 37) Which one of the following is most likely to result in hypovolemic shock? A) Acute spinal cord injury B) Gunshot wound to the hand C) Left ventricular failure D) Penetrating trauma to the abdomen Answer: D Diff: 1 Page Ref: 308 Standard: Pathophysiology Objective: 20

38) When cells are moderately differentiated with some structural similarity to the tissue of origin and the prognosis is fair, this is what grade of cancer cell? A) 2 B) X C) 1 D) 3 Answer: A Diff: 1 Page Ref: 295 Standard: Pathophysiology Objective: 17 39) How many molecules of ATP are produced from glycolysis? A) 2 B) 3 C) 4 D) 5 Answer: C Diff: 1 Page Ref: 276-277 Standard: Pathophysiology Objective: 14 40) Which of the following impairs cellular metabolism in shock? A) Impaired use of both oxygen and glucose B) Impaired use of oxygen only C) Impaired use of glucose only D) Impaired use of metabolic substrates and glucose Answer: A Diff: 1 Page Ref: 303 Standard: Pathophysiology Objective: 19 41) The most abundant cation in extracellular fluid is: A) magnesium. B) sodium. C) calcium. D) potassium. Answer: B Diff: 1 Page Ref: 264 Standard: Pathophysiology Objective: 11

42) A patient is given antibody therapy in the hospital to prevent infection after exposure to a communicable disease. This is an example of ________ immunity. A) passive natural B) active natural C) passive acquired D) active acquired Answer: C Diff: 2 Page Ref: 317 Standard: Pathophysiology Objective: 24 43) Which of the following is a response to histamine release? A) Release of leukotrienes B) Increase in blood flow at the site of injury C) Decrease in vascular wall permeability D) Suppression of lysosomal enzymes Answer: B Diff: 1 Page Ref: 328 Standard: Pathophysiology Objective: 25 44) Which of the following mechanisms buffers the acidity of the blood the fastest? A) Increased hydrogen ion elimination in the urine B) Protein buffering system C) The carbonic acid-bicarbonate buffer system D) Increased respiratory rate Answer: C Diff: 1 Page Ref: 250 Standard: Pathophysiology Objective: 8 45) Your patient is presenting with rapid-onset hypotension, tachycardia, and absent radial pulses. Which type of shock is LEAST likely to be the cause? A) Septic B) Cardiogenic C) Hypovolemic D) Neurogenic Answer: D Diff: 2 Page Ref: 309-310 Standard: Pathophysiology Objective: 20

46) Which of the following adaptive mechanisms for cellular injury is LEAST likely to result in the proliferation of malignant cells? A) Atrophy B) Dysplasia C) Metaplasia D) Hyperplasia Answer: A Diff: 1 Page Ref: 280-281 Standard: Pathophysiology Objective: 27 47) Which of the following is a hypertonic solution? A) 0.9 percent sodium chloride B) 0.45 percent sodium chloride C) 1.8 percent sodium chloride D) 0.2 percent sodium chloride Answer: C Diff: 2 Page Ref: 270 Standard: Pathophysiology Objective: 13 48) You are presented with a patient displaying urticaria, dyspnea, hypotension, nausea, vomiting, and dizziness. This patient is MOST likely suffering from: A) anaphylaxis. B) hypovolemia. C) sepsis. D) cardiogenic failure. Answer: A Diff: 1 Page Ref: 337 Standard: Pathophysiology Objective: 25 49) The chemical mediators that are released when mast cells degranulate primarily cause: A) enhanced cardiac contractility. B) vasodilation. C) depressed pumping action of the heart. D) vasoconstriction. Answer: B Diff: 1 Page Ref: 328 Standard: Pathophysiology Objective: 24

50) Which of the following terms can be defined as the activities of the body that allow the maintenance of physiologic stability? A) Sympathetic tone B) Homeostasis C) Inflammation D) General adaptation syndrome Answer: B Diff: 1 Page Ref: 265 Standard: Pathophysiology Objective: 1 51) What type of epithelial tissue is found in the ureters and urinary bladder? A) Glandular B) Transitional C) Stratified squamous D) Pseudostratified Answer: B Diff: 1 Page Ref: 288 Standard: Pathophysiology Objective: 16 52) The tissue that lines many internal and external body surfaces is known as ________ tissue. A) fibrous B) connective C) parietal D) epithelial Answer: D Diff: 1 Page Ref: 287 Standard: Pathophysiology Objective: 1 53) Two solutions are separated by a membrane that is more permeable to water than to sodium. Solution A contains 250 mEq/mL of sodium, and Solution B contains 125 mEq/mL of sodium. Given this, which of the following is TRUE? A) Active transport is required to move sodium ions from Solution A to Solution B. B) Water will move from Solution A to Solution B. C) Water will move from Solution B to Solution A. D) Sodium ions will diffuse from Solution A to Solution B. Answer: C Diff: 2 Page Ref: 256 Standard: Pathophysiology Objective: 11

54) A solution having a comparatively higher concentration of solutes is said to be: A) hypertonic. B) osmotic. C) isotonic. D) hypotonic. Answer: A Diff: 1 Page Ref: 257-258 Standard: Pathophysiology Objective: 1 55) Treatment of immune deficiencies through the use of replacement therapies includes all of the following, EXCEPT: A) gene therapy. B) transplantation. C) psychoneuroimmunologic regulation. D) gamma globulin therapy. Answer: C Diff: 1 Page Ref: 341 Standard: Pathophysiology Objective: 26 56) Which of the following conditions may result in edema? A) Inhibition of ADH (vasopressin) B) Decreased hydrostatic pressure C) Loss of plasma proteins D) Administration of a hypertonic solution Answer: C Diff: 2 Page Ref: 263 Standard: Pathophysiology Objective: 11 57) A positively charged atom or group of atoms is known as a(n): A) electron. B) neutron. C) cation. D) anion. Answer: C Diff: 1 Page Ref: 238 Standard: Pathophysiology Objective: 1

58) The abnormal or disordered growth of a cell from rapid preproduction is known as: A) mitosis. B) dysplasia. C) adaptation. D) dysphasia. Answer: B Diff: 1 Page Ref: 283 Standard: Pathophysiology Objective: 15 59) The enzymes necessary for DNA replication are in the ________ of the cell. A) cytoplasmic membrane B) Golgi apparatus C) lysosomes D) nucleus Answer: D Diff: 1 Page Ref: 244-245 Standard: Pathophysiology Objective: 9 60) Hypoperfusion can result in: A) acidosis. B) hyperoxia. C) hypocarbia. D) alkalosis. Answer: A Diff: 1 Page Ref: 313 Standard: Pathophysiology Objective: 19 61) Which of the following events does NOT occur during an inflammation response? A) Development of humoral immunity B) Promotion of healing C) Removal of unwanted substances D) Walling off of the infected and inflamed area Answer: A Diff: 1 Page Ref: 317-318 Standard: Pathophysiology Objective: 26

62) The amount of blood that returns to the heart during diastole is called: A) cardiac output. B) preload. C) myocardial capacity. D) afterload. Answer: B Diff: 1 Page Ref: 300 Standard: Pathophysiology Objective: 1 63) Normal saline solution contains ________ percent sodium chloride. A) 90 B) 0.09 C) 0.9 D) 9.0 Answer: C Diff: 1 Page Ref: 270 Standard: Pathophysiology Objective: 13 64) Allergy, autoimmunity, and isoimmunity are types of: A) hypersensitivity. B) insensitivity. C) polysensitivity. D) hyposensitivity. Answer: A Diff: 1 Page Ref: 336 Standard: Pathophysiology Objective: 24 65) Which of the following is defined as the percentage of blood volume occupied by erythrocytes? A) Differential B) Hemoglobin C) Hematocrit D) Complete blood count (CBC) Answer: C Diff: 1 Page Ref: 269 Standard: Pathophysiology Objective: 1

66) The process that produces an increase in cell size as a result of increasing workload is known as: A) hyperplasia. B) hypertrophy. C) metaplasia. D) atrophy. Answer: B Diff: 1 Page Ref: 280 Standard: Pathophysiology Objective: 1 67) Shock can best be described as: A) hypotension. B) a decrease in myocardial contractility. C) decreased cardiac output. D) a state of inadequate tissue perfusion. Answer: D Diff: 1 Page Ref: 299 Standard: Pathophysiology Objective: 20 68) Patients who suffer graft rejections and contact allergic reactions are experiencing which type of hypersensitivity reaction? A) Type II B) Type IV C) Type III D) Type I Answer: A Diff: 1 Page Ref: 337 Standard: Pathophysiology Objective: 26 69) Which of the following best describes the body's reaction to exposure to or invasion by antigens? A) Anaphylaxis B) Adaptation C) Immune response D) Tachyphylaxis Answer: C Diff: 1 Page Ref: 315 Standard: Pathophysiology Objective: 24

70) Which of the following is NOT a function of exudate? A) To destroy the infected host cell B) To dilute toxins released by bacteria and the toxic products of dying cells C) To bring plasma proteins and leukocytes to the site to attack the invaders D) To carry away the products of inflammation Answer: A Diff: 1 Page Ref: 334 Standard: Pathophysiology Objective: 24 71) The general term for creating, storing, and using energy in the body is: A) homeostasis. B) metabolism. C) anabolism. D) catabolism. Answer: B Diff: 1 Page Ref: 253 Standard: Pathophysiology Objective: 1 72) Which of the following is NOT consistent with an IgE mediated response to antigens? A) Flushed, itching skin B) Increased heart rate C) Nausea and vomiting D) Profound vasoconstriction Answer: D Diff: 2 Page Ref: 337 Standard: Pathophysiology Objective: 26 73) Septic shock is precipitated by: A) poisoning. B) exposure to an antigen. C) multiple organ dysfunction syndrome. D) an overwhelming infection. Answer: D Diff: 1 Page Ref: 311 Standard: Pathophysiology Objective: 20

74) Substances that separate into electrically charged particles in water are known as: A) electrolytes. B) elements. C) anions. D) molecules. Answer: A Diff: 1 Page Ref: 264 Standard: Pathophysiology Objective: 1 75) ________ are the most common type of cell in the blood. A) Thrombocytes B) Erythrocytes C) Stem cells D) Leukocytes Answer: B Diff: 1 Page Ref: 268 Standard: Pathophysiology Objective: 12 76) When a foreign substance invades the body, the inflammatory response develops ________ compared to the immune response. A) more quickly B) more specifically C) for a longer time D) with fewer cell types Answer: A Diff: 2 Page Ref: 316 Standard: Pathophysiology Objective: 23 77) An excessive absorption and accumulation of iron in the body, causing weight loss, joint pain, abdominal pain, palpitations and testicular atrophy in males is: A) splenomegaly. B) cholecystitis. C) hemophilia. D) hemochromatosis. Answer: D Diff: 2 Page Ref: 298 Standard: Pathophysiology Objective: 18

78) One of the body's anatomical barriers to infection and injury is/are: A) epithelium. B) endoplasmic reticulum. C) cytotoxic factors. D) phagocytes. Answer: A Diff: 1 Page Ref: 286 Standard: Pathophysiology Objective: 16 79) Elevations in brain natriuretic peptide (BNP) in the blood have become the "marker" for which of the following conditions? A) Liver failure B) Brain cancer C) Congestive heart failure D) Pancreatitis Answer: C Diff: 1 Page Ref: 301 Standard: Pathophysiology Objective: 18 80) What is a predisposing factor to the development of disease within the human body? A) Lifestyle B) Bacteria C) Immunity D) Biology Answer: A Diff: 1 Page Ref: 296 Standard: Pathophysiology Objective: 3 81) In some instances, when the predisposing factors to development of a disease cannot be identified, the disease is termed: A) idiopathic. B) congenital. C) pathogenic. D) irreversible. Answer: A Diff: 1 Page Ref: 231 Standard: Pathophysiology Objective: 1

82) A subclavian central intravenous line is placed into a patient to administer intravenous nutrition following a severe burn. During the line insertion, the dome of the lung is inadvertently punctured, resulting in a pneumothorax. The cause of the pneumothorax in this case is: A) iatrogenic. B) neoplastic. C) teratogenic. D) ischemic. Answer: A Diff: 1 Page Ref: 340 Standard: Pathophysiology Objective: 18 83) Why are gases such as helium considered extremely stable? A) They have a full valence shell. B) They are the most abundant in nature. C) They have a short half-life. D) They are in the top portion of the periodic table. Answer: A Diff: 1 Page Ref: 236 Standard: Pathophysiology Objective: 5 84) Covalent bonds: A) share electrons equally and are the strongest of the three types of chemical bonds. B) trade electrons equally and are the weakest of the three types of chemical bonds. C) share electrons unequally and are the strongest of the three types of chemical bonds. D) trade electrons unequally and are the weakest of the three types of chemical bonds. Answer: A Diff: 1 Page Ref: 237 Standard: Pathophysiology Objective: 5 85) What makes an inorganic compound different from an organic compound? A) An inorganic compound does not contain carbon. B) An inorganic compound does contain carbon. C) An inorganic compound is found commonly in plants. D) An inorganic compound is more common than organic compounds. Answer: A Diff: 1 Page Ref: 239 Standard: Pathophysiology Objective: 1

86) Which of the following is an organic compound? A) Protein B) Salt C) Acid D) Base Answer: A Diff: 1 Page Ref: 241 Standard: Pathophysiology Objective: 7 87) What is a chemical property of amylose within the body? A) It is insoluble in water and thus allows it to serve as a storage reservoir for glucose. B) It is important in creating bulk and moving fecal matter through the large intestine. C) It is essential for the growth and repair of living tissues. D) It is a substance that speeds up a chemical reaction without being consumed in the process. Answer: A Diff: 1 Page Ref: 240 Standard: Pathophysiology Objective: 6 88) A highly reactive molecule or atom that has an unpaired electron in an outer orbital that is NOT contributing to molecular bonding is termed a: A) free radical. B) nucleic acid. C) cofactor. D) peptide. Answer: A Diff: 1 Page Ref: 243 Standard: Pathophysiology Objective: 1 89) Which of the following is NOT a property of water? A) The ability to pass through cellular membranes with ease B) The ability to carry away a significant amount of heat C) The ability to dissolve both polar and charged substances D) The ability to absorb a large amount of heat energy Answer: A Diff: 1 Page Ref: 248 Standard: Pathophysiology Objective: 7

90) What is a major enzyme found in the blood that is an important part of the protein buffer system? A) Carbonic anhydrase B) Acetylcholinesterase C) Monoamine oxidase D) Renal alteplase Answer: A Diff: 1 Page Ref: 250 Standard: Pathophysiology Objective: 8 91) What is the major role of the phosphate buffer system? A) Stabilization of urine's pH B) Stimulating a chloride shift in the ECF C) Promotion of the glycolysis process D) Oxidation of all free radicals Answer: A Diff: 1 Page Ref: 250 Standard: Pathophysiology Objective: 8 92) When the respiratory system cannot effectively eliminate all the carbon dioxide generated through metabolic activities in the peripheral tissues, this causes: A) respiratory acidosis. B) metabolic alkalosis. C) respiratory alkalosis. D) metabolic acidosis. Answer: A Diff: 1 Page Ref: 252 Standard: Pathophysiology Objective: 8 93) The cellular membrane proteins and their functions include all of the following, EXCEPT: A) buffers. B) linkers. C) receptors. D) enzymes. Answer: A Diff: 1 Page Ref: 255 Standard: Pathophysiology Objective: 9

94) The movement of water from a region of low solute concentration to a region of high solute concentration is known as: A) osmosis. B) diffusion. C) active transport. D) endocytosis. Answer: A Diff: 1 Page Ref: 266 Standard: Pathophysiology Objective: 10 95) Approximately 70 percent of all body water is found within which compartment? A) Intracellular B) Extracellular C) Intravascular D) Interstitial Answer: A Diff: 1 Page Ref: 261 Standard: Pathophysiology Objective: 11 96) When the concentration of a solute is less on one side of the cell membrane, as compared to the other, the solution is referred to as: A) hypotonic. B) hypertonic. C) isotonic. D) deficient. Answer: A Diff: 1 Page Ref: 258 Standard: Pathophysiology Objective: 10 97) Which of the following is a formed element? A) Platelet B) Enzyme C) Lipid D) Electrolyte Answer: A Diff: 1 Page Ref: 301 Standard: Pathophysiology Objective: 12

98) The development of the breasts in females during puberty and enlargement of the breasts during pregnancy are two examples of: A) hyperplasia. B) hypertrophy. C) atrophy. D) metaplasia. Answer: A Diff: 1 Page Ref: 280 Standard: Pathophysiology Objective: 9 99) Which of the following is NOT derived from three distinct cell lines seen during early embryonic development? A) Epiderm B) Endoderm C) Mesoderm D) Ectoderm Answer: A Diff: 1 Page Ref: 285 Standard: Pathophysiology Objective: 16 100) All the organisms of the same species residing in a distinct geographic area (e.g., continent, city) are called: A) a population. B) an ecosystem. C) a community. D) a biome. Answer: A Diff: 1 Page Ref: 229 Standard: Pathophysiology Objective: 2 101) Which of these terms refers to a disease caused by diminished blood supply? A) infectious B) immunologic C) ischemic D) metabolic Answer: C Diff: 1 Page Ref: 232 Standard: Pathophysiology Objective: 4

102) Which of these terms refers to a disease caused by problems occurring during fetal development? A) genetic B) iatrogenic C) neoplastic D) congenital Answer: D Diff: 1 Page Ref: 233 Standard: Pathophysiology Objective: 4 103) Which of these are single-celled organisms that consist of internal cytoplasm surrounded by a rigid cell wall? A) prions B) viruses C) parasites D) bacteria Answer: D Diff: 1 Page Ref: 314 Standard: Pathophysiology Objective: 22 Chapter 13 Emergency Pharmacology 1) In which class of the Vaughn-Williams classification system of antidysrhythmic medications does amiodarone belong? A) III B) IB C) II D) IV Answer: A Diff: 2 Page Ref: 405, 407 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 3, 15 2) The FDA's numerical classification of a newly approved drug as "3" denotes it as a new: A) combination not previously marketed. B) generation of a marketed drug. C) formulation or dosage form not previously marketed. D) molecular drug. Answer: C Diff: 2 Page Ref: 359 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 6 135 Copyright © 2017 Pearson Education, Inc.

3) According to Starling's Law, the administration of nitroglycerin will result in ________ preload, ________ stroke volume, and ________ myocardial oxygen demand. A) decreased; decreased; increased B) decreased; increased; decreased C) increased; increased; decreased D) decreased; decreased; decreased Answer: D Diff: 3 Page Ref: 408, 412 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 4) A lesion in the posterior pituitary gland resulting in hypersecretion of ADH may result in: A) hypercalcemia. B) hypokalemia. C) hypertension. D) hyponatremia. Answer: C Diff: 2 Page Ref: 424 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 19 5) All of the following statements about insulin are true, EXCEPT: A) it must be given subcutaneously. B) it is classified as either natural (regular) or modified. C) it is available as short, intermediate, or long acting. D) it can now be produced through recombinant DNA technology. Answer: A Diff: 2 Page Ref: 425-426 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 19 6) The FDA's classification of a drug's treatment or therapeutic potential as "P" means that the drug: A) offers an important therapeutic gain. B) is an orphan drug. C) is similar to drugs already on the market. D) is indicated for AIDS and HIV-related disease. Answer: A Diff: 2 Page Ref: 359 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 6

7) Which of the following is the generic name of a drug? A) Diazepam B) Excedrin C) Tylenol D) Motrin Answer: A Diff: 2 Page Ref: 354 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 2 8) All of the following statements about hormone replacement therapy (HRT) with estrogen are true EXCEPT that HRT: A) may increase the risk of breast cancer and stroke. B) has side effects that include nausea, fluid retention, and breast tenderness. C) is often used to treat postmenopausal symptoms and osteoporosis. D) ineffectively delays the onset of senile dementia in many patients. Answer: D Diff: 2 Page Ref: 427 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 20 9) Which of the following statements about hemostatic agents, such as adenosine diphosphate (ADP) and thromboxane A2 (TXA2), is TRUE? A) They are responsible for converting plasminogen to plasmin. B) They have their effect early in the clotting process. C) They convert fibrinogen to fibrin. D) They limit the clotting cascade to the immediate area of the vessel injury. Answer: B Diff: 1 Page Ref: 414 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 10) All of the following statements about nonsteroidal anti-inflammatory drugs (NSAIDs) are true EXCEPT that NSAIDs: A) are used as analgesics and antipyretics. B) are prescribed to relieve pain following trauma and surgery. C) interfere with the production of prostaglandins, thereby interrupting the inflammatory process. D) include aspirin, acetaminophen, and ibuprofen. Answer: D Diff: 2 Page Ref: 431 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 21 137 Copyright © 2017 Pearson Education, Inc.

11) Which of the following medications has the shortest half-life? A) Verapamil B) Epinephrine C) Digitalis D) Adenosine Answer: D Diff: 2 Page Ref: 407 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 8 12) Which of the following medications would most likely be considered for emergent treatment in the prehospital management of hypertensive crisis? A) Labetalol (Normodyne) B) Nitroglycerin paste (Nitro-Bid) C) Enalaprilat (Vasotec IV) D) Nifedipine (Procardia) Answer: A Diff: 2 Page Ref: 410 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 13) In which class of the Vaughn-Williams classification system of antidysrhythmic medications does quinidine belong? A) IA B) IB C) IC D) II Answer: A Diff: 2 Page Ref: 404 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 3 14) Tachyphylaxis can be managed by: A) changing to a similar drug in the same family. B) decreasing the frequency with which the medication is administered. C) decreasing the dosage of the medication. D) concurrently administering an anti-inflammatory drug to blunt the allergic response. Answer: A Diff: 2 Page Ref: 397 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 14 138 Copyright © 2017 Pearson Education, Inc.

15) Methylphenidate (Ritalin), a drug used to treat attention deficit hyperactivity disorder (ADHD), achieves its therapeutic action by ________ the CNS, thereby causing ________ and allowing for greater concentration and focus. A) stimulating; heightened awareness and arousal B) depressing; sedation C) stimulating; paradoxical sedation D) depressing; relaxation Answer: A Diff: 2 Page Ref: 381 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 14 16) All of the following result from administration of insulin, EXCEPT: A) increased synthesis of proteins, carbohydrates, lipids, and nucleic acids. B) conversion of glucose to glycogen. C) increased cellular transport of glucose, potassium, and amino acids D) gluconeogenesis and glycogenolysis. Answer: D Diff: 3 Page Ref: 425 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 19 17) The use of tobacco, because of its nicotine content, may cause subtle symptoms due to stimulation of the: A) parasympathetic division of the autonomic nervous system. B) nicotinic receptor sites at the neuromuscular junction in the sympathetic nervous system. C) sympathetic division of the autonomic nervous system. D) sympathetic and parasympathetic divisions of the autonomic nervous system. Answer: D Diff: 2 Page Ref: 392 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 14 18) A diuretic that affects reabsorption early in the nephron filtration process will: A) affect water reabsorption but not electrolytes. B) affect electrolytes but not fluid reabsorption. C) have a lesser impact on water and sodium removal. D) have a greater impact on water and sodium removal. Answer: D Diff: 2 Page Ref: 408 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 19 139 Copyright © 2017 Pearson Education, Inc.

19) A larger-than-expected dose of adenosine may be necessary in patients regularly taking: A) amphetamines. B) benzodiazepines. C) Class I anti-dysrhythmic. D) aminophylline. Answer: D Diff: 2 Page Ref: 407 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 13 20) Glucagon will affect blood glucose levels by: A) inducing glycogenolysis and gluconeogenesis. B) inducing the storage of glucose into the liver and skeletal muscle through glycogenesis. C) enhancing the absorption of glucose from the gastrointestinal tract. D) enabling the rapid absorption of glucose into the cells. Answer: A Diff: 3 Page Ref: 425 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 19 21) Which class of hormones is NOT synthesized and secreted by the adrenal cortex? A) Androgens B) Catecholamines C) Mineralocorticoids D) Glucocorticoids Answer: B Diff: 2 Page Ref: 424 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 19 22) Digoxin is a paradoxical drug, which means: A) its many effects on the lungs make it an effective bronchodilator. B) its many effects on the heart make it both an ineffective antiarrhythmic and an antidysrhythmic. C) its many effects on the heart make it both an effective antiarrhythmic and a potent prodysrhythmic. D) its many effects on the lungs make it an ineffective bronchodilator. Answer: C Diff: 1 Page Ref: 407-408 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15

23) Which of the following is NOT a potential side effect of oral contraceptives? A) Early-onset osteoporosis B) Hypertension C) Thromboembolism D) Unintended pregnancy Answer: A Diff: 2 Page Ref: 427 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 20 24) Current treatment regimens for peptic ulcer disease may include all of the following, EXCEPT: A) nonsteroidal anti-inflammatory drugs (NSAIDs). B) H2 receptor antagonists. C) proton pump inhibitors. D) antacids. Answer: A Diff: 1 Page Ref: 419 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 17 25) To relieve nasal congestion, which of the following medications would be most effective when administered intranasally? A) Epinephrine B) Propranalol C) Physostigmine D) Phenylepherine Answer: D Diff: 2 Page Ref: 417 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 21 26) Aspirin is beneficial to patients with a history of cardiac disease because it: A) inhibits the clotting cascade. B) provides analgesia. C) inhibits platelet aggregation. D) causes thrombolysis. Answer: C Diff: 2 Page Ref: 414 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15

27) Which term best describes the effects a drug has on its target organs? A) Biotransformation B) Pharmacodynamics C) Pharmacokinetics D) Bioavailability Answer: B Diff: 1 Page Ref: 367 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 11 28) If you were to administer an antiarrhythmic drug that was a complete sodium channel blocker, which of the following would you expect? A) It would prevent the efflux (outflow) of calcium from within the cell. B) It would impede the sodium-potassium pump from replacing the ions to their original locations. C) It would cause excessive muscular contraction, because sodium is the principal cation in myofibril contraction. D) It would prevent the development of phase 0, thereby inhibiting depolarization. Answer: D Diff: 3 Page Ref: 404, 407 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 29) Once a drug is proven safe and tested on a limited group of people with the disease it is intended to treat, and the therapeutic dose is refined, the drug manufacturer can file a new drug application (NDA) following this phase of human studies. A) 3 B) 4 C) 2 D) 1 Answer: A Diff: 2 Page Ref: 358 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 6

30) A gelatin container filled with powder, liquid, or tiny granules is called a: A) tablet. B) capsule. C) caplet. D) pill. Answer: B Diff: 1 Page Ref: 367 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 9 31) Which of the following medications will block the influx of calcium ions during phase 0 of the slow potential in the heart? A) Amiodarone (Cordarone) B) Lidocaine (Xylocaine) C) Esmolol (Brevibloc) D) Digoxin (Lanoxin) Answer: C Diff: 2 Page Ref: 407 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 32) A significant characteristic of digitalis preparations is that they: A) have a negative inotropic effect. B) are not prodysrhythmic drugs. C) have a positive chronotropic effect. D) have a very narrow therapeutic index. Answer: D Diff: 2 Page Ref: 412 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 33) If a patient were exhibiting pupillary constriction, hypersalivation, bronchial wheezing, and bradycardia, you should suspect ________ of the ________ nervous system. A) blockade; voluntary B) stimulation; sympathetic C) stimulation; parasympathetic D) blockade; cholinergic Answer: C Diff: 2 Page Ref: 434 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 13

34) Which of the following diseases is characterized by hypersecretion of adrenocorticotropic hormone leading to hyperglycemia, obesity, hypertension, and electrolyte imbalances? A) Cushing's disease B) Gigantism C) Hashimoto's disease D) Addison's disease Answer: A Diff: 2 Page Ref: 425 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 19 35) Which class of antiarrhythmic drugs is LEAST likely to contribute to hypotension? A) I B) II C) III D) IV Answer: A Diff: 2 Page Ref: 404, 407 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 4, 15 36) You are caring for a 68-year-old patient with an altered level of consciousness and reported seizure activity. You obtain a blood pressure of 244/140 mmHg, a pulse of 90, and respirations of 18. Which of the following medications would be most suitable for this patient? A) Minoxidil (Loniten) B) Hydralizine (Apresoline) C) Enalapril (Vasotec) D) Nitroprusside (Nipride) Answer: D Diff: 2 Page Ref: 412 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 13 37) Which of the following statements about antibiotics is NOT true? A) Antibiotics typically achieve their therapeutic action by destroying the bacterial cell wall. B) Viruses are not susceptible to antibiotics. C) Antibiotics are generally safe and can be prescribed indiscriminately. D) An individual who has developed a resistance to one type of antibiotic will typically respond well to other antibiotics in a similar class. Answer: D Diff: 2 Page Ref: 430 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 8 144 Copyright © 2017 Pearson Education, Inc.

38) The principal mechanism of action of phenytoin (Dilantin) in treating status seizures is the: A) blocking of GABA receptor sites to prevent further cellular activity in the CNS. B) influx of calcium ions through calcium channels to enhance depolarization. C) blocking of acetylcholine receptor sites at the neuromuscular junction to prevent convulsions. D) prevention of sodium ions entering the cell by closing sodium channels. Answer: D Diff: 2 Page Ref: 379 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 13 39) A drug that blocks the muscarinic receptors in the peripheral nervous system would be classified as a: A) sympathomimetic. B) sympatholytic. C) parasympathomimetic. D) parasympatholytic. Answer: D Diff: 2 Page Ref: 391 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 14 40) Monoamine oxidase inhibitors (MAOIs) achieve their therapeutic effects by: A) enhancing degradation of monoamine neurotransmitters at the synapses. B) preventing the breakdown of neurotransmitters, such as norepinephrine, in the CNS. C) enhancing the effects of monoamine oxidase at the synapse. D) blocking the norepinephrine receptor sites in the CNS. Answer: B Diff: 2 Page Ref: 385 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 13 41) One important distinction with potassium-sparing diuretics over other forms of diuretics is that potassium-sparing diuretics: A) exert their effects early in the nephritic process. B) are more efficient than loop diuretics in sodium and water reabsorption. C) not only decrease sodium reabsorption, they increase potassium reabsorption. D) are so potent that they are rarely used with other diuretics. Answer: C Diff: 2 Page Ref: 409 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 19

42) A major concern during the administration of an alpha agonist is infiltration, because it may cause: A) enhanced systemic effects. B) tissue necrosis. C) excessive bleeding at the site of infiltration. D) cardiac dysrhythmias. Answer: B Diff: 1 Page Ref: 397 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 14 43) Medications best suited for treating bronchoconstriction generally stimulate ________ receptors. A) beta1 B) alpha1 C) beta2 D) alpha2 Answer: C Diff: 2 Page Ref: 416 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 16 44) Types of medications commonly used to relieve symptoms of bronchospasm and decrease inflammation include all of the following, EXCEPT: A) anticholinergics. B) beta2 selective sympathomimetics. C) glucocorticoids. D) expectorants. Answer: D Diff: 2 Page Ref: 416 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 16 45) The chief physiologic effect of nerve gas, such as VX, is to: A) reversibly block the enzyme acetylcholinesterase. B) competitively block the nicotinic receptor sites at the neuromuscular junction. C) competitively block the muscarinic receptor sites at the target organs. D) produce an adrenergic blockade throughout the body. Answer: A Diff: 2 Page Ref: 391 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 14 146 Copyright © 2017 Pearson Education, Inc.

46) When administering glucagon to a patient, it is important to remember that: A) glucagon can be administered only intravenously. B) it is effective only in patients with elevated blood glucose levels. C) glucagon will stimulate glycogenesis in a hypoglycemic patient. D) it increases the rate of gluconeogenesis. Answer: D Diff: 2 Page Ref: 425 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 19 47) The time from when a drug is administered until it reaches the minimum effective concentration is known as the: A) peak action. B) therapeutic interval. C) onset of action. D) duration of action. Answer: C Diff: 1 Page Ref: 370 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 1 48) Sympathetic nervous system stimulation that results in vasoconstriction is most likely affecting: A) beta2 receptor sites. B) alpha1 receptor sites. C) beta1 receptor sites. D) alpha2 receptor sites. Answer: B Diff: 2 Page Ref: 395 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 14 49) Children under one year of age have a ________ plasma protein concentration than older children. Therefore, medications that bind to plasma proteins will have a ________ effect in them. A) greater; greater B) greater; diminished C) lower; greater D) lower; diminished Answer: C Diff: 2 Page Ref: 361 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 7 147 Copyright © 2017 Pearson Education, Inc.

50) While caring for a 60-year-old man with a suspected femur fracture, your partner accidentally administers the full vial of morphine sulfate (15 mg) when only 4 mg was ordered. What adverse effects are likely to occur in this patient? A) Widened QRS and respiratory depression B) Hypotension and tachypnea C) Sedation and hypertension D) Hypotension and respiratory depression Answer: D Diff: 2 Page Ref: 373 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 12 51) In a patient experiencing a myocardial infarction, a medication that reduces afterload is beneficial because it: A) reduces the workload of the heart, reducing myocardial oxygen consumption. B) reduces the blood flow to unnecessary areas, redirecting blood to the heart. C) improves the stroke volume of blood ejected from the heart by also reducing preload. D) prolongs the Q-T interval, thereby allowing time for complete atrial contribution to the ventricles. Answer: A Diff: 3 Page Ref: 413 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 52) A concern for patients taking both insulin and beta-blockers is: A) the two medications, when taken together, have a synergistic effect. B) beta-blockers, due to their sympatholytic effects on the nervous system, can further reduce available ATP to the cells of the body in the presence of insulin. C) beta2 adrenergic blockers can both hide the effects of hypoglycemia, making it difficult to recognize, and decrease the release of glucagon. D) beta-blockers prevent the release of insulin from the beta cells in the pancreas. Answer: C Diff: 2 Page Ref: 426 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 12, 19

53) The narcotic nalbuphine (Nubain) not only binds to opiate receptor sites to provide analgesia, but it also prevents other opioids, such as morphine sulfate, from binding to these sites, lessening respiratory depression. These characteristics make the drug a(n): A) agonist-antagonist. B) competitive antagonist. C) competitive agonist. D) agonist. Answer: A Diff: 2 Page Ref: 368 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 12, 16 54) Which of the following statements about vitamins is NOT true? A) Vitamin D is unique in that it can be produced in the skin by sunlight exposure. B) The liver stores the fat-soluble vitamins; consequently, they will become deficient only after long periods of inadequate vitamin intake. C) The individual B vitamins are named for the order in which they are required by the body. D) The water-soluble vitamins must be routinely ingested, because the body does not store them. Answer: C Diff: 1 Page Ref: 433 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 22 55) Which of the following statements about cough suppressants is TRUE? A) Some cough suppressants contain opioid antitussives that can be habit forming. B) They often include expectorants that reduce the amount of sputum produced. C) They may include mucolytics that greatly diminish sputum production. D) Non-opioid medications are available by prescription only. Answer: A Diff: 2 Page Ref: 419 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 21 56) Teratogenic refers to the: A) effects of a drug on the developing fetus. B) decreased ability of the elderly to metabolize drugs. C) potential of a drug to cause cancer. D) likelihood of multiple births as a drug side effect. Answer: A Diff: 1 Page Ref: 360 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 1 149 Copyright © 2017 Pearson Education, Inc.

57) In the renin-angiotensin-aldosterone system (RAAS), which element is most responsible for widespread vasoconstriction? A) Angiotensin I B) Angiotensinogen C) Angiotensin-converting enzyme (ACE) D) Angiotensin II Answer: D Diff: 2 Page Ref: 410 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 58) Which of the following statements about warfarin (Coumadin) is NOT true? A) It actively breaks down the fibrin network, thereby dissolving formed thrombi. B) It helps treat chronic atrial fibrillation. C) It prevents coagulation by antagonizing the effects of vitamin K. D) It was originally used as rat poison. Answer: A Diff: 2 Page Ref: 415 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 59) Drugs with high abuse potential and no accepted medical benefits are classified as Schedule: A) I. B) II. C) III. D) IV. Answer: A Diff: 1 Page Ref: 357 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 5 60) Benzodiazepines are safer than barbiturates in seizure patients because: A) the effect of benzodiazepines is limited by the amount of endogenous GABA in the CNS. B) benzodiazepines cannot cause hypotension or respiratory depression. C) the therapeutic dose of barbiturates is very close to the lethal dose. D) benzodiazepines cause a counteraction by inducing high levels of dopamine in the CNS. Answer: A Diff: 2 Page Ref: 378 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 13

61) In which class of the Vaughn-Williams classification system of anti-dysrhythmic medications does propranolol belong? A) IA B) IB C) IC D) II Answer: D Diff: 2 Page Ref: 404, 407 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 3, 15 62) Which of the following statements about sodium nitroprusside (Nipride) administration is NOT true? A) Severe hypotension may occur. B) Cyanide poisoning may occur. C) It is given as an intravenous push. D) It must be protected from light. Answer: C Diff: 2 Page Ref: 412 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 63) According to the classifications of the Controlled Substance Act of 1970, an example of a Schedule I drug would be: A) atropine sulfate. B) diazepam. C) heroin. D) morphine sulfate. Answer: C Diff: 2 Page Ref: 357 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 5 64) Which of the following is a statin? A) Lovenox B) Activase C) Zocor D) Questran Answer: C Diff: 2 Page Ref: 416 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 151 Copyright © 2017 Pearson Education, Inc.

65) A college student, in an effort to improve test scores, takes a drug, Intelliboost, which enhances cortical function by increasing dopamine release in the brain. He also is taking a cold remedy, Sneezeless, which inhibits the chemical breakdown of dopamine at all receptor sites. Which of the following best describes the drug interaction? A) Sneezeless potentiates the effects of Intelliboost. B) Sneezeless has a cumulative effect. C) Sneezeless and Intelliboost have a synergistic effect. D) Sneezeless and Intelliboost have an additive effect. Answer: A Diff: 3 Page Ref: 371 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 12 66) Which of the following drugs are often found in both topical and oral nasal decongestants? A) Alpha1 antagonists B) Alpha1 agonists C) Alpha2 agonists D) Beta2 agonists Answer: B Diff: 1 Page Ref: 417 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 16 67) A drug that serves as a sodium channel blocker will have the greatest effect on which phase of ion exchange in the normal, fast-potential cardiac cell? A) 0 B) 1 C) 2 D) 3 Answer: A Diff: 2 Page Ref: 404 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 68) Which statement about levodopa in the treatment of Parkinson's disease is NOT true? A) Levodopa is an effective therapy because it converts to dopamine in the brain. B) Levodopa crosses the blood-brain barrier. C) Levodopa remains an effective therapy throughout the disease. D) Levodopa is often combined with another ingredient to prevent metabolism outside the brain. Answer: C Diff: 1 Page Ref: 386 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 13 152 Copyright © 2017 Pearson Education, Inc.

69) Naloxone is an ________ to opioid receptors. A) agonist B) agonist-antagonist C) antagonist D) analgesic Answer: C Diff: 1 Page Ref: 369 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 11 70) An important physiologic distinction between the sympathetic and parasympathetic divisions of the autonomic nervous system is: A) the sympathetic ganglia are close to the spinal cord. B) only the sympathetic division innervates the target organs or tissue directly. C) the parasympathetic nervous system contains no ganglionic fibers. D) the sympathetic division does not use acetylcholine as a neurotransmitter. Answer: A Diff: 2 Page Ref: 387 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 14 71) You respond to the aid of a 19-year-old patient who is reported to have taken an overdose of a prescribed medication. She exhibits combativeness and severe tremors. Her blood pressure is 160/100 mmHg, and her pulse is 132. Sinus tachycardia appears on her ECG. Which of the following classification of drugs is most likely to cause these symptoms? A) Benzodiazepines B) Amphetamines C) Opiates D) Barbiturates Answer: B Diff: 3 Page Ref: 381 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 22

72) Which class of anti-dysrhythmics characteristically blocks sodium influx during fast potential depolarization? A) I B) II C) III D) IV Answer: A Diff: 2 Page Ref: 404 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 73) With regard to the endocrine system, which of the following statements is NOT true? A) The pituitary gland is often called the "master gland." B) The posterior pituitary hormones are actually synthesized in the hypothalamus. C) The hypothalamus and pituitary glands have no physical link. D) The hypothalamus controls many of the functions of the pituitary gland. Answer: C Diff: 2 Page Ref: 423 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 19 74) A new synthetic narcotic has been developed by the pharmaceutical industry. This drug, called Drug A, has three times the efficacy of an existing synthetic narcotic, Drug B. However, Drug B has twice the affinity for opiate receptor sites in the body as Drug A. Which drug will have the greater effect when administered at the same dosage? A) Drug A B) Drug B C) Identical effects when administered at the same dosage D) Cannot be determined by the information given Answer: A Diff: 3 Page Ref: 368 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 11

75) Part of the reason that tricyclic antidepressants (TCAs) have fallen somewhat out of favor compared with selective serotonin reuptake inhibitors (SSRIs) is because: A) SSRIs have the added advantage of also blocking norepinephrine and dopamine. B) TCA overdoses have a cardiotoxic effect. C) SSRIs have the added advantage of also blocking histamine and acetylcholine. D) TCA overdoses often create a hypertensive crisis in patients. Answer: B Diff: 2 Page Ref: 385 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 12 76) Beta-adrenergic antagonists reduce hypertension through all of the following effects, EXCEPT: A) diminishing reflex tachycardia as a compensatory response. B) suppressing renin release from the kidneys. C) a negative inotropic effect. D) reduction of peripheral vascular resistance through vasodilation. Answer: D Diff: 2 Page Ref: 400 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 77) The relative therapeutic effectiveness of chemically comparable drugs is regarded as the: A) bioassay of the drugs. B) relative efficacy of the drugs. C) bioequivalence. D) therapeutic index. Answer: C Diff: 2 Page Ref: 357 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 1 78) Tachyphylaxis can best be described as: A) an unexpected increase in heart rate as a side effect of a drug. B) an allergic reaction that occurs when a drug is administered for the first time. C) anaphylactoid episodes occurring due to cross-sensitivity. D) rapidly decreasing effects with repeated administration of a drug. Answer: D Diff: 1 Page Ref: 370 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 1

79) Which of the following is NOT typically associated with type 1 diabetes mellitus? A) Juvenile onset B) Inadequate insulin release from the beta cells of the pancreatic islets C) Insulin dependence D) Obesity Answer: D Diff: 1 Page Ref: 425 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 19 80) Which of the following is NOT one of the main sources of drugs? A) Minerals B) Synthetic materials C) Plants D) Animals Answer: A Diff: 1 Page Ref: 355 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 2 81) The acronym SLUDGE helps identify the effects of ________ drugs on the autonomic nervous system. A) sympathomimetic B) sympatholytic C) parasympathomimetic D) parasympatholytic Answer: C Diff: 1 Page Ref: 390 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 14 82) The study of the basic processes that determine the duration and intensity of a drug's effect and how those drugs are absorbed, distributed, biotransformed, and eliminated is called: A) pharmacodynamics. B) drug profiling. C) polypharmacy. D) pharmacokinetics. Answer: D Diff: 1 Page Ref: 357 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 8

83) Treatment of poisoning emergencies may generally consist of any of the following methods, EXCEPT: A) hemodialysis. B) alkalinizing the urine with sodium bicarbonate. C) administering acid solutions to neutralize alkalis in the stomach. D) emptying the stomach. Answer: C Diff: 2 Page Ref: 433-434 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 22 84) An important distinction between analgesics and anesthetics is: A) anesthetics block all sensations. B) anesthetics can be administered only intravenously. C) analgesics produce unconsciousness in high doses. D) analgesics are reversible, whereas anesthetics are not. Answer: A Diff: 1 Page Ref: 375 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 10 85) Your patient, a known alcoholic, has developed a cardiac arrhythmia that you intend to treat with synchronized cardioversion. Because he is awake, you decide to administer diazepam to ease this experience. However, you find that to induce the desired state you must administer more than twice the normal dose of diazepam. This condition is known as: A) cumulative effect. B) cross tolerance. C) tachyphylaxis. D) idiosyncrasy. Answer: B Diff: 2 Page Ref: 370 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 11, 15

86) You are caring for an elderly woman with suspected vertebral fracture secondary to osteoporosis. She frequently takes a hydrocodone-containing preparation (Vicoprofen) for pain. With her current injury, you find it necessary to administer a greater-than-expected dosage of morphine. Why is this higher dosage needed? A) Cross tolerance B) Psychological dependency C) Potentiation D) Synergism Answer: A Diff: 2 Page Ref: 370 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 11, 12 87) Which of the following medications is a loop diuretic? A) Furosemide (Lasix) B) Spironolactone (Aldactone) C) Mannitol (Osmitrol) D) Hydrochlorothiazide (HydroDIURIL) Answer: A Diff: 2 Page Ref: 409-410 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 88) What two components of a drug's profile are taken into consideration when determining what the therapeutic index will be? A) Half-life and lethal dose B) Effective dose and duration of action C) Lethal dose and effective dose D) Bioequivalence and half-life Answer: C Diff: 1 Page Ref: 357 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 4 89) Which of the following is most likely to affect elimination of a medication? A) Burns on more than 30 percent of the body surface area B) Metabolic alkalosis C) Renal disease D) Hemorrhage Answer: C Diff: 2 Page Ref: 361 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 8 158 Copyright © 2017 Pearson Education, Inc.

90) Which of the following is NOT a common side effect of a loop diuretic? A) Orthostatic hypotension B) Hypokalemia C) Hypernatremia D) Reflex tachycardia Answer: C Diff: 2 Page Ref: 408-409 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 91) In which class of the Vaughn-Williams classification system of antidysrhythmic medications does lidocaine belong? A) IA B) IB C) IC D) II Answer: B Diff: 2 Page Ref: 404, 405 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 3, 15 92) Multiple transmitters are involved in the vomiting reflex, including all of the following, EXCEPT: A) norepinephrine. B) acetylcholine. C) dopamine. D) serotonin. Answer: A Diff: 2 Page Ref: 421 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 17 93) The paramedic's chief concern with patients taking sildenafil (Viagra) is: A) agitation and combative behavior. B) profound hypotension. C) acute renal failure. D) uncontrolled hypertension. Answer: B Diff: 1 Page Ref: 428 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 20 159 Copyright © 2017 Pearson Education, Inc.

94) Administration of a nonselective beta-antagonist will most likely result in: A) tachycardia and diaphoresis. B) increased cardiac output. C) bronchoconstriction and inhibited glycogenolysis. D) bradycardia and some bronchodilation. Answer: C Diff: 2 Page Ref: 397 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 95) When treating patients with suspected hypoglycemia, which of the following should be of greatest concern regarding the administration of 50 percent dextrose in water? A) Infiltration of the IV during the drug administration B) The administration of oxygen before any other therapies C) Ensuring that a blood glucose specimen is obtained before administering the drug D) Confirming the patient has a history of diabetes Answer: A Diff: 3 Page Ref: 427 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 19 96) Two drugs that augment or replace posterior pituitary hormones are: A) insulin and glucagon. B) glucagon and vasopressin. C) adenosine and vasopressin. D) oxytocin and antidiuretic hormone. Answer: D Diff: 2 Page Ref: 424 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 19 97) A drug with a wax-like base that melts at body temperature, allowing absorption into body tissue, is called a(n): A) capsule. B) suppository. C) elixir. D) suspension. Answer: B Diff: 1 Page Ref: 367 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 10

98) Which of the following medications is a cardioselective beta-blocker? A) Propranolol B) Atenolol C) Metaproterenol D) Albuterol Answer: B Diff: 2 Page Ref: 400 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 99) The FDA's pregnancy safety designation of Category A for a drug means: A) no adequate animal studies or adequate studies of pregnant women have been done. B) animal studies have demonstrated adverse effects, but there are no adequate studies in pregnant women; benefits may be acceptable despite the potential risks. C) adequate studies in pregnant women have not demonstrated a risk to the fetus in the first trimester or later trimesters. D) fetal risk has been demonstrated, which outweighs any possible benefit to the mother; avoid using in pregnant or potentially pregnant patients. Answer: C Diff: 2 Page Ref: 361 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 6 100) A similarity all laxatives share is that they: A) reduce the molecular bonds of colon contents. B) increase peristalsis via direct stimulation. C) increase bulk in the intestines. D) increase the water content in the colon. Answer: D Diff: 2 Page Ref: 420 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 17 101) Which of the following is NOT associated with the sympathetic nervous system? A) Vagus nerve B) Adrenergic C) Thoracolumbar D) Fight-or-flight response Answer: A Diff: 1 Page Ref: 388 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 14 161 Copyright © 2017 Pearson Education, Inc.

102) An "orphan drug" is best defined as a drug that is: A) in its own chemical classification. B) used specifically to treat a rare disease. C) intended only for the pediatric population. D) not producible as a generic alternative. Answer: B Diff: 1 Page Ref: 354 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 6 103) Hypoparathyroidism leads to decreased: A) calcium levels. B) metabolic rate. C) thyroxine (T4) levels. D) growth hormone levels. Answer: A Diff: 2 Page Ref: 424 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 19 104) Medications instilled directly into the auditory canal to treat ear problems include all of the following, EXCEPT: A) antibacterial agents. B) topical anesthetics. C) anticholinergic agents. D) ceruminolytic agents. Answer: C Diff: 2 Page Ref: 423 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 18 105) Which of the following antihypertensive medications is an angiotensin-converting enzyme (ACE) inhibitor? A) Reserpine (Serpalan) B) Clonidine (Catapres) C) Captopril (Capoten) D) Labetalol (Normodyne) Answer: C Diff: 2 Page Ref: 410 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15

106) One important reason medications are given intravenously is that they: A) bypass the liver initially. B) have minimal effects on the CNS system. C) can be more easily reversed if an untoward effect occurs. D) have a delayed onset of action compared to the oral route. Answer: A Diff: 2 Page Ref: 364 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 9 107) At the cellular level, the treatment of seizures is generally accomplished by ________ the influx of ________ ions into the neural cells. A) enhancing; potassium B) inhibiting; potassium C) inhibiting; sodium and calcium D) enhancing; sodium and calcium Answer: C Diff: 2 Page Ref: 379 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 13 108) Loop diuretics achieve their therapeutic effects by: A) decreasing the absorption of sodium at the glomerulus. B) decreasing the reabsorption of sodium at the ascending loop of Henle. C) enhancing reabsorption throughout the loop of Henle. D) increasing the reabsorption of sodium at the ascending loop of Henle. Answer: B Diff: 2 Page Ref: 408-409 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 109) In which class of the Vaughn-Williams classification system of anti-dysrhythmic medications does verapamil belong? A) IA B) IB C) II D) IV Answer: D Diff: 2 Page Ref: 404, 407 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 3, 15

110) Tricyclic antidepressants achieve their therapeutic effect by: A) prolonging the duration of norepinephrine and serotonin at the receptor sites. B) enhancing degradation of norepinephrine and serotonin at the synapse. C) blocking the release of norepinephrine and serotonin at the synapse. D) blocking the release of acetylcholine at the synapse. Answer: A Diff: 2 Page Ref: 383 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 13 111) Which of the following best explains why many former prescription drugs have become over-the-counter (OTC) drugs? A) Consumers are more aware, and pharmaceutical marketing strategies have improved. B) Many drug actions, once believed to be harmful, have been found to be relatively safe. C) Physicians have lobbied to reduce the number of prescriptions they must write. D) Prescription-only medications are much more expensive to manufacture. Answer: A Diff: 1 Page Ref: 356 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 6 112) What is the assigned schedule number for phenobarbital according to the Controlled Substances Act of 1970? A) I B) II C) III D) IV Answer: D Diff: 2 Page Ref: 357 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 5

113) You are seeing a 69-year-old female patient complaining of fatigue and nausea. She has a history of heart failure and two previous myocardial infarctions. She reports having blurred vision with halos around objects. Her blood pressure is 144/88 mmHg, her pulse is 110 and irregular, and her ventilations are 16. What should you suspect is causing her symptoms? A) Impaired cerebral perfusion secondary to heart failure B) Acute closed-angle glaucoma C) Toxic blood levels of digoxin D) Cerebral embolus secondary to atrial fibrillation Answer: C Diff: 3 Page Ref: 412 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 12, 15 114) Benzodiazepines and barbiturates achieve their sedation effects by ________ in the CNS. A) enhancing the GABA receptor sites B) depolarizing the neural membranes C) blocking the GABA receptor sites D) blocking the dopaminergic receptor sites Answer: A Diff: 2 Page Ref: 378 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 13 115) Which of the following medications prevents coagulation by antagonizing the effects of vitamin K? A) Streptokinase (Streptase) B) Heparin C) Aspirin D) Warfarin (Coumadin) Answer: D Diff: 2 Page Ref: 415 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 116) Propranolol (Inderal) causes a ________ effect. A) positive chronotropic B) negative chronotropic C) positive dromotropic D) positive inotropic Answer: B Diff: 2 Page Ref: 397, 400 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 14 165 Copyright © 2017 Pearson Education, Inc.

117) All of the following changes in the geriatric patient affect the pharmacokinetics of a medication, EXCEPT: A) decreased gastrointestinal motility. B) depressed liver function that may prolong drug action. C) increased body fat and decreased muscle mass. D) uncompromised renal function. Answer: D Diff: 1 Page Ref: 361 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 7, 8 118) Physostigmine (Antilirium) is a useful antidote for which drug overdose? A) Atropine B) Dopamine C) Norepinephrine D) Epinephrine Answer: A Diff: 2 Page Ref: 391 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 22 119) Which of the following foods should a patient on MAOIs avoid? A) Cheese B) White wine C) Chocolate D) Bananas Answer: A Diff: 2 Page Ref: 385 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 12 120) Shortly after you have treated a patient who was experiencing a cardiac dysrhythmia, the patient complains of dry mouth, blurred vision, palpitations, and sensitivity to light. Which of the following drugs is most likely to cause these effects? A) Adenosine B) Lidocaine C) Amiodarone D) Atropine Answer: D Diff: 2 Page Ref: 386-387 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 166 Copyright © 2017 Pearson Education, Inc.

121) Which of the following medications is a proton-pump inhibitor? A) Cimetidine (Tagamet) B) Omeprazole (Prilosec) C) Pirenzepine (Gastrozepine) D) Ranitidine (Zantac) Answer: B Diff: 2 Page Ref: 420 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 17 122) When a drug causes a change in the cell membrane, preventing additional stimulation of the cell no matter how much stimulation is offered, that drug is called a: A) competitive agonist. B) competitive antagonist. C) noncompetitive antagonist. D) noncompetitive agonist. Answer: C Diff: 2 Page Ref: 369 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 11 123) In the treatment of acute glaucoma, which classifications of drugs are most useful? A) Alpha agonists and anticholinergics B) Beta agonists and anticholinergics C) Anticholinergics and beta blockers D) Beta-blockers and cholinergics Answer: D Diff: 2 Page Ref: 421 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 18 124) Fibrinolytics achieve their therapeutic action by: A) interfering with the clotting cascade. B) breaking up a thrombus that has formed. C) blocking the conversion of plasminogen to plasmin. D) decreasing platelet aggregation. Answer: B Diff: 1 Page Ref: 415 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15

125) Which of the following is a property of a reversible cholinesterase inhibitor? A) Enables parasympathetic stimulation for a finite period B) Blocks sympathetic stimulation for a finite period C) Blocks parasympathetic stimulation for a finite period D) Enables sympathetic stimulation for a finite period Answer: A Diff: 3 Page Ref: 391 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 14 126) Symptoms of hyperthyroidism include all of the following, EXCEPT: A) nervousness. B) bradycardia. C) insomnia. D) hypertension. Answer: B Diff: 2 Page Ref: 424 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 19 127) Stimulation of the histamine (H1) receptors often results in: A) vasodilation and increased vascular permeability. B) increased gastric acid release. C) inhibition of antibody production. D) bronchodilation. Answer: A Diff: 2 Page Ref: 418 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 21 128) A beta2 specific agonist causes which of the following physiologic responses? A) Bronchodilation B) Bronchoconstriction C) Decreased heart rate D) Increased heart rate Answer: A Diff: 2 Page Ref: 396 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 21

129) You are caring for a 45-year-old male patient who was tending to his fruit orchard when he suddenly developed headache, dizziness, blurred vision, and tremors. You note that he was incontinent of urine, has pupillary constriction, and is salivating excessively. Which of the following medications would be most appropriate to manage this patient? A) Atropine B) Physostigmine C) Diazepam D) Ipratropium bromide Answer: A Diff: 3 Page Ref: 391 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 22 130) If a newly developed drug is undergoing a double-blind study in a large patient population, it is most likely undergoing what phase of human studies? A) 1 B) 2 C) 3 D) 4 Answer: C Diff: 1 Page Ref: 358 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 6 131) Which of the following statements about histamines and antihistamines is NOT true? A) A chief side effect of antihistamines is sedation. B) Stimulation of the H1 histamine receptors plays a major role in the development of anaphylaxis. C) Although asthma attacks can be caused by allergens, antihistamines should not be administered as a treatment. D) There are antagonists for both H1 and H2 histamine receptor sites. Answer: B Diff: 2 Page Ref: 418 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 21

132) Medications to treat extrapyramidal side effects from antipsychotic medications, as well as drugs used to treat Parkinson's disease, achieve their therapeutic effects by: A) enhancing the effects of acetylcholine, an inhibitory neurotransmitter, in the basal ganglia. B) blocking the release of dopamine from the substantia nigra in the basal ganglia. C) blocking the transmission of neural impulses through the pyramidal decussation of the brain. D) increasing the amount of dopamine at the receptor sites in the basal ganglia. Answer: D Diff: 2 Page Ref: 386 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 13 133) Which of the following is an acceptable antidote for a specific poisoning? A) Acetylcysteine (Mucomyst) for acetaminophen overdose B) Sodium bicarbonate for muriatic acid ingestion C) Amyl nitrite, sodium nitrite, and sodium thiosulfate for organophosphate exposure D) Naloxone for diazepam overdose Answer: A Diff: 2 Page Ref: 434 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 22 134) Which of the following is NOT a characteristic of nifedipine (Procardia)? A) It has little effect on preload, so orthostatic hypotension is not a problem. B) Reduction of blood pressure is accomplished by reducing the peripheral vascular resistance. C) It effectively dilates the coronary arteries. D) It produces a positive inotropic effect on the heart. Answer: D Diff: 2 Page Ref: 410 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 135) What distinguishes verapamil (Calan, Isoptin) and diltiazem (Cardizem) from nifedipine (Procardia)? A) Verapamil and diltiazem are calcium channel blockers, whereas nifedipine is not. B) Verapamil and diltiazem reduce SA and AV node conductivity. C) Nifedipine can be used only to treat anginal episodes. D) Only nifedipine causes smooth muscle relaxation. Answer: B Diff: 2 Page Ref: 413 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15

136) Dopamine is not administered directly to the patient during the treatment of Parkinson's disease because: A) dopamine is not a therapeutic consideration; only acetylcholine replacement therapy is. B) dopamine cannot cross the blood-brain barrier. C) the half-life of dopamine is too short to enable pharmacologic effects in the brain. D) the type of dopamine necessary in the brain is different from the type administered intravenously. Answer: B Diff: 2 Page Ref: 386 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 13 137) Which of the following statements about nitroglycerin is NOT true? A) Nitroglycerin achieves its therapeutic effects by blocking the entry of calcium into the cells of smooth muscle. B) Nitroglycerin is poorly lipid soluble, which prevents it from passing through cell membranes, thereby prolonging its effects. C) Nitroglycerin primarily dilates veins and coronary vessels. D) Nitroglycerin commonly causes headache and orthostatic hypotension. Answer: B Diff: 2 Page Ref: 413 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 138) You are caring for a middle-aged male patient who has a long history of psychiatric disorders. During your assessment, you note excessive tremors and uncontrollable spasms in his head, neck, and arms. These are most likely: A) manifestations of his psychotic illness. B) extrapyramidal side effects of his antipsychotic medication. C) complex partial (or psychomotor) seizures. D) drug interactions produced by antihypertensive medications and diuretics. Answer: B Diff: 3 Page Ref: 382 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 13

139) You are caring for a young mother who just gave birth to her first child. Despite taking all the appropriate measures, she continues to exhibit postpartum hemorrhage. In addition to crystalloid intravenous infusions, what medication might you consider to manage this patient? A) Terbutaline (Brethine) B) Oxytocin (Pitocin) C) Epinephrine infusion D) Dopamine (Intropin) infusion Answer: B Diff: 2 Page Ref: 427 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 7, 20 140) Which of the following medications promotes the conversion of plasminogen to plasmin? A) rtPA B) Heparin C) Coumadin D) Vitamin K Answer: A Diff: 1 Page Ref: 415 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 141) Which of the following medications is appropriate for the routine treatment of type 2 diabetes mellitus? A) Ultralente insulin B) Chlorpropamide (Diabinese) C) Glucagon D) NPH insulin Answer: B Diff: 2 Page Ref: 426 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 19 142) As antiemetics, phenothiazines (Compazine, Phenergan) have which of the following undesirable side effects? A) Extrapyramidal effects and sedation B) Headache and diarrhea C) Hallucinations D) Euphoria Answer: A Diff: 1 Page Ref: 421 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 17 172 Copyright © 2017 Pearson Education, Inc.

143) Which of the following drug names are the same? A) Brand and trade B) Chemical and generic C) Chemical and trade D) Proprietary and official Answer: A Diff: 1 Page Ref: 354 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 2 144) Oxytocin is frequently used in the prehospital setting to: A) control seizures from eclampsia of pregnancy. B) stop preterm labor contractions. C) help control postpartum hemorrhage. D) facilitate labor and induce delivery. Answer: C Diff: 2 Page Ref: 427 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 7, 20 145) The pharmacological effects of administering insulin to a hyperglycemic patient is an example of increased: A) biotransformation. B) carrier-mediated diffusion. C) passive transport. D) transference. Answer: B Diff: 2 Page Ref: 362 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 8 146) Digoxin is prescribed to patients with congestive heart failure primarily to: A) improve myocardial contractility and cardiac output. B) improve blood flow to the lungs, thereby reducing pulmonary edema. C) achieve a negative chronotropic effect and thereby reduce the myocardial workload. D) control rapid ventricular rates, because many of these patients also have atrial fibrillation. Answer: A Diff: 2 Page Ref: 408 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15

147) What is the drug of choice when treating patients having generalized motor (grand mal) seizures? A) Lithium B) Romazicon C) Valproic acid D) Dilantin Answer: D Diff: 2 Page Ref: 379 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 13 148) Which of the following is NOT associated with the parasympathetic division of the autonomic nervous system? A) Thoracolumbar B) Craniosacral C) Vagal tone D) Cholinergic Answer: A Diff: 1 Page Ref: 388 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 14 149) Phase 0 of cardiac cell depolarization in the fast potentials is characterized by rapid: A) Efflux of Na+ B) Influx of Na+ C) Efflux of Ca++ D) Influx of Ca++ Answer: B Diff: 2 Page Ref: 403 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 150) The term oxytocin means: A) uterine contraction. B) rapid birth. C) uterine relaxation. D) none of the above. Answer: B Diff: 1 Page Ref: 427 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 7, 20

151) You are caring for a 48-year-old patient with acute onset pulmonary edema secondary to an acute myocardial infarction. He has rales (crackles) in both lung fields and wheezes in the bronchial regions. His blood pressure is 160/90 mmHg, his pulse is 112, and his ventilations are 32. Which of the following medications is indicated FIRST, and why? A) Nitroglycerin (Nitrostat) to vasodilate the coronary vessels to maximize myocardial oxygen supply B) Furosemide (Lasix) to achieve a diuresis and remove a portion of fluids from the intravascular space C) Nitroglycerin (Nitrostat) to reduce preload and afterload to redistribute fluids to the periphery D) Morphine sulfate to decrease anxiety and reduce afterload Answer: C Diff: 3 Page Ref: 413 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 152) Which of the following medications will have the greatest impact on reducing stroke volume? A) Furosemide B) Dobutamine C) Dopamine D) Digoxin Answer: A Diff: 2 Page Ref: 408 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 153) Sildenafil (Viagra) achieves its therapeutic action in the treatment of erectile dysfunction by: A) enhancing neuronal stimulation of the amygdala in the brain. B) stimulating parasympathetic receptors in the nerve fibers leading to the sexual organs. C) stimulating sympathetic receptors in the nerve fibers leading to the sexual organs. D) relaxing vascular smooth muscle, which increases blood flow to the corpus cavernosum. Answer: D Diff: 2 Page Ref: 428 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 20

154) A prolonged deficiency of vitamin C may result in: A) pernicious anemia. B) increased bleeding. C) kwashiorkor. D) scurvy. Answer: D Diff: 1 Page Ref: 434 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 22 155) Which of the following statements about bronchial asthma is TRUE? A) The nonselective sympathomimetics continue to be the most popular treatments for mild to moderate asthma attacks. B) Prednisolone and methylprednisolone should be reserved for only the most severe asthma attacks. C) People with bronchial asthma maintain symptom-free lifestyles with daily treatments of propranolol. D) Ipratropium (Atrovent) is often added to beta-agonists to treat bronchospasm because it works through a different mechanism from beta agonists to relax bronchial smooth muscle. Answer: D Diff: 2 Page Ref: 392 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 16 156) Which of the following pharmacokinetic processes would be LEAST affected by the hypotensive state of a patient in cardiogenic shock? A) Absorption B) Distribution C) Biotransformation D) Elimination Answer: C Diff: 3 Page Ref: 365 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 8

157) If a drug were to block the nicotinic receptors at the neuromuscular junction, what symptomatic effect might this have on the patient? A) Inability to move voluntary and involuntary muscles B) Decrease in heart rate C) Increase in gastric motility D) Pupillary constriction Answer: A Diff: 2 Page Ref: 434 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 14 158) Which of the following best describes the cardiovascular effects of calcium channel blockers, such as verapamil (Calan) and diltiazem (Cardizem)? A) Increased peripheral vascular resistance, widened QRS, and increased afterload B) Increased heart rate and stroke volume, decreased afterload C) Decreased peripheral vascular resistance, widened QRS, and increased afterload D) Decreased automaticity and decreased AV node conductivity Answer: D Diff: 2 Page Ref: 413 Standard: Pharmacology (Principles of Pharmacology) and Pharmacology (Emergency Medications) Objective: 15 159) What is a method of determining the concentration, activity, or effect of a change to a substance by testing its effect on a living organism and comparing this with the activity of an agreed standard? A) Bioassay B) Idiosyncrasy C) Adverse effect D) Potentiation Answer: A Diff: 1 Page Ref: 357 Standard: Pharmacology (Emergency Medications) Objective: 1 160) Normally, taken alone, neither substance would cause serious harm, but if taken together, the combination could cause coma or death. This is an example of: A) synergism. B) efficacy. C) duration of action. D) summation. Answer: A Diff: 1 Page Ref: 370 Standard: Pharmacology (Emergency Medications) Objective: 12 177 Copyright © 2017 Pearson Education, Inc.

161) Which of the following is NOT a source of a drug? A) Vegetable B) Mineral C) Animal D) Microorganism Answer: A Diff: 1 Page Ref: 355 Standard: Pharmacology (Emergency Medications) Objective: 2 162) The chemical analysis of the strength, purity, and effectiveness of a drug is termed a(n): A) assay. B) formulary. C) bioassay. D) teratogen. Answer: A Diff: 1 Page Ref: 357 Standard: Pharmacology (Emergency Medications) Objective: 1 163) Where in the body are the parasympathetic ganglia located? A) Near the target organ B) Near the brainstem C) Near the spinal cord D) Near the sacrum Answer: A Diff: 1 Page Ref: 387 Standard: Pharmacology (Emergency Medications) Objective: 14 164) Nicotinic receptors are found on all of the following, EXCEPT: A) cholinergic and adrenergic preganglionic neurons. B) cholinergic and adrenergic postganglionic neurons. C) spinal cord neurons. D) skeletal muscle. Answer: A Diff: 1 Page Ref: 391 Standard: Pharmacology (Emergency Medications) Objective: 16

165) What is a process in which a cell may decrease the number of receptors exposed to a particular substance to reduce its sensitivity? A) Down-regulation B) Resourcing C) Up-regulation D) Adaptation Answer: A Diff: 1 Page Ref: 368 Standard: Pharmacology (Emergency Medications) Objective: 1 166) Which of the following cranial nerves is NOT part of the parasympathetic system? A) VI B) III C) VII D) IX Answer: A Diff: 1 Page Ref: 388 Standard: Pharmacology (Emergency Medications) Objective: 14 167) Which of the following is NOT a factor that affects drug absorption? A) Metabolism rate B) Dosage form C) Drug solubility D) pH Answer: A Diff: 1 Page Ref: 371 Standard: Pharmacology (Emergency Medications) Objective: 8 168) What type of drugs are lipid soluble and readily diffuse across a cell membrane? A) Nonionized B) Isotonic C) Ionized D) Hypertonic Answer: A Diff: 1 Page Ref: 365 Standard: Pharmacology (Emergency Medications) Objective: 8

169) What is the process of chemically converting drugs into metabolites? A) Biotransformation B) Excretion C) Distribution D) Absorption Answer: A Diff: 1 Page Ref: 357 Standard: Pharmacology (Emergency Medications) Objective: 1 170) What is the term for the ability of a drug to initiate biological activity as a result of binding to a receptor site? A) Efficacy B) Affinity C) Agonism D) Antagonism Answer: A Diff: 1 Page Ref: 368 Standard: Pharmacology (Emergency Medications) Objective: 1 171) What is the term for the time the body takes to clear one-half of a drug from the body? A) Half-life B) Therapeutic level C) Optimum dose D) Duration of action Answer: A Diff: 1 Page Ref: 370 Standard: Pharmacology (Emergency Medications) Objective: 11 172) Variables to consider when determining the proper method of drug storage include all of the following, EXCEPT: A) potency. B) temperature. C) light. D) moisture. Answer: A Diff: 1 Page Ref: 367 Standard: Pharmacology (Emergency Medications) Objective: 10

Chapter 14 Intravenous Access and Medication Administration 1) The maximum volume of medication to be delivered into the deltoid muscle is ________ mL. A) 3 B) 1 C) 2 D) 5 Answer: C Diff: 1 Page Ref: 466 Standard: Pharmacology (Medication Administration) Objective: 7 2) Using microdrip IV tubing, how many drops of fluid equal 1 mL? A) 60 B) 10 C) 20 D) 15 Answer: A Diff: 1 Page Ref: 472 Standard: Pharmacology (Medication Administration) Objective: 11 3) Which of the following is a disadvantage of pulmonary drug administration via nebulizer or metered dose inhaler? A) It requires a larger dose than other routes. B) It requires the patient to have adequate ventilation. C) Pulmonary absorption is a slow route for drug administration. D) Side effects are more likely with pulmonary drug administration. Answer: B Diff: 2 Page Ref: 452 Standard: Pharmacology (Medication Administration) Objective: 6 4) A plastic or glass container with a self-sealing rubber top is known as a(n): A) vial. B) blister pack. C) ampule. D) prefilled syringe. Answer: A Diff: 1 Page Ref: 460 Standard: Pharmacology (Medication Administration) Objective: 1

5) Your patient weighs 22 pounds and is to receive 0.02 mg/kg of atropine IV push. You have a multidose vial of atropine containing 20 mL at a concentration of 0.04 mg/mL. What volume (in mL) of medication is to be injected? A) 0.5 B) 2.5 C) 0.25 D) 5 Answer: D Diff: 3 Page Ref: 505 Standard: Pharmacology (Medication Administration) Objective: 21 6) Which of the following types of medication would be placed in a soufflé cup for administration to a patient? A) Suppository B) Powder C) Syrup D) Tablet Answer: D Diff: 1 Page Ref: 453-454 Standard: Pharmacology (Medication Administration) Objective: 7 7) Which of the following is a disadvantage to intravascular volume replacement with isotonic crystalloid solutions? A) Two-thirds of the volume leaves the intravascular space within 1 hour. B) Intracellular fluid shifts to the vascular space. C) Sodium shifts into cells, and potassium shifts out of cells. D) There is an immediate shift of vascular volume to the interstitial space. Answer: A Diff: 2 Page Ref: 471 Standard: Pharmacology (Medication Administration) Objective: 8 8) A liquid preparation that contains small particles of a solid medication is known as a(n): A) suspension. B) elixir. C) syrup. D) reconstituted medication. Answer: A Diff: 1 Page Ref: 453 Standard: Pharmacology (Medication Administration) Objective: 1

9) Which of the following is appropriate for a subcutaneous injection of medication? A) Volume of 1 mL or less B) 18 gauge, ¾ʺ needle C) Insertion of the needle at a 90-degree angle D) Up to 2 mL of medication Answer: A Diff: 2 Page Ref: 465 Standard: Pharmacology (Medication Administration) Objective: 7 10) When preparing for venipuncture, a constricting band should be applied tight enough to restrict ________ flow. A) venous but not arterial B) arterial but not venous C) neither arterial nor venous D) both arterial and venous Answer: A Diff: 2 Page Ref: 476 Standard: Pharmacology (Medication Administration) Objective: 13 11) Your protocols call for a dopamine infusion beginning at 5 micrograms per kilogram per minute. You estimate that your patient weighs 190 pounds. Using a standard dopamine concentration of 800 mg in 500 mL, at what drip rate (in drops/minute) will you need to administer the infusion using microdrip tubing? A) 27 B) 432 C) 4 D) 16 Answer: D Diff: 3 Page Ref: 506 Standard: Pharmacology (Medication Administration) Objective: 21 12) Which of the following is considered a site of central venous access? A) Femoral vein B) Median cephalic vein C) External jugular vein D) Saphenous vein Answer: A Diff: 1 Page Ref: 470 Standard: Pharmacology (Medication Administration) Objective: 9

13) Which of the following is the appropriate method for preparing a site for venipuncture or injection? A) Chemical sterilization B) Use of a disinfectant C) Use of an antiseptic D) Use of a sanitizer Answer: C Diff: 1 Page Ref: 476 Standard: Pharmacology (Medication Administration) Objective: 13 14) A solid disk of compressed medicated powder, which may be scored to permit breaking, is known as a: A) suppository. B) capsule. C) tablet. D) lozenge. Answer: C Diff: 1 Page Ref: 453 Standard: Pharmacology (Medication Administration) Objective: 1 15) Into which of the following containers would it be necessary to inject a volume of air equal to the intended volume of medication before withdrawing the medication with a needle and syringe? A) Ampule B) Vial C) Nebulizer D) Prefilled syringe Answer: B Diff: 1 Page Ref: 460-461 Standard: Pharmacology (Medication Administration) Objective: 7 16) Administration of medication into the dorsal gluteal muscle must be injected into which quadrant of the muscle? A) Upper inner B) Upper outer C) Lower outer D) Lower inner Answer: B Diff: 1 Page Ref: 467 Standard: Pharmacology (Medication Administration) Objective: 6

17) Which of the following would NOT be appropriate for intradermal drug administration? A) 27 gauge, 3/8ʺ needle B) 20 gauge, 3/4ʺ needle C) 25 gauge, 1ʺ needle D) 25 gauge, 3/4ʺ needle Answer: B Diff: 2 Page Ref: 463 Standard: Pharmacology (Medication Administration) Objective: 6 18) By which of the following routes will medication have the quickest onset of action? A) Intramuscular B) Subcutaneous C) Oral D) Intradermal Answer: A Diff: 1 Page Ref: 465-466 Standard: Pharmacology (Medication Administration) Objective: 6 19) Your patient is a 46-year-old with a history of pancreatitis. He has had abdominal pain and vomiting for 24 hours. The ED physician requests that you initiate an IV for rehydration. You will be using a 15 drops/mL infusion set to administer 250 mL of 5 percent dextrose in 0.9 percent NS per hour. What drip rate (at drops/minute) is needed to deliver the fluids at this rate? A) 41 B) 63 C) 75 D) 100 Answer: B Diff: 3 Page Ref: 507 Standard: Pharmacology (Medication Administration) Objective: 21 20) You are to give your patient 50 mg of ketorolac (Toradol) IM for musculoskeletal pain. Ketorolac is supplied 60 mg/2 mL. What volume of drug (in mL) is to be drawn up for administration? A) 0.17 B) 1.7 C) 17 D) 170 Answer: B Diff: 2 Page Ref: 505 Standard: Pharmacology (Medication Administration) Objective: 21

21) Which of the following is NOT a percutaneous route of medication administration? A) Buccal B) Sublingual C) Transdermal D) Inhalation Answer: D Diff: 1 Page Ref: 447 Standard: Pharmacology (Medication Administration) Objective: 6 22) What is the preferred access site for intraosseous infusion in both pediatric and adult patients? A) Distal tibia B) Proximal humerus C) Distal femur D) Proximal tibia Answer: D Diff: 2 Page Ref: 495 Standard: Pharmacology (Medication Administration) Objective: 20 23) Having a patient swallow a tablet of medication with a drink of water is an example of which route of medication administration? A) Buccal B) Sublingual C) Aural D) Oral Answer: D Diff: 1 Page Ref: 454 Standard: Pharmacology (Medication Administration) Objective: 7 24) Which of the following intravenous solutions would remain in the vascular system the longest? A) Plasmanate B) 5 percent dextrose in water C) 0.9 percent sodium chloride D) Lactated Ringer's solution Answer: A Diff: 2 Page Ref: 470 Standard: Pharmacology (Medication Administration) Objective: 10

25) Your patient is having a cholecystectomy this evening. To prevent dehydration, she is to receive 5 percent dextrose in 0.45 percent saline solution at a rate of 150 mL/hour. Using 20 drops/mL tubing, what is the drip rate in drops/minute? A) 150 B) 75 C) 60 D) 50 Answer: D Diff: 3 Page Ref: 506-507 Standard: Pharmacology (Medication Administration) Objective: 21 26) Your patient is experiencing right lower quadrant pain following a syncopal episode. She reports that her last menstrual period (LMP) was about six weeks ago. While she is awaiting an abdominal CT, the surgery resident asks that you initiate an IV of lactated Ringer's solution using a blood set (10 drops/mL) and infuse 1 liter over 1 hour. What drip rate (in drops/minute) will you use to attain this rate of administration? A) 17 B) 600 C) 67 D) 167 Answer: D Diff: 3 Page Ref: 506-507 Standard: Pharmacology (Medication Administration) Objective: 21 27) Shortly after starting an IV on your patient, you note that the IV is not dripping. You have removed the constricting band, and all the clamps on the tubing are open. You note that there is minor swelling around the venipuncture site. There is no discoloration of the site, but it is cool and firm to the touch. Which of the following most likely accounts for your findings? A) The site has become infected. B) The tip of the catheter is occluded by a blood clot. C) Fluids extravasated into the tissue surrounding the IV site. D) The tip of the catheter is occluded by a valve in the vein. Answer: C Diff: 2 Page Ref: 483 Standard: Pharmacology (Medication Administration) Objective: 14

28) Which of the following is an advantage of sublingual drug administration? A) Uniform absorption through the conjunctival mucosa B) Rapid absorption due to sublingual vasculature C) Slow rate of drug absorption D) Rapid dissolution of tablets so the medication can be swallowed Answer: B Diff: 2 Page Ref: 448 Standard: Pharmacology (Medication Administration) Objective: 6 29) Which of the following catheters would allow the greatest volume of fluid to be delivered in a given period? A) 16 gauge, 2ʺ B) 14 gauge, ʺ C) 16 gauge,

D) 14 gauge, 2ʺ Answer: B Diff: 2 Page Ref: 476 Standard: Pharmacology (Medication Administration) Objective: 11 30) Which of the following is a parenteral route of drug administration? A) Gastric tube B) Oral C) Intramuscular D) Rectal Answer: C Diff: 1 Page Ref: 463 Standard: Pharmacology (Medication Administration) Objective: 1 31) Administration of a medication to the right eye would be documented medically as: A) o.d. B) o.u. C) o.s. D) o.g. Answer: A Diff: 1 Page Ref: 449 Standard: Pharmacology (Medication Administration) Objective: 7

32) Which of the following solutions is appropriate for the patient needing vascular volume replacement in the prehospital setting? A) 0.9 percent sodium chloride solution B) Dextran 40 C) 5 percent dextrose in water D) 0.45 percent sodium chloride and 5 percent dextrose in water Answer: A Diff: 2 Page Ref: 472 Standard: Pharmacology (Medication Administration) Objective: 10 33) Which of the following veins is NOT a site of peripheral venous access? A) Subclavian B) Median basilic C) Saphenous D) External jugular Answer: A Diff: 1 Page Ref: 470 Standard: Pharmacology (Medication Administration) Objective: 13 34) Which of the following is NOT a pulmonary route of medication administration? A) Inhalation of aerosolized medications B) Instillation of liquid medications into an endotracheal tube C) Nasal drops and sprays D) Nebulization of liquid medications by pressurized air Answer: C Diff: 1 Page Ref: 450 Standard: Pharmacology (Medication Administration) Objective: 6 35) Which of the following is a contraindication to intraosseous needle placement? A) Establishment of a peripheral IV line B) Development of a pulmonary embolism C) Too large a needle or forceful insertion D) Long-term growth complications and swelling Answer: A Diff: 1 Page Ref: 500 Standard: Pharmacology (Medication Administration) Objective: 20

36) Just as you are arriving at the emergency department bay, your patient, on whom you started an IV at the scene, complains of sudden chills, back pain, and nausea. The patient appears flushed, and his skin is hot and moist to the touch. Which of the following most likely accounts for your patient's presentation? A) Pulmonary thromboembolism B) Pyrogenic reaction C) Circulatory overload D) Anaphylaxis Answer: B Diff: 2 Page Ref: 482 Standard: Pharmacology (Medication Administration) Objective: 14 37) Which of the following is NOT a route for enteral medication administration? A) Buccal B) Oral C) Rectal D) Gastric Answer: A Diff: 1 Page Ref: 453 Standard: IV Access and Medication Administration Objective: 6 38) Which of the following is a medication that, when inserted into a body opening, dissolves into the surrounding mucosa? A) Suppository B) Ointment C) Liniment D) Enteric-coated capsule Answer: A Diff: 1 Page Ref: 457 Standard: IV Access and Medication Administration Objective: 1 39) What is defined as the removal or destruction of disease-causing organisms or infected material by using hygienic measures, cleaning agents, antiseptics and/or disinfectants? A) Medical asepsis B) Sterilization C) Cauterization D) Standard Precautions Answer: A Diff: 1 Page Ref: 445 Standard: IV Access and Medication Administration Objective: 5

40) What must be done to the concentration of a medication if it is given endotracheally? A) 2 to 2.5 times normal IV dose B) 1.5 times normal IV dose C) Same as IV dose D) 3 times the IV dose Answer: A Diff: 1 Page Ref: 452 Standard: IV Access and Medication Administration Objective: 16 41) Which of the following sites on the body is NOT used for an intradermal injection? A) Abdomen B) Upper back C) Upper chest D) Inside of middle forearm Answer: B Diff: 1 Page Ref: 463 Standard: IV Access and Medication Administration Objective: 6 42) What cleaning supply is toxic to living tissue and used on nonliving surfaces or objects? A) Disinfectant B) Antiseptic C) Soap D) Gel Answer: A Diff: 1 Page Ref: 446 Standard: IV Access and Medication Administration Objective: 4 43) What is a small, sterile glass or plastic container that usually contains a single dose of a solution? A) Ampule B) Vial C) MDI D) Mix-O-Vial Answer: A Diff: 1 Page Ref: 458-459 Standard: IV Access and Medication Administration Objective: 1

44) After administering a medication by the nasogastric or orogastric tube, how much fluid should you flush with? A) 50 mL B) 20 mL C) 30 mL D) 10 mL Answer: A Diff: 1 Page Ref: 456 Standard: IV Access and Medication Administration Objective: 6 45) The intranasal route of drug administration can be used for which of the following? A) Analgesia B) Antiarrhythmic C) Aural application D) Airway constriction Answer: A Diff: 1 Page Ref: 449 Standard: IV Access and Medication Administration Objective: 6 46) What is the MOST common catheter used in prehospital IV starts? A) Over-the-needle B) Plastic C) Hollow-needle D) Butterfly set Answer: A Diff: 1 Page Ref: 475 Standard: IV Access and Medication Administration Objective: 9 47) Dislodgement of the catheter from the vein, puncture of the distal vein wall during venipuncture, and/or a poorly secured IV can lead to what? A) Extravasation B) Speed shock C) Venous spasm D) Septic shock Answer: A Diff: 1 Page Ref: 481 Standard: IV Access and Medication Administration Objective: 14

48) What is the name of the needle used to access an implanted port? A) Huber B) Portacath C) Broviac D) Hickman Answer: A Diff: 1 Page Ref: 489 Standard: IV Access and Medication Administration Objective: 9 49) How do you calculate the administration of a specific amount of drug via infusion, based on weight? A) Dose ordered × total volume of bag used × drip factor of IV tubing × weight in kg/total amount of drug dissolved within the bag B) Dose ordered × total volume of bag used × drip factor of IV tubing/total amount of drug dissolved within the bag C) Dose ordered × total volume of the drug container/total amount of drug dissolved within the fluid D) Dose ordered × total volume of the drug container × weight in kg/total amount of drug dissolved within the fluid Answer: A Diff: 1 Page Ref: 506 Standard: IV Access and Medication Administration Objective: 21 50) When a patient requires occasional medications or IV drips but does NOT need a continuous infusion, which device might be implanted into a patient? A) Saline lock B) IV piggyback C) Through-the-needle catheter D) Constriction needle Answer: A Diff: 1 Page Ref: 487 Standard: IV Access and Medication Administration Objective: 16 51) Which of these procedures does NOT require a constricting band? A) External jugular IV insertion B) Peripheral IV insertion C) Cephalic vein IV insertion D) Basilic vein IV insertion Answer: A Diff: 1 Page Ref: 478 Standard: IV Access and Medication Administration Objective: 13

52) Which of the following is a crystalloid solution? A) Normal saline B) Dextran C) Plasmanate D) Hespan Answer: A Diff: 1 Page Ref: 471 Standard: IV Access and Medication Administration Objective: 10 53) Which of these is NOT one of the six rights of drug administration? A) Right person B) Right dose C) Right distribution D) Right documentation Answer: C Diff: 1 Page Ref: 444 Standard: IV Access and Medication Administration Objective: 2 54) Paramedics administer some medications under direct authorization from the medical director, and some under: A) Standard Precautions. B) administration tubing. C) blood tubing. D) standing orders. Answer: D Diff: 1 Page Ref: 444 Standard: IV Access and Medication Administration Objective: 3 55) In an over-the-needle catheter, which of the following slides over the metal stylet into a successfully punctured vein? A) metal chamber B) hub C) flashback chamber D) Teflon catheter Answer: D Diff: 1 Page Ref: 475 Standard: IV Access and Medication Administration Objective: 12

56) Which of the following gives you greater control over medication delivery and allows you to easily discontinue the infusion when therapy is complete or must be stopped? A) piggybacking IV infusions through an existing intravenous line B) establishing a primary IV line and ensuring patency C) inserting the hypodermic needle into the medication port and injecting the medication D) confirming the medication, indication, dosage, and need for an IV bolus Answer: A Diff: 1 Page Ref: 485 Standard: IV Access and Medication Administration Objective: 15 57) Which of the following are gravity-flow devices that regulate the fluid’s passage through the pump? A) infusion pumps B) infusion controllers C) ultrasound-guided intravenous access devices D) blood tubes Answer: B Diff: 1 Page Ref: 490 Standard: IV Access and Medication Administration Objective: 17 58) With regard to placing peripheral intravenous lines with an ultrasound device, which of the following is NOT a correct statement about arteries and veins? A) Veins collapse easily and completely when gentle pressure is applied with the transducer. B) Arteries will not collapse completely, although slight compression of artery walls can be seen. C) Color-flow Doppler and pulsed-wave spectral Doppler can help identify veins and differentiate them from arteries. D) Veins will often be pulsating and the venous walls may be thicker than arterial walls. Answer: D Diff: 1 Page Ref: 491 Standard: IV Access and Medication Administration Objective: 18 59) In which of the following situations should you NOT obtain venous blood? A) during peripheral access B) before medication administration C) after medication administration D) when medication administration may be needed Answer: C Diff: 1 Page Ref: 492 Standard: IV Access and Medication Administration Objective: 19

Chapter 15 Airway Management and Ventilation 1) Which of the following is the correct order of events after an endotracheal tube has been properly inserted? A) Inflate the cuff with 5 to 10 mL of air, secure the tube, listen for equal breath sounds bilaterally, and listen for breath sounds over the epigastrium. B) Inflate the cuff with 5 to 10 mL of air, auscultate the epigastrium and then the lungs, and secure the tube. C) Secure the tube, listen for breath sounds over the epigastrium, listen for equal breath sounds bilaterally, and inflate the cuff with 5 to 10 mL of air. D) Inflate the cuff with 5 to 10 mL of air, listen for breath sounds over the epigastrium, listen for equal breath sounds bilaterally, and secure the tube. Answer: B Diff: 2 Page Ref: 552 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 10 2) The patient with COPD may benefit from oxygen delivery through a Venturi mask because: A) oxygen concentration is controlled more carefully. B) it delivers intermittent positive pressure to the airway. C) it both protects the airway and delivers oxygen. D) it delivers the highest oxygen concentration possible. Answer: A Diff: 1 Page Ref: 543 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 6 3) A peak flow meter measures: A) inspiratory reserve volume. B) tidal volume. C) the force of expiratory volume. D) respiratory efficacy during forced expiration. Answer: D Diff: 1 Page Ref: 540 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 5 4) Applying posteriorly directed pressure on the cricoid cartilage to facilitate endotracheal intubation is also referred to as: A) digital intubation. B) cricoid pressure. C) retrograde intubation. D) cricothyrotomy. Answer: B Diff: 1 Page Ref: 548 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 1 196 Copyright © 2017 Pearson Education, Inc.

5) When swallowing occurs, the structure that occludes the tracheal opening to prevent aspiration of food and liquid is the: A) cricoid cartilage. B) epiglottis. C) pyriform fossa. D) uvula. Answer: B Diff: 1 Page Ref: 517 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 2 6) Moderate hypoxemia is indicated with a pulse oximeter reading of ________ percent. A) 86 to 90 B) 95 to 100 C) 81 to 85 D) 90 to 94 Answer: A Diff: 1 Page Ref: 533 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 5 7) During spontaneous breathing, which of the following reflexes prevents overexpansion of the lungs? A) Cheyne-Stokes B) Hering-Breuer C) Apneustic D) Cushing's Answer: B Diff: 1 Page Ref: 525 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 2 8) Which of the following is an objective technique to verify proper endotracheal tube placement? A) Direct visualization B) Esophageal detector device C) Tube misting D) Auscultation Answer: B Diff: 1 Page Ref: 567 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 12

9) Which of the following interferes with ventilation in the presence of a flail segment? A) The ability to generate positive intrathoracic pressure is impaired. B) Intrathoracic pressure increases on the affected side. C) Intrathoracic pressure decreases on the affected side. D) The ability to generate negative intrathoracic pressure is impaired. Answer: D Diff: 3 Page Ref: 528 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 3 10) Progressively deeper, faster breathing alternating gradually with shallow, slower breathing is called: A) Cheyne-Stokes respirations. B) Kussmaul's respirations. C) Biot's respirations. D) agonal respirations. Answer: A Diff: 1 Page Ref: 530 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 3 11) Which of the following is an advantage of the two-person method of bag-valve-mask ventilation? A) Reduces the risk of gastric distension B) Provides tidal volumes of 1,500 to 1,700 mL C) Delivers a higher concentration of oxygen D) Easier to maintain a seal between the patient's face and the mask Answer: D Diff: 1 Page Ref: 549 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 6 12) What is the normal partial pressure of oxygen (in torr) in the arterial blood? A) 35 to 45 B) 50 to 75 C) 80 to 100 D) 100 to 150 Answer: C Diff: 1 Page Ref: 523 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 5

13) Which of the following is the most common cause of airway obstruction? A) Foreign bodies B) Food C) Upper airway edema D) Tongue Answer: D Diff: 1 Page Ref: 527 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 3 14) In an adult, the narrowest part of the airway is the: A) trachea. B) cricoid cartilage. C) hypopharynx. D) glottis. Answer: D Diff: 1 Page Ref: 527 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 2 15) A musical, squeaking, or whistling sound that may be heard on inspiration or expiration while auscultating lung fields is known as: A) crackles. B) stridor. C) rhonchi. D) wheezing. Answer: D Diff: 1 Page Ref: 531 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 1 16) The automatic transport ventilator is contraindicated for all of the following intubated patients, EXCEPT: A) a 17-year-old gunshot victim. B) a 4-year-old near-drowning victim. C) a 56-year-old patient in pulmonary edema. D) a 34-year-old patient with adult respiratory distress syndrome. Answer: A Diff: 2 Page Ref: 601 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 22

17) Of the normal tidal volume for the average 70-kg adult, what amount of air (in mL) is NOT available for gas exchange? A) 50 B) 100 C) 150 D) 250 Answer: C Diff: 1 Page Ref: 526 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 5 18) The preferred depolarizing neuromuscular agent for rapid sequence intubation is: A) pancuronium. B) midazolam. C) succinylcholine. D) vecuronium. Answer: C Diff: 1 Page Ref: 589, 590 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 17 19) All of the following are indications for endotracheal intubation, EXCEPT: A) a heart rate over 100. B) respiratory arrest. C) cardiac arrest. D) airway swelling. Answer: A Diff: 1 Page Ref: 557 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 10 20) A properly placed ________ effectively isolates the trachea for ventilation and protection from aspiration. A) dual lumen airway B) endotracheal tube C) laryngeal mask airway D) King LTD airway Answer: B Diff: 1 Page Ref: 557 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 10

21) When using a colorimetric end-tidal carbon dioxide detector, the absence of carbon dioxide in exhaled air after six breaths indicates that the endotracheal tube has been placed: A) in the right mainstem bronchus. B) in the esophagus. C) in the left mainstem bronchus. D) in the trachea. Answer: B Diff: 1 Page Ref: 563 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 12 22) Which of the following devices is known as a dual-lumen airway? A) Combitube B) Endotracheal tube C) Laryngeal mask airway D) King LTD airway Answer: A Diff: 1 Page Ref: 551 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 9 23) What percentage of oxygen is delivered by a simple face mask? A) 60 to 80 B) 95 to 100 C) 40 to 60 D) 80 to 90 Answer: C Diff: 1 Page Ref: 543 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 6 24) A high-pitched inspiratory noise caused by a partial upper airway obstruction is called: A) stridor. B) dysphonia. C) rhonchi. D) wheezing. Answer: A Diff: 1 Page Ref: 531 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 1

25) An attempt at endotracheal intubation must not interrupt ventilations for more than ________ seconds. A) 10 B) 15 C) 20 D) 30 Answer: C Diff: 1 Page Ref: 562 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 10 26) A(n) ________ may be used to facilitate nasotracheal intubation. A) uncuffed endotracheal tube B) malleable stylette C) lighted stylette D) Endotrol tube Answer: D Diff: 2 Page Ref: 573 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 13 27) Which of the following serves as an important visual landmark when performing endotracheal intubation under direct visualization? A) Cricothyroid membrane B) Cricoid cartilage C) Thyroid cartilage D) Posterior cartilages Answer: D Diff: 1 Page Ref: 565 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 10 28) What is the highest flow rate on a demand valve device (in liters per minute)? A) 30 B) 20 C) 15 D) 40 Answer: D Diff: 1 Page Ref: 550 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 6

29) The hypoxic drive is stimulated by: A) high PaCO2. B) low PaO2. C) high PaO2. D) low PaCO2. Answer: B Diff: 1 Page Ref: 525-526 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 2 30) The reading obtained by the use of a pulse oximeter reflects the: A) amount of saturated hemoglobin per deciliter of blood. B) amount of oxygen dissolved in the blood. C) ratio of unsaturated hemoglobin to saturated hemoglobin. D) partial pressure of oxygen in capillary blood. Answer: C Diff: 3 Page Ref: 532-533 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 5 31) Which of the following is NOT a structure of the upper airway? A) Larynx B) Trachea C) Hypopharynx D) Nasopharynx Answer: B Diff: 1 Page Ref: 516 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 2 32) Shallow, slow, or infrequent breathing, indicating severe ICP buildup and brain anoxia, is known as: A) Kussmaul's respirations. B) grunting. C) Biot's respirations. D) agonal respirations. Answer: D Diff: 2 Page Ref: 530 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 3

33) At the end of exhalation, the intrathoracic pressure is: A) significantly less than atmospheric pressure. B) slightly less than atmospheric pressure. C) greater than atmospheric pressure. D) equal to atmospheric pressure. Answer: D Diff: 2 Page Ref: 521 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 2 34) Which of the following manual airway maneuvers should be used when you are caring for a patient with a suspected cervical spine injury? A) Sellick's B) Modified jaw-thrust C) Jaw/tongue lift D) Head-tilt/chin-lift Answer: B Diff: 1 Page Ref: 544 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 4 35) When you are intubating a stoma site, how far beyond the distal cuff (in cm) should you insert the endotracheal tube? A) 1 to 2 B) 3 to 4 C) 2 to 3 D) 4 to 5 Answer: A Diff: 1 Page Ref: 597 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 19 36) In which of the following conditions should you suspect pulmonary shunting? A) A foreign body in the right mainstem bronchus B) Pneumonia C) Pulmonary embolism D) All of the above Answer: D Diff: 2 Page Ref: 523-524 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 8

37) Which of the following mechanisms is responsible for hypoxemia in the patient with a pulmonary embolism? A) Pulmonary shunting B) Pulsus paradoxus C) Lower airway obstruction D) Atelectasis Answer: A Diff: 1 Page Ref: 524 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 8 38) End-tidal colorimetric capnography measures: A) carbon dioxide in exhaled air. B) the partial pressure of carbon dioxide in arterial blood. C) the amount of carbon dioxide dissolved in plasma. D) the percentage of hemoglobin saturated with carbon dioxide. Answer: A Diff: 2 Page Ref: 535 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 12 39) A drop in blood pressure of greater than 10 torr during inspiration is called: A) pulsus paradoxus. B) pulsus obliterans. C) pulsus tardus. D) pulsus alternans. Answer: A Diff: 1 Page Ref: 530 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 2 40) What is visualized with a class 3 Mallampati score? A) Entire tonsil B) Upper half of the tonsil fossa C) Soft and hard palate D) Only the hard palate Answer: C Diff: 1 Page Ref: 593 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 18

41) The major drawback of mouth-to-mouth ventilations is: A) an oxygen level in the rescuer's exhaled air of only 10 to 12 percent. B) potential exposure of the rescuer to body fluids. C) inability to achieve adequate tidal volumes for ventilation. D) a high level of carbon dioxide in the rescuer's exhaled air. Answer: B Diff: 1 Page Ref: 547 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 6 42) The maximum flow rate to be used with a nasal cannula is ________ liters per minute. A) 10 B) 6 C) 8 D) 4 Answer: B Diff: 1 Page Ref: 543 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 6 43) Which of the following increases the risk of foreign body airway obstruction? A) Age B) Alcohol consumption C) Dentures D) All of the above Answer: D Diff: 1 Page Ref: 527 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 3 44) The simplest airway management technique in a patient without suspected cervical spine injury is the: A) head-tilt/chin-lift maneuver. B) modified jaw-thrust maneuver. C) use of an oropharyngeal airway. D) Sellick's maneuver. Answer: A Diff: 1 Page Ref: 544 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 6

45) The aspiration of vomitus into the lungs may result in: A) tissue damage. B) pulmonary edema. C) pneumonia. D) all of the above. Answer: D Diff: 1 Page Ref: 527-528 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 9 46) The MOST common indication for a surgical cricothyrotomy is: A) massive facial or neck trauma. B) failed rapid sequence intubation. C) status seizures with trismus. D) foreign body airway obstruction. Answer: A Diff: 1 Page Ref: 581 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 16 47) When you are suctioning an adult patient, the onset of bradycardia is most likely due to: A) hypercarbia. B) hypoxia. C) stimulation of the vagus nerve. D) increased intracranial pressure. Answer: C Diff: 1 Page Ref: 599 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 6 48) Which of the following basic airway adjuncts prevents the tongue from falling back to occlude the airway? A) Yankauer catheter B) Laryngeal mask airway C) Nasal cannula D) Oropharyngeal airway Answer: D Diff: 1 Page Ref: 546 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 6

49) A fine, bubbling sound heard on inspiration and associated with fluid in the alveoli and terminal bronchioles is called: A) bronchovesicular sounds. B) rales (crackles). C) rhonchi. D) pleural friction. Answer: B Diff: 1 Page Ref: 531 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 3 50) The tip of a curved laryngoscope blade is placed correctly: A) at the junction of the hard and soft palates. B) at the glottic opening. C) under the epiglottis. D) in the vallecular. Answer: D Diff: 1 Page Ref: 558 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 10 51) Which of the following is a disadvantage of pulse oximetry? A) Tissue hypoxia may be present even with a normal SaO2 reading. B) Pulse oximetry cannot differentiate between hemoglobin bound to oxygen and hemoglobin bound to carbon monoxide. C) Pulse oximetry gives no information about the amount of carbon dioxide in the blood. D) All of the above are disadvantages. Answer: D Diff: 2 Page Ref: 532-533 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 5 52) The movement of oxygen from the alveoli to the blood in the pulmonary capillaries depends on: A) facilitated transport by way of the hemoglobin molecule. B) active transport of oxygen from an area of lower concentration to an area of higher concentration. C) diffusion of oxygen from an area of higher concentration to an area of lower concentration. D) osmosis of the H2O molecule across the respiratory membrane, where oxygen dissociates from hydrogen. Answer: C Diff: 2 Page Ref: 523 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 2

53) A portable suction device should generate a flow rate of ________ liters per minute when the tube is open. A) 20 B) 30 C) 40 D) 50 Answer: B Diff: 1 Page Ref: 598 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 20 54) As the thoracic cavity begins to expand, the intrathoracic pressure: A) does not change. B) is greater than atmospheric pressure. C) is the same as atmospheric pressure. D) is less than atmospheric pressure. Answer: D Diff: 2 Page Ref: 521 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 2 55) When a bag-valve ventilation device is used with supplemental oxygen, it delivers an oxygen concentration of ________ percent. A) 40 B) 90 C) 60 D) 21 Answer: B Diff: 1 Page Ref: 548 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 6 56) In which of the following patients would a Combitube dual-lumen airway be used with caution? A) A 28-year-old man who is in cardiac arrest after his kayak capsized, trapping him under water for several minutes B) A 40-year-old woman who has taken an overdose of tricyclic antidepressants and is unresponsive to all stimuli C) A 59-year-old man with a history of chronic alcoholism who was found in cardiac arrest at a homeless shelter D) A 16-year-old woman who is unresponsive following a motor vehicle collision in which she was ejected, sustaining traumatic brain injury Answer: C Diff: 2 Page Ref: 552 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 23 209 Copyright © 2017 Pearson Education, Inc.

57) When a portion of the lung is unavailable for gas exchange, yet pulmonary circulation continues in that area of the lung, a condition known as ________ results. A) pulsus paradoxus B) ventilation/perfusion mismatch C) atelectasis D) eupnea Answer: B Diff: 1 Page Ref: 524 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 2 58) Physiologically, the term respiration refers to the: A) exchange of gases at the alveolar-capillary interface. B) mechanical process that moves air into and out of the lungs. C) exchange of all gases, nutrients, and wastes at the cellular level. D) exchange of gases at the cellular level. Answer: D Diff: 1 Page Ref: 521 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 2 59) Without adequate airway maintenance and ventilation, the patient can succumb to brain injury or death in how many minutes? A) 4 B) 10 C) 6 D) 12 Answer: A Diff: 1 Page Ref: 515 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 2 60) The bifurcation of the trachea is called the: A) glottic opening. B) hilum. C) cricoid cartilage. D) carina. Answer: D Diff: 1 Page Ref: 519 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 2

61) Which of the following statements about manual airway maneuvers is TRUE? A) They require specialized equipment. B) They are often neglected by EMTs and paramedics. C) They are contraindicated in trauma patients. D) They are difficult to learn. Answer: B Diff: 1 Page Ref: 544 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 6 62) Which of the following about the use of a dual-lumen airway device is TRUE? A) It is not recommended for trauma patients. B) It may be used for adult and pediatric patients. C) It may be inserted in patients with a gag reflex. D) Insertion requires no direct visualization. Answer: D Diff: 2 Page Ref: 551 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 9 63) When correctly placed, the tip of a straight laryngoscope blade should be: A) under the epiglottis. B) at the uvula. C) at the soft palate. D) in the vallecula. Answer: A Diff: 1 Page Ref: 558 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 10 64) Insertion of an endotracheal tube too far is likely to result in ventilation of: A) the right lung only. B) the left lung only. C) only the lower lobes of both lungs. D) neither lung. Answer: A Diff: 1 Page Ref: 563 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 10

65) During a respiratory assessment, the absence of breath sounds may indicate: A) a pneumothorax. B) a pulmonary embolism. C) flail chest. D) bronchitis. Answer: A Diff: 1 Page Ref: 528 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 4 66) In which of the following conditions is insertion of a nasogastric tube contraindicated? A) Patient having a gag reflex B) Patient with facial fractures C) Patient awake and alert D) All of the above Answer: B Diff: 1 Page Ref: 600 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 8 67) Which of the following may complicate airway management procedures in the pediatric patient? A) The trachea narrows at the cricoid cartilage. B) The tongue occupies a greater proportion of space. C) The epiglottis is larger and floppier than in an adult. D) All of the above are possible complications. Answer: D Diff: 1 Page Ref: 520-521 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 14 68) When performing tracheobronchial suctioning, what should be the maximum amount of suction time? A) 15 seconds B) 20 seconds C) 10 seconds D) 5 seconds Answer: C Diff: 1 Page Ref: 599 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 20

69) Which of the following best suggests an esophageal intubation? A) Color change from purple to yellow with a colorimetric ETCO2 detector B) Free return of air when aspirating with an esophageal detector device C) Gurgling sounds over the epigastrium with each ventilation delivered D) Maintaining a pulse oximetry reading of 80 to 85 percent Answer: C Diff: 1 Page Ref: 563 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 10 70) The tip of the endotracheal tube for the pediatric patient should be inserted no more than ________ cm below the vocal cords. A) 1 to 2 B) 3 to 4 C) 2 to 3 D) 4 to 5 Answer: C Diff: 1 Page Ref: 577-578 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 14 71) The respiratory rate may be greater than normal because of: A) alcoholic beverage ingestion. B) the use of medications such as diazepam or morphine. C) being asleep or nearly asleep. D) acidosis. Answer: D Diff: 2 Page Ref: 526 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 8 72) In which of the following situations would you expect end-tidal carbon dioxide levels to be very low, despite a patent airway? A) Room air PPV B) Hyperthermia C) Hypoventilation D) Cardiac arrest Answer: D Diff: 2 Page Ref: 535 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 5

73) You are managing a 29-year-old male patient who was shot in the head. There is a gurgling noise in the airway. The patient is breathing spontaneously at 42 breaths per minute and has a heart rate of 110 and a systolic and diastolic pressure of 102/82. What airway intervention should be performed first on this patient? A) Head-tilt/chin-lift maneuver B) Suctioning the airway C) Insertion of an oropharyngeal airway D) Endotracheal intubation Answer: B Diff: 2 Page Ref: 599 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 23 74) You are managing a 29-year-old male patient who was shot in the head. There is a gurgling noise in the airway. The patient is breathing spontaneously at 42 breaths per minute and has a heart rate of 110 and a systolic and diastolic pressure of 102/82. The correct rate of assisted ventilation for this patient is ________ breaths per minute. A) 6 B) 12 C) 14 D) 18 Answer: B Diff: 1 Page Ref: 547 Standard: Airway Management, Respiration, and Artificial Ventilation Objective: 23 75) When intubating using a lighted stylet, you see a dim, indistinct light in the throat. You have MOST likely intubated the: A) esophagus. B) left mainstem bronchus. C) trachea. D) right mainstem bronchus. Answer: A Diff: 1 Page Ref: 571 Standard: Airway Management and Ventilation Objective: 13 76) In which of the following instances might digital intubation NOT be indicated? A) The airway is blocked by a foreign body. B) The patient has copious secretions. C) Your equipment fails. D) Patient position does not allow for visualization. Answer: A Diff: 1 Page Ref: 573-574 Standard: Airway Management and Ventilation Objective: 13 214 Copyright © 2017 Pearson Education, Inc.

77) When providing rescue breathing to an apneic patient using a pocket face mask, each breath should be delivered with ________ of air. A) 6-8 mL/kg B) 10 mL/kg C) 15 mL/kg D) 2-4 mL/kg Answer: A Diff: 1 Page Ref: 547 Standard: Airway Management and Ventilation Objective: 6 78) What is the MOST commonly aspirated material? A) Vomit B) Blood C) Pus D) Saliva Answer: A Diff: 1 Page Ref: 527 Standard: Airway Management and Ventilation Objective: 9 79) Which of the following statements regarding needle cricothyrotomy is FALSE? A) Upon removal of the needle, the secured catheter allows for direct tracheal suctioning. B) High pressure during jet ventilation may cause a pneumothorax. C) Perforation of the esophagus may occur if the needle is advanced too far. D) It is the least invasive of the surgical procedures and can be initiated quickly. Answer: A Diff: 1 Page Ref: 582 Standard: Airway Management and Ventilation Objective: 16 80) Chemoreceptors could be stimulated when which one of the following chemical imbalances occurs? A) Decreased pH B) Increased bicarbonate C) Decreased renin D) Increased nitrogen Answer: A Diff: 1 Page Ref: 525 Standard: Airway Management and Ventilation Objective: 8

81) Advantages of a nasopharyngeal airway include all of the following, EXCEPT: A) it isolates the trachea. B) it can be suctioned through. C) it can be inserted with an intact gag reflex. D) it can be placed blindly and safely. Answer: A Diff: 1 Page Ref: 545 Standard: Airway Management and Ventilation Objective: 6 82) One disadvantage of the oropharyngeal airway is: A) it doesn't prevent aspiration. B) air can pass around it. C) it can be used as a bite block. D) it can be sized to the patient. Answer: A Diff: 1 Page Ref: 546 Standard: Airway Management and Ventilation Objective: 6 83) All of the following are disadvantages of the LMA-Fastrach, EXCEPT: A) it can facilitate blind endotracheal intubation. B) its inability to decompress the stomach. C) its absence of sizes for patients less than 30 kg. D) its temperamental positioning. Answer: A Diff: 1 Page Ref: 555-556 Standard: Airway Management and Ventilation Objective: 9 84) The amount of gas moved in and out of the respiratory tract in one minute is termed: A) minute volume. B) alveolar volume. C) tidal volume. D) residual volume. Answer: A Diff: 1 Page Ref: 526 Standard: Airway Management and Ventilation Objective: 2

85) A slow, deep, involuntary inspiration followed by a prolonged expiration that hyperinflates the lungs and re-expands atelectatic alveoli is a: A) sigh. B) hiccough. C) grunt. D) sneeze. Answer: A Diff: 1 Page Ref: 530 Standard: Airway Management and Ventilation Objective: 3 86) One way to improve airway management and ventilation is to make sure that: A) the ear-to-sternal notch axis is aligned. B) the BVM is squeezed as fully as possible. C) oxygen is not administered to COPD patients. D) a patient is never put in the "ramped" position. Answer: A Diff: 1 Page Ref: 540-541 Standard: Airway Management and Ventilation Objective: 6 87) Which of the following devices can be used as a simple mechanical airway adjunct in situations in which laryngoscopy is difficult and is similar to an oropharyngeal airway and also as a blind endotracheal tube introducer in situations in which laryngoscopy is difficult? A) S.A.L.T. B) LMA C) ETC D) NPA Answer: A Diff: 1 Page Ref: 554 Standard: Airway Management and Ventilation Objective: 9 88) Which of the following is NOT an absolute contraindication to rapid sequence airway (RSA)? A) Only one paramedic on scene B) Blunt or penetrating anterior neck trauma C) Upper airway tumor D) Caustic ingestion Answer: A Diff: 1 Page Ref: 592 Standard: Airway Management and Ventilation Objective: 17

89) The CORRECT sequence for intubating an apneic patient is: A) ventilation, positioning, visualization, tube placement, and verification of tracheal insertion. B) visualization, tube placement, positioning, verification of tracheal insertion, and ventilation. C) tube placement, visualization, positioning, verification of tracheal insertion, and ventilation. D) verification of tracheal insertion, tube placement, visualization, positioning, and ventilation. Answer: A Diff: 1 Page Ref: 548 Standard: Airway Management and Ventilation Objective: 10 90) When ventilating a patient via a nasal ET, what is one advantage this has over an orally placed ET? A) The tube cannot be bitten down on. B) There is a need for a laryngoscope. C) Gag stimulation occurs every time. D) Head and neck are extended into position. Answer: A Diff: 1 Page Ref: 571 Standard: Airway Management and Ventilation Objective: 13 91) A technique for intubation by passing a wire through the cricothyroid membrane cephalad through a catheter is called ________ intubation. A) retrograde B) reverse C) recumbent D) rear tracheal Answer: A Diff: 1 Page Ref: 568 Standard: Airway Management and Ventilation Objective: 13 92) What does the "L" in the LEMONS mnemonic stand for? A) Look externally B) Leave alone C) Laryngoscopy D) Loose dentures Answer: A Diff: 1 Page Ref: 594 Standard: Airway Management and Ventilation Objective: 18

93) Which of the following patients tends to have a decreased oxygen storage capacity? A) Pregnant woman B) Patient in shock C) Child D) Patient in pain Answer: A Diff: 1 Page Ref: 542 Standard: Airway Management and Ventilation Objective: 8 94) All of the following are indications for RSI, EXCEPT: A) predicted difficult airway. B) hypoxemia despite maximal therapy. C) combativeness secondary to presumed head trauma. D) impending or actual respiratory failure from any cause. Answer: A Diff: 1 Page Ref: 588 Standard: Airway Management and Ventilation Objective: 17 95) What would be the approximate size ET tube to use for a toddler you intend to intubate? A) 4 B) 5 C) 3 D) 6 Answer: A Diff: 1 Page Ref: 578 Standard: Airway Management and Ventilation Objective: 14 96) What does the "B" in BURP stand for? A) Backward B) Below C) Bloody D) Behind Answer: A Diff: 1 Page Ref: 570 Standard: Airway Management and Ventilation Objective: 18

97) Which of the followng is not one of the Rule of Threes? A) three providers B) three bags C) three fingers D) three PEEP Answer: B Diff: 1 Page Ref: 549 Standard: Airway Management and Ventilation Objective: 7 98) Studies with video laryngoscopy demonstrate that it is superior to traditional direct laryngoscopy unless: A) the patient is not properly positioned. B) optical laryngoscopy has already been used. C) retrograde intubation is in effect. D) the pharynx is full of blood, emesis, or secretions. Answer: D Diff: 1 Page Ref: 568 Standard: Airway Management and Ventilation Objective: 11 99) Which of these is NOT a step in performing field extubation? A) Advance the straight blade gently into the esophagus. B) Suction the patient’s oropharynx. C) Remove the ETT upon cough or expiration. D) Position patient on side if possible. Answer: A Diff: 1 Page Ref: 581 Standard: Airway Management and Ventilation Objective: 15 100) Gastric tubes may be gently placed in patients who have gastric or esophageal varices unless they have undergone a banding or cautery procedure within the past: A) month. B) week. C) six weeks. D) two weeks. Answer: D Diff: 1 Page Ref: 600 Standard: Airway Management and Ventilation Objective: 21

Paramedic Care: Principles & Practice V. 1-5, 5e (Bledsoe)

Volume 2 Patient Assessment Chapter 1 Scene Size-Up 1) You arrive at a location and begin to read the scene by: A) approaching the patient. B) observing the immediate surroundings. C) conducting a focused exam. D) addressing life threats. Answer: B Diff: 1 Page Ref: 3 Standard: Assessment (Scene Size-Up) Objective: 2 2) Which of the following is a potentially life-threatening patient complaint? A) Fractures of the tibia and radius B) Asthma C) Headache D) Chest pain Answer: D Diff: 2 Page Ref: 15-16 Standard: Assessment (Scene Size-Up) Objective: 7 3) At the scene of a multiple-vehicle collision, which of the following actions should you take first? A) Wait for additional resources to arrive. B) Treat the most seriously injured patient. C) Quickly scan the scene to count patients. D) Go directly to the first patient you see. Answer: C Diff: 2 Page Ref: 14-15 Standard: Assessment (Scene Size-Up) Objective: 6 4) A scene size-up is performed for all of the following reasons EXCEPT: A) to assess the mechanism of injury. B) to assess a baseline mental status. C) to provide information that will guide your medical care. D) to assess the need for additional resources. Answer: B Diff: 1 Page Ref: 3 Standard: Assessment (Scene Size-Up) Objective: 2

5) Which of the following is usually the best source of information about an alert and oriented patient? A) The patient B) Visual cues C) Diagnostic tests D) Family members Answer: A Diff: 1 Page Ref: 16 Standard: Assessment (Scene Size-Up) Objective: 7 6) Which of the following is NOT a consideration when evaluating the mechanism of injury? A) Mass and velocity of objects involved B) Whether the mechanism was blunt or penetrating C) Direction of impact D) Whether it is a rural or an urban setting Answer: D Diff: 2 Page Ref: 15-16 Standard: Assessment (Scene Size-Up) Objective: 7 7) When approaching a potential crime scene, you should: A) enter the scene if no signs of danger are noted. B) quickly enter the scene, retrieve the victim, and withdraw to the vehicle. C) park away from the scene until the police arrive and secure the scene. D) park and wait in front of the scene so the victim knows you are there. Answer: C Diff: 2 Page Ref: 10 Standard: Assessment (Scene Size-Up) Objective: 5 8) Which of the following best describes when you should perform a scene size-up? A) Once you arrive at the patient's side B) Throughout your time on the scene C) When you initially arrive at the scene D) As you are leaving the scene Answer: B Diff: 1 Page Ref: 3 Standard: Assessment (Scene Size-Up) Objective: 2

9) A paramedic should wear a properly fitted HEPA mask when evaluating a patient exhibiting signs and symptoms of: A) influenza. B) asthma. C) COPD. D) tuberculosis. Answer: D Diff: 1 Page Ref: 4 Standard: Assessment (Scene Size-Up) Objective: 4 10) A car has struck a pedestrian at about 45 mph. While assessing the patient, you note bilateral tibia and fibula fractures. Which of the following best describes why the patient should be transported to a trauma center? A) Pain from the fractures cannot be treated in the prehospital setting. B) Other serious injuries are likely. C) These fractures cannot be treated in a community hospital. D) Fractures always require immediate surgery. Answer: B Diff: 2 Page Ref: 16 Standard: Assessment (Scene Size-Up) Objective: 8 11) Which of the following is NOT an example of a mechanism of injury? A) An episode of chest pressure B) A fall from a ladder C) A low-speed motor vehicle collision D) A high-velocity gunshot wound Answer: A Diff: 1 Page Ref: 15-16 Standard: Assessment (Scene Size-Up) Objective: 1 12) Your patient is a 75-year-old man who is alert and responds to your questions. Which of the following is the best source of information about this patient? A) Family or friends B) The medical record C) The patient D) The physician Answer: C Diff: 1 Page Ref: 16 Standard: Assessment (Scene Size-Up) Objective: 7

13) A paramedic should wear protective eyewear when caring for a patient who is: A) coughing up blood-tinged sputum. B) complaining of dizziness. C) unresponsive. D) all of the above. Answer: A Diff: 1 Page Ref: 4 Standard: Assessment (Scene Size-Up) Objective: 4 14) All of the following mechanisms of injury yield a high level of suspicion for life-threatening injury EXCEPT: A) a stab wound distal to the knee. B) a collision between a motorcycle and a pedestrian. C) falling off the top of a 30-foot extension ladder. D) a patient ejection from a motor vehicle after a collision. Answer: A Diff: 2 Page Ref: 15-16 Standard: Assessment (Scene Size-Up) Objective: 7 15) Which of the following provides a clue to the nature of an illness? A) Medication bottles on the nightstand B) Length of a knife C) Caliber of ammunition D) Surface on which a patient fell Answer: A Diff: 1 Page Ref: 16 Standard: Assessment (Scene Size-Up) Objective: 7 16) Which of the following is most likely to result in life-threatening hemorrhage? A) Epistaxis B) Lacerated femoral artery C) Fractured radius and ulna D) Bleeding hemorrhoids Answer: B Diff: 1 Page Ref: 15 Standard: Assessment (Scene Size-Up) Objective: 7

17) Which of the following factors may influence your index of suspicion of a patient's condition? Select the letter choice with the best combination of the following factors: 1. Age 2. Gender 3. Race 4. Forces involved with the mechanism of injury A) 1, 2, and 4 B) 1, 3, and 4 C) 1, 2, 3, and 4 D) 4 only Answer: D Diff: 2 Page Ref: 15 Standard: Assessment (Scene Size-Up) Objective: 7 18) Components of a scene size-up include all of the following EXCEPT: A) patient's chief complaint. B) number of patients. C) mechanism of injury. D) dangers to bystanders. Answer: A Diff: 1 Page Ref: 3 Standard: Assessment (Scene Size-Up) Objective: 3 19) You find an adult patient lying supine on the sidewalk after being struck by a vehicle traveling at 10 mph. The patient is alert with stable vital signs. The mechanism of injury and initial patient presentation are most consistent with suspected: A) pneumothorax. B) closed-head injury. C) abdominal trauma. D) lower extremity trauma. Answer: D Diff: 2 Page Ref: 15-16 Standard: Assessment (Scene Size-Up) Objective: 7 20) When responding to calls involving two-vehicle collisions, you must always suspect: A) multiple patients. B) patients with altered mental status. C) flail chest. D) severe lower extremity injuries. Answer: A Diff: 1 Page Ref: 14 Standard: Assessment (Scene Size-Up) Objective: 6 5 Copyright © 2017 Pearson Education, Inc.

21) You respond to a scene where gunshots have been heard, and there is a report of a "man down." You should enter the scene when: A) you arrive on the scene. B) dispatch informs you the scene is safe. C) you observe the gunman fleeing the scene. D) police officers arrive and secure the scene. Answer: D Diff: 1 Page Ref: 10 Standard: Assessment (Scene Size-Up) Objective: 5 22) As the first unit on the scene of a mass-casualty incident, you and your partner should: A) stay together, assuming a joint command role. B) split up, with one assuming a command role, the other a triage role. C) stay together, both locating and triaging patients. D) split up, with both initiating patient triage. Answer: B Diff: 2 Page Ref: 14 Standard: Assessment (Scene Size-Up) Objective: 6 23) When responding to a domestic dispute, you should: A) have your dispatcher tell the patient to come outside. B) wait for law enforcement to arrive. C) refuse the call unless law enforcement is on the scene. D) determine whether or not the assailant is still on the scene. Answer: B Diff: 2 Page Ref: 10 Standard: Assessment (Scene Size-Up) Objective: 5 24) Which of the following best describes why you should call for additional assistance when dealing with multiple patients? A) Risks to each provider decrease as more responders arrive on the scene. B) You are responsible only for command and triage. C) You cannot safely and effectively treat all the patients. D) Fair distribution of workload is required by most unions. Answer: C Diff: 2 Page Ref: 14 Standard: Assessment (Scene Size-Up) Objective: 6

25) You are treating a 27-year-old asthmatic patient outside a bar when a growing crowd becomes hostile and unruly. To protect yourself, your crew, and your patient, you should: A) move the patient into the bar. B) use your vehicle to disperse the crowd. C) exit the scene, leaving the patient behind. D) remove yourselves and the patient from the scene. Answer: D Diff: 1 Page Ref: 10 Standard: Assessment (Scene Size-Up) Objective: 5 26) Which of the following senses should a paramedic use to recognize hazards at the scene of an emergency? A) Smell B) Hearing C) Sight D) All of the above Answer: D Diff: 1 Page Ref: 4 Standard: Assessment (Scene Size-Up) Objective: 2 Chapter 2 Primary Assessment 1) A patient with skin described as "clammy" has ________ skin. A) cool and dry B) warm and dry C) warm and moist D) cool and moist Answer: D Diff: 1 Page Ref: 30 Standard: Assessment (Primary Assessment) Objective: 4 2) After determining that a patient does not respond to verbal stimuli, your next action would be to: A) place him in the recovery position. B) pinch one of his fingernails. C) insert an oropharyngeal airway. D) apply manual cervical spine stabilization. Answer: B Diff: 1 Page Ref: 25 Standard: Assessment (Primary Assessment) Objective: 6

3) Forming a general impression as part of your primary assessment helps you to: A) determine baseline mental status. B) determine general clinical status and priority. C) make a determination about stabilization of the cervical spine. D) estimate vital signs. Answer: B Diff: 2 Page Ref: 22 Standard: Assessment (Primary Assessment) Objective: 3 4) The sound of gurgling associated with breathing usually indicates: A) foreign body obstruction of the upper airway. B) fluid in the upper airway. C) thick mucus in the lower airways. D) constriction of the bronchioles. Answer: B Diff: 1 Page Ref: 25 Standard: Assessment (Primary Assessment) Objective: 7 5) The purpose of manual stabilization of the cervical spine during the primary assessment of a trauma patient is to: A) allow you to control the patient. B) allow for easier airway manipulation. C) prevent the patient from moving his neck. D) help you avoid litigation. Answer: C Diff: 1 Page Ref: 23 Standard: Assessment (Primary Assessment) Objective: 5 6) To assess an infant's airway, you should: A) perform a tongue-jaw lift. B) hyperextend the head and lift the chin. C) perform a jaw-thrust maneuver. D) carefully extend the head and neck. Answer: D Diff: 1 Page Ref: 25 Standard: Assessment (Primary Assessment) Objective: 7

7) To determine whether a patient is breathing, you should: A) listen and feel for breathing at the mouth and nose. B) observe for movement of the abdomen. C) apply a pulse oximeter. D) auscultate the chest. Answer: A Diff: 1 Page Ref: 25 Standard: Assessment (Primary Assessment) Objective: 7 8) Your patient appears awake, but barely looks at you when you call his name. His airway is open, and he is breathing at 34 times per minute. He appears cyanotic. Which of the following adjuncts is most appropriate at this point? A) Nonrebreather mask B) Bag-valve mask C) Nasopharyngeal airway D) Nasal cannula Answer: B Diff: 2 Page Ref: 28 Standard: Assessment (Primary Assessment) Objective: 8 9) When assessing the airway, which of the following actions is NOT appropriate? A) Look for chest rise and fall. B) Feel for air movement. C) Listen for airflow. D) Count the number of breaths over a minute. Answer: D Diff: 2 Page Ref: 28 Standard: Assessment (Primary Assessment) Objective: 7 10) You are assessing a 28-year-old man with multiple gunshots to his abdomen. You should expect his skin to be: A) cool and moist. B) hot and moist. C) warm and dry. D) cold and dry. Answer: A Diff: 1 Page Ref: 30 Standard: Assessment (Primary Assessment) Objective: 9

11) Mottled, cyanotic, pale, or ashen skin color may indicate any of the following EXCEPT: A) hypertensive crisis. B) impaired blood flow to an extremity. C) significant blood loss. D) loss of spinal cord function. Answer: A Diff: 2 Page Ref: 30 Standard: Assessment (Primary Assessment) Objective: 9 12) Steps in assessing circulation during a primary assessment include all of the following EXCEPT: A) controlling major bleeding. B) determining the blood pressure. C) checking for skin signs. D) checking for a radial pulse. Answer: B Diff: 2 Page Ref: 29-31 Standard: Assessment (Primary Assessment) Objective: 9 13) You are assessing an adult patient. When you palpate her wrist to locate a pulse, you do not feel one. You should immediately palpate for a ________ pulse. A) brachial B) femoral C) apical D) carotid Answer: D Diff: 1 Page Ref: 29 Standard: Assessment (Primary Assessment) Objective: 8 14) Which of the following statements regarding stridor is TRUE? A) Stridor originates in the lower airways. B) Stridor is seldom of clinical significance. C) The correct treatment of stridor depends on the underlying problem. D) The presence of stridor requires immediate intubation. Answer: C Diff: 2 Page Ref: 25-26 Standard: Assessment (Primary Assessment) Objective: 7

15) Patterns of deterioration in patient condition may include all of the following EXCEPT: A) skin becomes cool, pale, and moist. B) the heart rate significantly increases or decreases. C) the respiratory rate significantly increases or decreases. D) the level of consciousness increases. Answer: D Diff: 1 Page Ref: 24 Standard: Assessment (Primary Assessment) Objective: 10 16) During the primary assessment, your patient groans and tries to turn away when you apply a sternal rub. Otherwise, there is no other response. The patient's mental status can best be described as: A) alert. B) responds to painful stimulus. C) responds to verbal stimulus. D) unresponsive. Answer: B Diff: 1 Page Ref: 25 Standard: Assessment (Primary Assessment) Objective: 6 17) Your patient is not alert but is responsive to painful stimulus. His airway is patent. He is breathing at eight times per minute. Your next action should be to administer oxygen via a: A) nasal cannula. B) simple face mask. C) nonrebreather mask. D) bag-valve-mask device. Answer: D Diff: 2 Page Ref: 25-28 Standard: Assessment (Primary Assessment) Objective: 7 18) The best method for determining responsiveness to painful stimuli in an infant is to: A) pinch his cheeks. B) pinch his fingernails. C) rub his sternum. D) flick the soles of his feet. Answer: D Diff: 1 Page Ref: 25 Standard: Assessment (Primary Assessment) Objective: 6

19) While performing a primary assessment on a trauma patient who has fallen from a roof, you discover absent lung sounds on the right side. Which of the following actions should you take next? A) Assess for signs of a tension pneumothorax. B) Intubate the patient. C) Continue the rapid trauma assessment. D) Decompress the patient's chest. Answer: A Diff: 2 Page Ref: 29 Standard: Assessment (Primary Assessment) Objective: 7 20) Signs of inadequate breathing include all of the following EXCEPT: A) presence of bronchovesicular breath sounds. B) retractions of intercostal and supraclavicular tissues. C) nasal flaring. D) accessory muscle use. Answer: A Diff: 1 Page Ref: 28 Standard: Assessment (Primary Assessment) Objective: 8 21) What does the "U" in A-V-P-U stand for? A) Unresponsive B) Unconscious C) Uncooperative D) Undetermined Answer: A Diff: 1 Page Ref: 24 Standard: Assessment (Primary Assessment) Objective: 1 22) Medical patients with altered mental status are stabilized in a manner similar to that that is appropriate for: A) critical trauma patients. B) any other medical patient. C) a patient complaining of chest pain. D) a patient with isolated extremity trauma. Answer: A Diff: 2 Page Ref: 23 Standard: Assessment (Primary Assessment) Objective: 6

23) Devices for maintaining airway patency in a five-year-old patient include all of the following EXCEPT a(n): A) endotracheal tube. B) oropharyngeal airway. C) suction unit. D) pharyngotracheal lumen airway. Answer: D Diff: 2 Page Ref: 25-27 Standard: Assessment (Primary Assessment) Objective: 7 24) In an infant, the heart rate is best detected by either palpating the brachial artery or: A) auscultating the carotid pulse. B) palpating the femoral pulse. C) palpating the carotid pulse. D) auscultating the apical pulse. Answer: D Diff: 1 Page Ref: 29 Standard: Assessment (Primary Assessment) Objective: 9 25) Your patient is awake and complaining of chest pain. His airway is patent, and he is breathing at 18 times per minute with adequate tidal volume. What is your next action? A) Administer oxygen at 15 lpm via nonrebreather mask. B) Begin positive pressure ventilations via bag-valve-mask device. C) Insert a nasopharyngeal airway. D) Administer oxygen at 2 lpm via nasal cannula. Answer: D Diff: 2 Page Ref: 25-28 Standard: Assessment (Primary Assessment) Objective: 11 26) Which of the following best describes why patients with serious illnesses or injuries should be transported without delay? A) Definitive care cannot be provided in the prehospital setting. B) Most patients are uncomfortable with the level of care provided by paramedics. C) Paramedics must become available for additional calls as soon as possible. D) The shorter the contact time with the patient, the less the potential for liability. Answer: A Diff: 2 Page Ref: 31 Standard: Assessment (Primary Assessment) Objective: 2

27) You locate a 55-year-old woman lying supine on the side of a road. There are no bystanders. You determine that the patient is unresponsive. Which of the following should be your next action? A) Apply a cervical collar. B) Provide high-flow oxygen. C) Open the airway with a jaw-thrust maneuver. D) Intubate the trachea. Answer: C Diff: 2 Page Ref: 23 Standard: Assessment (Primary Assessment) Objective: 5 28) Your three-year-old patient opens her eyes and responds when you speak to her. Her mental status is best described as: A) alert. B) responsive to tactile stimuli. C) responsive to verbal stimuli. D) lethargic. Answer: C Diff: 1 Page Ref: 24 Standard: Assessment (Primary Assessment) Objective: 6 29) When assessing the chest, you should cover any open wounds you locate with a(n) ________ dressing. A) wet B) occlusive C) antibacterial D) dry gauze Answer: B Diff: 1 Page Ref: 28-29 Standard: Assessment (Primary Assessment) Objective: 8 30) Which of the following problems is it NOT critical to find during the primary assessment? A) Scalp hematoma B) Bright red blood spurting from a thigh wound C) Respiratory distress D) Foreign body airway obstruction Answer: A Diff: 2 Page Ref: 31 Standard: Assessment (Primary Assessment) Objective: 2

31) Your patient is unresponsive to painful stimulus and has snoring respirations. What is your next action? A) Check for a pulse. B) Perform a head-tilt, chin-lift maneuver. C) Administer oxygen at 15 lpm. D) Suction. Answer: B Diff: 2 Page Ref: 25 Standard: Assessment (Primary Assessment) Objective: 7 32) All of the following are signs of inadequate breathing in an infant EXCEPT: A) cyanosis. B) use of accessory muscles. C) altered mental status. D) a respiratory rate of 32 breaths per minute. Answer: D Diff: 1 Page Ref: 28 Standard: Assessment (Primary Assessment) Objective: 8 33) Which of the following statements about airway management is TRUE? A) Immediate intubation is required for all unresponsive patients. B) Dual lumen airways are acceptable for use in children over the age of four years. C) If a patient cannot be intubated because of an intact gag reflex, a dual lumen airway can be used. D) Nasopharyngeal airways are contraindicated in patients with possible basilar skull fracture. Answer: D Diff: 2 Page Ref: 27 Standard: Assessment (Primary Assessment) Objective: 7 34) Your patient does not respond to you when you call his name. What should you do next? A) Apply a painful stimulus. B) Continue shouting. C) Assume he is unresponsive. D) Insert an oral airway. Answer: A Diff: 1 Page Ref: 24-25 Standard: Assessment (Primary Assessment) Objective: 6

35) Which of the following conditions is NOT typically associated with wheezing? A) Foreign bodies in the small airways B) Asthma C) Bronchospasm D) Upper airway swelling Answer: D Diff: 1 Page Ref: 26 Standard: Assessment (Primary Assessment) Objective: 7 36) In infants, capillary refill is a good incicatior of adequate circulation and can be checked in the: A) limbs. B) dorsum of the hand. C) torso. D) face. Answer: B Diff: 1 Page Ref: 30 Standard: Assessment (Primary Assessment) Objective: 9 37) Which of the following sounds can typically be heard without the use of a stethoscope? A) Rhonchi B) Bowel sounds C) Stridor D) Crackles Answer: C Diff: 2 Page Ref: 25-26 Standard: Assessment (Primary Assessment) Objective: 8 38) If an abnormal finding is noted in the patient's respiratory rate or pattern during the chest examination, you should: A) immediately ensure adequate ventilation. B) intervene only if pulse oximetry is less than 85 percent. C) immediately determine the exact cause. D) continue the examination before finding and treating the cause. Answer: A Diff: 1 Page Ref: 26-27 Standard: Assessment (Primary Assessment) Objective: 8

39) Pulse quality refers to: A) rhythm. B) strength. C) location. D) rate. Answer: B Diff: 1 Page Ref: 30 Standard: Assessment (Primary Assessment) Objective: 9 40) Your patient is a three-year-old who presents with a fever. His parents state that he has had diarrhea and vomiting for two days. The patient has not eaten in 24 hours. To best evaluate the patient's peripheral perfusion status, you should evaluate his: A) respiratory rate. B) fingertip sensation. C) capillary refill. D) blood pressure. Answer: C Diff: 1 Page Ref: 30-31 Standard: Assessment (Primary Assessment) Objective: 9 41) You are examining a patient's peripheral vasculature when you note that he has no radial pulse. Your next step would be to: A) prepare for immediate transport. B) defibrillate with 200 joules. C) start CPR. D) palpate a carotid pulse. Answer: D Diff: 1 Page Ref: 29 Standard: Assessment (Primary Assessment) Objective: 9 42) According to the 2015 AHA guidelines/recommendations, a patient who appears to be unresponsive and not breathing or breathing ineffectively should be assessed using which mnemonic memory aid? A) ABC B) BAC C) CBA D) CAB Answer: D Diff: 1 Page Ref: 22 Standard: Assessment (Primary Assessment) Objective: 10

Chapter 3 Therapeutic Communications 1) Without proper terminology and verbal communications skills, the receiver will be unable to ________ the message. A) decode B) resend C) encode D) receive Answer: A Diff: 1 Page Ref: 38 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 1 2) The active listening technique of reflection involves: A) repeating the patient's words back to him to check for understanding. B) confronting the patient if you feel he is hiding something relevant. C) not allowing the patient to stray from the current problem. D) asking closed-ended questions to keep the patient on track. Answer: A Diff: 1 Page Ref: 43 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 3 3) When you detect an inconsistency in a patient's story, which of the following techniques should you use? A) Clarification B) Interpretation C) Confrontation D) Facilitation Answer: C Diff: 1 Page Ref: 44 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 3 4) When you ask your patient questions to eliminated confusion, you are using the technique called: A) reflection. B) interpretation. C) facilitation. D) clarification. Answer: D Diff: 1 Page Ref: 43 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 3

5) Which of the following statements regarding patient communication is TRUE? A) Avoid using interpreters. B) Use language appropriate to the patient's level of understanding. C) Cultural differences make no difference in professional communication. D) Use medical terminology to keep things on a professional level. Answer: B Diff: 1 Page Ref: 45 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 4 6) The history begins with an open-ended question about your patient's: A) general health. B) chief complaint. C) severity of symptoms. D) past medical history. Answer: B Diff: 1 Page Ref: 39 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 4 7) Which of the following actions can you take to establish rapport with a patient early in the interview? A) Ask as many questions as possible. B) Maintain control of the interview at all times. C) Respond to her condition with empathy. D) Do not show emotion. Answer: C Diff: 1 Page Ref: 39 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 2 8) Which of the following nonverbal cues demonstrates your sincerity to the patient? A) Offering a comforting touch or shaking the patient's hand B) Averting your gaze to avoid making the patient uncomfortable C) Touching a patient, even though he may appear uncomfortable being touched D) Maintaining a distance of 4 to 6 feet from the patient Answer: A Diff: 1 Page Ref: 42 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 2

9) Which of the following statements regarding effective history taking is TRUE? A) Use a combination of open- and closed-ended questions. B) Never ask potentially embarrassing questions. C) Always use open-ended questions. D) Always use closed questions. Answer: A Diff: 1 Page Ref: 42 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 4 10) Encouraging your patient with your body language to provide more information is called: A) interpretation. B) clarification. C) reflection. D) facilitation. Answer: D Diff: 1 Page Ref: 43 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 1 11) Which of the following establishes the foundation for gathering good information? A) Using active listening B) Providing appropriate reassurance C) Asking only open-ended questions D) Using common sense Answer: A Diff: 2 Page Ref: 42 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 4 12) Which of the following statements can show your empathy toward the patient? A) "What is your name?" B) "You say that your chest doesn't hurt, but you keep rubbing it." C) "Are you sure that you take a diuretic?" D) "That must have been very difficult." Answer: D Diff: 1 Page Ref: 43 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 2

13) Which of the following is a challenge to your ability to solicit patient information? A) Complaints of multiple symptoms B) Patient's level of cognitive functioning C) Intoxication D) All of the above Answer: D Diff: 1 Page Ref: 45-51 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 5 14) Which of the following actions would you take if confronted with a patient who is silent? A) Assume that the patient is uncooperative. B) Assume that the reason is emotional. C) Encourage the patient to speak. D) Stay silent to show empathy. Answer: C Diff: 2 Page Ref: 49-50 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 5 15) Which of the following is an example of a closed question? A) "What is your medical history?" B) "Do you have any medical history?" C) "What were you doing when the pain began?" D) "How would you describe your discomfort?" Answer: B Diff: 1 Page Ref: 42 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 4 16) When asking about a patient's health status, you should ask about all of the following EXCEPT: A) religious beliefs. B) use of tobacco. C) immunizations. D) surgeries or hospitalizations. Answer: A Diff: 1 Page Ref: 48 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 2

17) Part of active listening includes maintaining eye contact and using appropriate gestures in a process known as: A) articulation. B) facilitation. C) formulation. D) reflection. Answer: B Diff: 1 Page Ref: 43 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 1 18) All of the following encourage patient communication EXCEPT: A) using medical jargon. B) asking the patient for clarification. C) maintaining eye contact. D) listening closely to everything the patient says. Answer: A Diff: 1 Page Ref: 45 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 4 19) Which of the following questions gathers information about a patient's current health status? A) "Where does the pain go?" B) "Do you also feel nauseous?" C) "When did you have your appendix removed?" D) "How many cigarettes do you smoke a day?" Answer: D Diff: 2 Page Ref: 43-44 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 4 20) Which of the following qualities should characterize your verbal interaction with a patient when obtaining the history? A) Speak softly. B) Speak loudly. C) Use a calm, reassuring voice. D) Demand the patient's attention. Answer: C Diff: 1 Page Ref: 40 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 2

21) Which of the following body positions best communicates that you care about your patient's problems? A) Getting as close to the patient as physically possible B) Maintaining a distance of 4 to 6 feet C) Standing next to where the patient is sitting or lying down D) Sitting next to the patient Answer: D Diff: 1 Page Ref: 40-41 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 2 22) Which of the following statements does NOT accurately describe depression? A) It is a common medical problem. B) It is commonly misdiagnosed or ignored. C) It often presents with insomnia and physical complaints. D) It is seldom lethal. Answer: D Diff: 2 Page Ref: 51 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 1 23) Which of the following is an example of an open-ended question? A) "Does your pain radiate to the shoulder?" B) "Where do you hurt?" C) "Do you have any allergies to medicine?" D) "Do you take high blood pressure medicine?" Answer: B Diff: 1 Page Ref: 42 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 3 24) Which of the following is the best way to address your patient? A) Stay neutral; do not use the patient's name. B) Ask the patient what he would like to be called. C) Avoid using the patient's name by using terms such as "dude" or "partner." D) Always use formal titles such as "Mr. Orphey." Answer: B Diff: 1 Page Ref: 40 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 2

25) When questioning a teenage female patient complaining of abdominal pain, you should: A) avoid direct questions about possible pregnancy. B) get the parents' consent to ask her about possible pregnancy. C) question her in private. D) question her in the presence of the mother, but not the father. Answer: C Diff: 1 Page Ref: 39 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 3 26) All of the following actions can help make taking a history on a sensitive subject easier EXCEPT: A) attending a lecture or seminar on these sensitive subjects to learn more about them. B) using euphemisms and metaphors to ask embarrassing questions. C) asking some opening question to these subjects as practice. D) observing experienced clinicians ask these types of questions. Answer: B Diff: 1 Page Ref: 49 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 3 27) Your partner has just asked Mrs. Jones, "Why didn't you call your physician's office for a prescription refill instead of calling 911?" This illustrates: A) closed questioning. B) empathetic communication. C) an appearance of blaming the patient. D) an attempt to educate the patient. Answer: C Diff: 2 Page Ref: 44 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 2 28) En route to the hospital, your patient says, "You know, I haven't had a date since my spouse died six years ago. Why don't you take down my phone number and call me?" Which of the following is an appropriate response? A) "I'm sure you understand my situation. I'm here to provide you with medical care and transportation to the hospital. It isn't proper for me to have anything but a professional relationship with you." B) "That is an inappropriate request, and I expect that you'll not make any further suggestions that we might become personally involved." C) "It isn't that I don't find you attractive; I certainly do, but it isn't proper for me to have a personal relationship with a patient." D) "I can't call you because of professional ethics, but my phone number is listed in the book." Answer: A Diff: 3 Page Ref: 48 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 5 24 Copyright © 2017 Pearson Education, Inc.

29) Which of the following may result in a failure of communication between a paramedic and a patient? A) External distractions B) Prejudice C) Lack of privacy D) All of the above Answer: D Diff: 1 Page Ref: 38 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 3 30) An "intimate zone" reflects about how many feet between two people? A) 0 to 1.5 B) 1.5 to 2 C) 2 to 2.5 D) 2.5 to 3 Answer: A Diff: 1 Page Ref: 40 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 2 31) Echoing a patient's message back to him in your own words is a technique known as: A) explanation. B) facilitation. C) reflection. D) clarification. Answer: C Diff: 1 Page Ref: 43 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 1 32) What questioning style used by the paramedic has the tendency to guide the patient's answers? A) Distracting B) Leading C) Closed D) Open-ended Answer: B Diff: 1 Page Ref: 42 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 1

33) When in a situation requiring an interpreter, it is important to: A) focus only on the current problem, not the medical history. B) look at the interpreter, not the patient. C) ask only one question at a time. D) only use family members to interpret. Answer: C Diff: 1 Page Ref: 48 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 3 34) "Public distance" refers to a space of how many feet between people? A) 2 to 3 B) 3 to 6 C) 4 to 12 D) 12 or more Answer: D Diff: 1 Page Ref: 41 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 1 35) You have overheard a hospital technician in the emergency department talking with a patient who has pancreatic cancer. The technician said, "Don't worry; everything will be all right." This is an example of: A) distraction. B) false reassurance. C) empathy. D) lack of concern. Answer: B Diff: 1 Page Ref: 44 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 6 36) "Please tell me about your abdominal pain" is an example of a(n) ________ question. A) closed B) distracting C) open-ended D) leading Answer: C Diff: 1 Page Ref: 42 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 4

37) Which of the following questions would provide the best quality and quantity of relevant information? A) "What time do you normally eat breakfast?" B) "When was the last time you had anything to eat or drink?" C) "What have you had to eat and drink today?" D) "Have you had breakfast?" Answer: C Diff: 2 Page Ref: 42 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 4 38) When interviewing patients from cultures other than our own, it is difficult for us to avoid interpreting the situation from the viewpoint of our own culture. This is known as: A) cultural imposition. B) racism. C) anthropomorphism. D) ethnocentrism. Answer: A Diff: 2 Page Ref: 48 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 1 39) You are caring for a sick five-year-old child in the emergency department. The ED physician has ordered some intravenous medication to stop the child from vomiting. Which of the following is the best way to approach the child with the issue of starting an IV? A) "I'm going to give you some medicine in your arm to help you stop throwing up. If you're a good boy and hold really still, it's not going to hurt a bit." B) "I'm going to give you some medicine to help you stop throwing up, but the medicine has to go through a tube and into your arm. So it's going to feel like you're getting a shot, but it will just take a second, and then the medicine will make you feel better." C) "I'm going to start an IV in your arm so I can give you some Phenergan for your nausea and vomiting. Be a big boy and don't cry, okay?" D) Say nothing about the procedure. Once you have everything set up, tell the child, "Let me see your arm," then quickly perform the procedure. Answer: B Diff: 2 Page Ref: 46-47 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 5

40) "Social distance" is a distance of ________ feet between people. A) 2 to 3 B) 3 to 6 C) 4 to 12 D) 12 or more Answer: C Diff: 1 Page Ref: 41 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 1 41) Upon questioning your patient about whether he has been feeling any particular stress lately, he asks, "Do you think I'll have to wait very long in the emergency department?" This is most illustrative of: A) confrontation. B) using avoidance language. C) distancing. D) overuse of professional jargon. Answer: B Diff: 2 Page Ref: 44 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 4 42) Which of the following responses illustrates the feedback technique of facilitation? A) "You said you weren't having any pain, but I see you're trying not to use your right arm." B) "I see. What happened after that?" C) "I'm not sure I understand. What do you mean when you say, 'It's a hard pain?'" D) "So you got up to go to the bathroom and tripped over something in the hallway?" Answer: B Diff: 2 Page Ref: 43 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 3 43) Which of the following nonverbal behaviors is likely to help you establish trust and rapport with a patient? A) Using medical terminology to establish your professionalism B) Assuring the patient that now that the ambulance is here everything is going to be okay C) Using an authoritarian tone of voice when addressing the patient D) Walking briskly to the patient without rushing or running Answer: D Diff: 2 Page Ref: 39 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 2

44) You are called to a scene at which a pedestrian has fallen on the sidewalk. When you arrive, the man is sitting up and appears alert and responsive. However, as you attempt to start your interview in your normal manner, you note that he is reluctant to speak with you. How should you proceed? A) Try to develop rapport by reviewing the reason you were dispatched on the call. B) Call the medical direction physician and allow the patient to speak to him or her. C) Confront the patient with your inability to help him if he does not tell you what is going on. D) Ask the patient to sign a refusal of treatment and transport form. Answer: A Diff: 2 Page Ref: 48 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 7 45) A five-year-old child is introduced to you as Robert Smith. The proper way for you to address him is: A) "Hey, little guy!" B) "Hi, Bobby." C) "Hello, Mr. Smith." D) "Hi, Robert." Answer: D Diff: 1 Page Ref: 40 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 4 46) Which of the following responses most clearly illustrates the feedback technique of confrontation? A) "A number of things can cause vomiting. We don't have enough information yet to determine what might be the cause in your situation." B) "I'm not sure I understand what you mean by 'feeling sick.'" C) "So first you vomited, then you began having abdominal pain?" D) "You said you aren't having any pain, but I notice you keep holding your stomach." Answer: D Diff: 2 Page Ref: 44 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 3 47) When you are taking a history, which of the following should typically drive the evolution of the questions asked of a patient after the first question? A) Patient's medical history B) Information from the patient's family C) Patient's list of medications D) Patient's chief complaint Answer: D Diff: 1 Page Ref: 39 Standard: Clinical Behavior/Judgment (Therapeutic Communication and Cultural Competency) Objective: 4 29 Copyright © 2017 Pearson Education, Inc.

Chapter 4 History Taking 1) Which of the following questions is designed to find out about palliation? A) "What were you doing when this pain began?" B) "How long have you been having this pain?" C) "What does the pain feel like?" D) "What makes the pain feel better?" Answer: D Diff: 2 Page Ref: 59 Standard: Assessment (History Taking) Objective: 3 2) A practical template for exploring various aspects of a chief complaint is: A) SAMPLE. B) ABCDE. C) OPQRST-ASPN. D) AEIOU-TIPS. Answer: C Diff: 1 Page Ref: 59-60 Standard: Assessment (History Taking) Objective: 1 3) Which of the following words are most likely to accurately represent the patient's chief complaint? A) Chest pain B) Myocardial infarction C) Dyspnea D) Fractured tibia Answer: A Diff: 2 Page Ref: 58 Standard: Assessment (History Taking) Objective: 4 4) Questions to ask about a patient's past medical history include all of the following areas EXCEPT: A) surgeries or injuries. B) general state of health. C) adult diseases. D) duration of the pain. Answer: D Diff: 2 Page Ref: 60-61 Standard: Assessment (History Taking) Objective: 6

5) Which of the following statements is TRUE regarding the components of a comprehensive patient history? A) Use only one component, so as to not confuse the patient. B) Use the components that apply to the patient's situation. C) Use all components every time you interview a patient. D) Use the components the patient chooses. Answer: B Diff: 2 Page Ref: 57 Standard: Assessment (History Taking) Objective: 2 6) What does the "C" in the CAGE alcohol-screening tool stand for? A) Are you careful when you drink? B) What causes your drinking? C) Are you concerned about your drinking? D) Have you ever felt the need to cut down on your drinking? Answer: D Diff: 1 Page Ref: 62 Standard: Assessment (History Taking) Objective: 6 7) A sign or symptom that causes a patient or bystander to request medical help is known as the: A) primary problem. B) present illness. C) associated symptom. D) chief complaint. Answer: D Diff: 1 Page Ref: 58 Standard: Assessment (History Taking) Objective: 1 8) Which of the following pieces of information should you record as preliminary data? A) The chief complaint B) Elements of the past history C) Aspects of the present illness D) The patient's age Answer: D Diff: 1 Page Ref: 58 Standard: Assessment (History Taking) Objective: 3

9) An example of a primary problem is: A) myocardial infarction. B) leg pain. C) nausea. D) shortness of breath. Answer: A Diff: 2 Page Ref: 58 Standard: Assessment (History Taking) Objective: 3 10) Which of the following is the best example of referred pain? A) Right shoulder pain associated with cholecystitis B) Abdominal pain related to pancreatitis C) Flank pain associated with a kidney stone D) Chest pain located under the sternum associated with a cardiac condition Answer: A Diff: 2 Page Ref: 59 Standard: Assessment (History Taking) Objective: 8 11) Areas in the patient's current health status include all of the following EXCEPT: A) home situation. B) previous illnesses. C) sleep patterns. D) environmental hazards. Answer: B Diff: 1 Page Ref: 57 Standard: Assessment (History Taking) Objective: 4 12) Elements of the patient history include all of the following EXCEPT: A) physical examination. B) present illness. C) current health status. D) preliminary data. Answer: A Diff: 1 Page Ref: 60-61 Standard: Assessment (History Taking) Objective: 6

13) For trauma patients you will use an abbreviated version of the past history known as: A) CAGE. B) HEENT. C) OPQRST-ASPN. D) SAMPLE. Answer: D Diff: 1 Page Ref: 63 Standard: Assessment (History Taking) Objective: 7 14) Using knowledge and experience to diagnose patients and plan their treatment is called clinical: A) judgment. B) intuition. C) practice. D) reflection. Answer: A Diff: 1 Page Ref: 65 Standard: Assessment (History Taking) Objective: 8 15) Critical thinking is a thought process used to: A) defend one's actions in a CQI review process. B) establish credibility with an emergency physician. C) analyze and evaluate. D) focus on a situation's most important aspect. Answer: C Diff: 2 Page Ref: 65-67 Standard: Assessment (History Taking) Objective: 8 16) Asking a patient, "What were you doing when this problem began?" represents what part of the OPQRST question format? A) P B) Q C) O D) R Answer: C Diff: 1 Page Ref: 59 Standard: Assessment (History Taking) Objective: 5

17) Asking a patient, "Does it hurt more when you breathe deeply?" represents what part of the OPQRST question format? A) Q B) O C) R D) P Answer: D Diff: 1 Page Ref: 59 Standard: Assessment (History Taking) Objective: 5 18) Asking a patient, "Where does it hurt?" represents what part of the OPQRST question format? A) P B) Q C) O D) R Answer: D Diff: 1 Page Ref: 59-60 Standard: Assessment (History Taking) Objective: 5 19) Asking a patient, "Can you rate your pain on a 0 to 10 scale?" represents what part of the OPQRST question format? A) S B) T C) R D) Q Answer: A Diff: 1 Page Ref: 60 Standard: Assessment (History Taking) Objective: 5 20) A patient who appears to be intoxicated has fallen and is complaining of pain in his right arm. He is agitated and loud. Which one of the following is appropriate to your initial approach to taking the history for this patient? A) "If you do not quiet down, I will call the police, and they will arrest you." B) "How much have you had to drink?" C) "I cannot help you if you keep yelling like that!" D) "Stop yelling, or I will have to strap you to the stretcher." Answer: B Diff: 2 Page Ref: 62 Standard: Assessment (History Taking) Objective: 9

Chapter 5 Secondary Assessment 1) You would like to test a patient's visual acuity, but a visual acuity card or wall chart is not available. You can still test for visual acuity by: A) asking the patient to indicate the farthest object he can see. B) checking the pupils. C) having the patient count your raised fingers. D) covering one eye and testing for light accommodation. Answer: C Diff: 2 Page Ref: 99 Standard: Assessment (Secondary Assessment) Objective: 9 2) You are able to feel vibrations through the chest wall as your patient speaks. This is called: A) egophony. B) auscultation. C) whispered pectoriloquy. D) tactile fremitus. Answer: D Diff: 2 Page Ref: 115 Standard: Assessment (Secondary Assessment) Objective: 4 3) The process in which a paramedic places a hand on a body part, then sharply taps a distal knuckle with the tip of another finger, is known as: A) percussion. B) hyperresonance. C) palpation. D) observation. Answer: A Diff: 1 Page Ref: 75 Standard: Assessment (Secondary Assessment) Objective: 3 4) Asking your patient to recall what he had for a meal earlier in the day would test: A) recent memory. B) remote memory. C) immediate memory. D) long-term memory. Answer: A Diff: 1 Page Ref: 81 Standard: Assessment (Secondary Assessment) Objective: 5

5) Physical exam techniques include all of the following EXCEPT: A) palpation. B) association. C) auscultation. D) inspection. Answer: B Diff: 1 Page Ref: 73 Standard: Assessment (Secondary Assessment) Objective: 3 6) Petechiae are skin lesions characterized by: A) reddish lines radiating from a red spot. B) irregular red spots. C) reddish-purple spots less than 0.5 cm in diameter. D) reddish-purple blotches greater than 0.5 cm in diameter. Answer: C Diff: 1 Page Ref: 90 Standard: Assessment (Secondary Assessment) Objective: 1 7) Which of the following is included in an examination of the cardiovascular system? A) Auscultate for carotid bruits. B) Palpate to check for Murphy's sign. C) Auscultate breath sounds. D) Palpate both carotid arteries simultaneously. Answer: A Diff: 1 Page Ref: 123 Standard: Assessment (Secondary Assessment) Objective: 6 8) Inspection of the maxillary sinuses is accomplished by: A) palpating under the zygomatic arches. B) obstructing one side of the nares and watching the patient breathe. C) using an otoscope for visualization. D) palpating the nose and septum. Answer: A Diff: 2 Page Ref: 107 Standard: Assessment (Secondary Assessment) Objective: 6

9) One sign of gonorrhea in males is a(n): A) profuse, yellow discharge. B) white, curdlike discharge. C) scant, clear discharge. D) external pustule. Answer: A Diff: 1 Page Ref: 134 Standard: Assessment (Secondary Assessment) Objective: 6 10) During a musculoskeletal exam, you find redness of the skin over a nontraumatized joint. Which of the following is LEAST likely to be the cause? A) Rheumatic fever B) Dislocation C) Gout D) Arthritis Answer: B Diff: 2 Page Ref: 136 Standard: Assessment (Secondary Assessment) Objective: 9 11) During the abdominal exam, areas that are known to be painful or tender should be examined: A) only by a physician. B) at the beginning and end of the exam. C) first. D) last. Answer: D Diff: 1 Page Ref: 129 Standard: Assessment (Secondary Assessment) Objective: 6 12) Discoloration over the umbilicus, known as ________ sign, is a(n) ________ indicator of intraabdominal bleeding. A) Cullen's; late B) Grey Turner's; early C) Grey Turner's; late D) Cullen's; early Answer: A Diff: 2 Page Ref: 129-130 Standard: Assessment (Secondary Assessment) Objective: 6

13) Which of the following best describes the technique of evaluating plantar reflexes? A) Have the patient dorsiflex the foot, then strike the Achilles tendon. B) Stroke the lateral aspect of the sole of the foot from heel to ball, curving medially. C) Tap the patellar tendon just below the edge of the patella. D) Strike the triceps along the posterior aspect of the distal humerus. Answer: B Diff: 2 Page Ref: 164 Standard: Assessment (Secondary Assessment) Objective: 6 14) To check for symmetrical chest expansion, you should place your hands on the patient's chest, with the thumbs resting on the ________, and ask the patient to inhale. A) costal margins B) nipples C) clavicles D) lateral chest wall Answer: A Diff: 2 Page Ref: 117 Standard: Assessment (Secondary Assessment) Objective: 6 15) Your patient is complaining of numbness and hand pain that wakes him. Of the following, which is most likely? A) Carpal tunnel syndrome B) Chondromalacia C) Bursitis D) Plantar fasciitis Answer: A Diff: 1 Page Ref: 138 Standard: Assessment (Secondary Assessment) Objective: 6 16) Which of the following findings is abnormal in a cardiovascular assessment? A) Splitting of the S2 heart sound in children B) Vibrations when palpating the carotid artery C) Jugular venous distension in the supine position D) Visible pulsation of the PMI at the fifth intercostal space, medial to the left midclavicular line Answer: B Diff: 2 Page Ref: 123 Standard: Assessment (Secondary Assessment) Objective: 6

17) All of the following characteristics indicate a normal appearance to oral mucosa EXCEPT: A) smooth. B) patches of white. C) pink. D) moist. Answer: B Diff: 1 Page Ref: 89, 109 Standard: Assessment (Secondary Assessment) Objective: 6 18) You have just percussed the patient's chest and heard a loud, booming, low-pitched sound. This indicates: A) atelectasis. B) a normal lung field. C) a hypoinflated lung field. D) a hyperinflated lung field. Answer: D Diff: 2 Page Ref: 75 Standard: Assessment (Secondary Assessment) Objective: 4 19) A condition marked by exaggerated lumbar concavity is called: A) scoliosis. B) lordosis. C) kyphosis. D) spondylosis. Answer: B Diff: 1 Page Ref: 153 Standard: Assessment (Secondary Assessment) Objective: 6 20) A light, popping, nonmusical sound heard upon auscultation of the lungs is best described as: A) wheezing. B) crackles. C) stridor. D) rhonchi. Answer: B Diff: 1 Page Ref: 115-117 Standard: Assessment (Secondary Assessment) Objective: 4

21) You can test the oculomotor, trochlear, and abducens nerves by: A) shining a light into the pupils and observing constriction of the pupils. B) conducting a visual acuity test. C) evaluating the patient's extraocular movements. D) closing one nostril while presenting a strong smell under the other nostril. Answer: C Diff: 2 Page Ref: 156-157 Standard: Assessment (Secondary Assessment) Objective: 6 22) A patient who loses his balance while standing with his eyes closed and feet together for 20 to 30 seconds is exhibiting a positive: A) tilt test. B) Babinski's reflex. C) Romberg test. D) Kehr's sign. Answer: C Diff: 2 Page Ref: 161 Standard: Assessment (Secondary Assessment) Objective: 3 23) By placing the tip of the index finger in the depression in front of the tragus and asking the patient to open his mouth, the paramedic can evaluate the: A) zygomatic arch. B) sphenoid bone. C) temporomandibular joint. D) external auditory canal. Answer: C Diff: 2 Page Ref: 97 Standard: Assessment (Secondary Assessment) Objective: 6 24) You are examining a 70-year-old female patient with altered mental status. She is awake and can speak. You detect an odor of acetone and suspect that the patient is suffering from: A) cyanide poisoning. B) alcohol poisoning. C) bowel obstruction. D) diabetic ketoacidosis. Answer: D Diff: 2 Page Ref: 111 Standard: Assessment (Secondary Assessment) Objective: 7

25) Increased fremitus over part of the patient's chest wall may indicate: A) pneumonia. B) emphysema. C) pleural effusion. D) pneumothorax. Answer: A Diff: 2 Page Ref: 115 Standard: Assessment (Secondary Assessment) Objective: 2 26) To avoid the carotid sinus, you should palpate for a carotid pulse at the level of: A) Terry's point. B) the cricoid cartilage. C) the sternocleidomastoid muscle. D) carotid bifurcation. Answer: B Diff: 1 Page Ref: 123 Standard: Assessment (Secondary Assessment) Objective: 5 27) The standard sequence for examining the chest is: A) palpate, percuss, auscultate, inspect. B) inspect, palpate, auscultate, percuss. C) inspect, palpate, percuss, auscultate. D) inspect, auscultate, percuss, palpate. Answer: C Diff: 2 Page Ref: 115-116 Standard: Assessment (Secondary Assessment) Objective: 3 28) Which of the following findings is NOT a sign of peritoneal irritation? A) Abdominal pain when the patient coughs B) Rebound tenderness C) Abdominal pain upon light palpation D) DeLorenzo's sign Answer: D Diff: 1 Page Ref: 131-132 Standard: Assessment (Secondary Assessment) Objective: 6

29) Select the choice below that best describes the sequence of a joint examination. 1. Palpation 2. Passive range of motion 3. Range of motion against resistance 4. Range of motion against gravity 5. Inspection A) 5, 1, 2, 4, 3 B) 5, 2, 1, 3, 4 C) 2, 3, 4, 5, 1 D) 1, 5, 2, 4, 3 Answer: A Diff: 2 Page Ref: 135-137 Standard: Assessment (Secondary Assessment) Objective: 6 30) During a neurologic exam, you ask your patient to stick out his tongue. It deviates to the right. This may indicate a lesion to the patient's ________ nerve. A) vagus B) glossopharyngeal C) facial D) hypoglossal Answer: D Diff: 1 Page Ref: 158 Standard: Assessment (Secondary Assessment) Objective: 6 31) Which of the following guidelines should be observed when examining a one- to three-yearold child? A) Restrain the child if necessary. B) Do not distract the toddler with toys. C) Do the most invasive procedure first in order to get it out of the way. D) Focus on the vital areas as indicated by the chief complaint. Answer: D Diff: 1 Page Ref: 77 Standard: Assessment (Secondary Assessment) Objective: 7 32) Jugular venous pressure approximates the patient's ________ pressure. A) left atrial B) right ventricular C) left ventricular D) right atrial Answer: D Diff: 2 Page Ref: 123 Standard: Assessment (Secondary Assessment) Objective: 6 42 Copyright © 2017 Pearson Education, Inc.

33) Assessing for bronchophony is important if the patient has abnormal or absent lung sounds because its presence can reveal: A) tension pneumothorax. B) breathing obstruction. C) emphysema. D) fluid in the lungs. Answer: D Diff: 2 Page Ref: 117 Standard: Assessment (Secondary Assessment) Objective: 6 34) Heart sound S2 may be heard at the end of systole by auscultating over the ________ intercostal space. A) second B) sixth C) first D) fifth Answer: A Diff: 2 Page Ref: 123 Standard: Assessment (Secondary Assessment) Objective: 4 35) The fourth heart sound, S4, is: A) an atrial gallop sound. B) a ventricular gallop sound. C) a high-pitched sound at the base of the heart. D) the "dub" of "dee-lub-dub." Answer: A Diff: 2 Page Ref: 123 Standard: Assessment (Secondary Assessment) Objective: 4 36) A scalp condition marked by mild flaking of skin is known as: A) psoriasis. B) dandruff. C) seborrheic dermatitis. D) hirsutism. Answer: B Diff: 1 Page Ref: 94 Standard: Assessment (Secondary Assessment) Objective: 6

37) The loss of muscle tone results in: A) rigidity. B) spasticity. C) paresthesia. D) flaccidity. Answer: D Diff: 1 Page Ref: 161 Standard: Assessment (Secondary Assessment) Objective: 1 38) Using an otoscope, you can examine the patient for ________ and ________. A) tympanic membrane rupture; color changes B) cranial nerve VIII function; basilar skull fracture C) otitis; mastoiditis D) tinnitus; eustachian tube blockage Answer: A Diff: 1 Page Ref: 104 Standard: Assessment (Secondary Assessment) Objective: 6 39) Dullness in the chest during percussion of the third to fifth intercostal spaces can be attributed to the location of the: A) spleen. B) heart. C) stomach. D) liver. Answer: B Diff: 1 Page Ref: 118 Standard: Assessment (Secondary Assessment) Objective: 4 40) When evaluating dorsiflexion, you should instruct the patient to point his: A) foot upward. B) hand downward. C) foot downward. D) hand upward. Answer: A Diff: 2 Page Ref: 145-147 Standard: Assessment (Secondary Assessment) Objective: 1

41) Which of the following is an abnormal finding of the pupils? A) Constriction when focusing on a near object B) Both pupils constricting when a penlight is shone in one eye C) Slow but equal reaction to light D) Less than 2 mm difference in size with normal reaction to light Answer: C Diff: 2 Page Ref: 101 Standard: Assessment (Secondary Assessment) Objective: 2 42) The condition of the nail bed caused by chronic hypoxia associated with cardiopulmonary diseases is called: A) Terry's nails. B) onycholysis. C) clubbing. D) paronychia. Answer: C Diff: 1 Page Ref: 95 Standard: Assessment (Secondary Assessment) Objective: 6 43) Your patient was in a motor vehicle collision but was not discovered until 3 hours after the event. When you examine her, you discover bilateral discolored skin over the mastoid process. You should suspect: A) temporal bone fracture. B) frontal bone fracture. C) basilar skull fracture. D) a fractured sinus. Answer: C Diff: 2 Page Ref: 97 Standard: Assessment (Secondary Assessment) Objective: 6 44) While assessing a 23-year-old man with abdominal pain, you note discoloration around the umbilicus. This is known as: A) ascites. B) borborygmi. C) Kernig's sign. D) Cullen's sign. Answer: D Diff: 1 Page Ref: 129-130 Standard: Assessment (Secondary Assessment) Objective: 6

45) Pleural effusion is characterized by the presence of: A) fluid in the pleural space. B) atelectasis in the affected area. C) secretions in large airways. D) increased friction between the pleural layers. Answer: A Diff: 2 Page Ref: 117 Standard: Assessment (Secondary Assessment) Objective: 6 46) A loud, harsh sound over the trachea on auscultation with a stethoscope suggests: A) bronchoconstriction. B) normal air movement. C) pneumothorax. D) foreign body obstruction. Answer: B Diff: 2 Page Ref: 115 Standard: Assessment (Secondary Assessment) Objective: 4 47) Skin color is best evaluated by observing the: A) limbs and torso. B) dorsum of the hand. C) nail beds and conjunctiva. D) face. Answer: C Diff: 1 Page Ref: 90 Standard: Assessment (Secondary Assessment) Objective: 6 48) Palpation and inspection of the point of maximal impulse can reveal certain conditions, such as: A) pneumothorax. B) enlarged right ventricle. C) coronary insufficiency. D) cardiac tamponade. Answer: B Diff: 1 Page Ref: 123 Standard: Assessment (Secondary Assessment) Objective: 4

49) Cyanosis is caused by increased: A) methemoglobin. B) oxyhemoglobin. C) carboxyhemoglobin. D) deoxyhemoglobin. Answer: D Diff: 2 Page Ref: 90 Standard: Assessment (Secondary Assessment) Objective: 6 50) Moving a finger in an "H" pattern in front of your patient's eyes tests: A) accommodation. B) extraocular muscles. C) visual acuity. D) corneal reflex. Answer: B Diff: 2 Page Ref: 100 Standard: Assessment (Secondary Assessment) Objective: 6 51) Which of the following sounds is produced when the tricuspid and mitral valves close during systole? A) S4 B) S3 C) S1 D) S2 Answer: C Diff: 2 Page Ref: 122 Standard: Assessment (Secondary Assessment) Objective: 4 52) Which of the following is a normal finding when examining a patient's neck? A) Tracheal tugging B) Visible lymph nodes C) Subcutaneous emphysema D) Movement of the thyroid gland during swallowing Answer: D Diff: 1 Page Ref: 111-112 Standard: Assessment (Secondary Assessment) Objective: 6

53) Nasal flaring is an indication of: A) dysfunction of cranial nerve I. B) respiratory distress. C) hypoxia. D) rhinitis. Answer: B Diff: 1 Page Ref: 107 Standard: Assessment (Secondary Assessment) Objective: 6 54) Which of the following best describes the technique of percussion? A) Using a reflex hammer to produce vibrations B) Pressing the bell of the stethoscope against the skin C) Shining a penlight into the ear to see the eardrum D) Striking the knuckle of one hand with the tip of a finger on the opposite hand Answer: D Diff: 1 Page Ref: 75 Standard: Assessment (Secondary Assessment) Objective: 3 55) For you to assess for jugular venous distention, your patient should be ________ at a ________-degree angle. A) sitting; 90 B) sitting; 45 C) supine; 45 D) standing; 90 Answer: B Diff: 2 Page Ref: 111 Standard: Assessment (Secondary Assessment) Objective: 5 56) Which of the following is LEAST important to the paramedic when evaluating a patient's skin in an emergency situation? A) Color B) Temperature C) Pigmentation D) Moisture Answer: C Diff: 2 Page Ref: 90 Standard: Assessment (Secondary Assessment) Objective: 5

57) The sounds auscultated when assessing the blood pressure are the ________ sounds. A) Kobileski B) Korotkoff C) Kunzlemann D) Kernig's Answer: B Diff: 1 Page Ref: 85 Standard: Assessment (Secondary Assessment) Objective: 4 58) To test an extremity for pain sensation, you should: A) use a sharp object, and have the patient tell you if he feels a sharp or dull sensation. B) firmly pinch a fold of skin over the most sensitive part of the extremity. C) stroke the extremity in a distal-to-proximal direction. D) briskly tap the tendon of the elbow or knee. Answer: A Diff: 2 Page Ref: 162 Standard: Assessment (Secondary Assessment) Objective: 6 59) Which of the following best describes the correct positioning of a patient for an abdominal exam? A) Lateral recumbent B) Supine with the head flat and legs extended C) Semi-Fowler's position D) Supine with the head and knees supported by pillows Answer: D Diff: 1 Page Ref: 129 Standard: Assessment (Secondary Assessment) Objective: 6 60) Which of the following best describes the technique for palpating the abdomen for large or deep masses? A) One hand pushing deeply in a quick, smooth motion B) One finger pressing firmly against the abdominal wall C) One hand over another, pushing down slowly D) Both hands side by side over the midline of the abdomen Answer: C Diff: 1 Page Ref: 132 Standard: Assessment (Secondary Assessment) Objective: 3

61) While you are assessing for Babinski's response, the patient's big toe dorsiflexes and the other toes fan out. This indicates a ________ response, which is ________. A) negative; normal B) positive; abnormal C) negative; abnormal D) positive; normal Answer: B Diff: 2 Page Ref: 164 Standard: Assessment (Secondary Assessment) Objective: 6 62) Using your sense of touch to gather information about the patient's condition is called: A) auscultation. B) percussion. C) palpation. D) inspection. Answer: C Diff: 1 Page Ref: 74 Standard: Assessment (Secondary Assessment) Objective: 1 63) A patient experienced a brief loss of consciousness following a blow to the head. During your questioning, she describes a series of events that do not match what observers had noted before the trauma. This might be an example of: A) delusion. B) incoherence. C) mania. D) confabulation. Answer: D Diff: 1 Page Ref: 80 Standard: Assessment (Secondary Assessment) Objective: 1 64) A patient who is misinterpreting what is happening is experiencing a(n): A) paresthesia. B) hallucination. C) delusion. D) illusion. Answer: D Diff: 2 Page Ref: 80 Standard: Assessment (Secondary Assessment) Objective: 1

65) Which of the following is included in examination of the mouth? A) Palpating the uvula B) Removing dentures C) Visualizing the larynx D) Looking under the tongue Answer: D Diff: 1 Page Ref: 110 Standard: Assessment (Secondary Assessment) Objective: 5 66) A condition that makes posterior chest and lung examination difficult is thoracic: A) kyphoscoliosis. B) spondylosis. C) ankylosis. D) lordosis. Answer: A Diff: 1 Page Ref: 114 Standard: Assessment (Secondary Assessment) Objective: 6 67) Which of the following best describes the pulse pressure? A) The difference between systolic and diastolic blood pressures B) The diastolic pressure plus one-third of systolic pressure C) The sum of systolic and diastolic blood pressures D) The systolic pressure minus one-third of the diastolic pressure Answer: A Diff: 1 Page Ref: 86 Standard: Assessment (Secondary Assessment) Objective: 1 68) Shining a light onto the iris from the lateral side could cause a crescent-shaped shadow on the medial side if the patient is suffering from: A) hemianopsia. B) glaucoma. C) retinal artery occlusion. D) anisocoria. Answer: B Diff: 2 Page Ref: 101 Standard: Assessment (Secondary Assessment) Objective: 6

69) Areas of a neurologic exam include all of the following EXCEPT: A) mental status and speech. B) reflexes. C) cranial nerves. D) cranium. Answer: D Diff: 1 Page Ref: 155 Standard: Assessment (Secondary Assessment) Objective: 6 70) You are assessing a 34-year-old female patient who appears to be in hypovolemic shock. You would expect her pulse to be: A) bradycardic and irregular. B) tachycardic and weak. C) tachycardic and bounding. D) bradycardic and strong. Answer: B Diff: 1 Page Ref: 85 Standard: Assessment (Secondary Assessment) Objective: 9 71) During the cardiac cycle, the S2 heart sound indicates the ________ of the ________ valves. A) closing; mitral and tricuspid B) opening; aortic and pulmonic C) opening; mitral and tricuspid D) closing; aortic and pulmonic Answer: D Diff: 2 Page Ref: 122 Standard: Assessment (Secondary Assessment) Objective: 6 72) When checking for skin turgor, you should: A) gently pick up a fold of skin, then release it. B) use the back of your hand to determine temperature. C) press the nail beds, then release. D) palpate the skin for flaking. Answer: A Diff: 2 Page Ref: 90 Standard: Assessment (Secondary Assessment) Objective: 5

73) A tear in the tracheobronchial tree or a pneumothorax can be characterized by ________ in the neck. A) swollen lymph nodes B) jugular venous distention C) mediastinal deviation D) subcutaneous emphysema Answer: D Diff: 2 Page Ref: 112 Standard: Assessment (Secondary Assessment) Objective: 6 74) To inspect and examine the anus, a paramedic should place the patient in the ________ position. A) supine B) left lateral recumbent C) kneeling D) prone Answer: B Diff: 1 Page Ref: 134 Standard: Assessment (Secondary Assessment) Objective: 5 75) The crunching sound that is made when unlubricated skeletal parts rub against each other is called: A) a synovial rub. B) bursal friction. C) crepitus. D) a pleural friction rub. Answer: C Diff: 1 Page Ref: 137 Standard: Assessment (Secondary Assessment) Objective: 1 76) When auscultating the posterior chest, you should listen: A) only at the apices. B) only at the bases. C) down one side first, then the other. D) from side to side as you proceed down the chest. Answer: D Diff: 1 Page Ref: 114 Standard: Assessment (Secondary Assessment) Objective: 3

77) A 23-year-old female patient is complaining of lower abdominal and genital pain. Upon examination you find a white, curdlike vaginal discharge. This is most typical of: A) Gardnerella. B) gonorrhea. C) candidiasis. D) herpes simplex. Answer: C Diff: 1 Page Ref: 133 Standard: Assessment (Secondary Assessment) Objective: 9 78) Components of a general survey include all of the following EXCEPT: A) cardiac monitoring. B) blood pressure. C) medical history. D) the patient's appearance. Answer: C Diff: 1 Page Ref: 77 Standard: Assessment (Secondary Assessment) Objective: 5 79) When you ask the patient to puff out her cheeks, show her upper and lower teeth, and raise her eyebrows, which cranial nerve are you evaluating? A) VI B) V C) VII D) IX Answer: C Diff: 2 Page Ref: 158 Standard: Assessment (Secondary Assessment) Objective: 6 80) During ventricular systole, the ventricles contract while the: A) foramen ovale opens. B) tricuspid and mitral valves open. C) pulmonic and aortic semilunar valves close. D) tricuspid and mitral valves close. Answer: D Diff: 2 Page Ref: 122 Standard: Assessment (Secondary Assessment) Objective: 6

81) You respond to a patient complaining of lower abdominal pain. Upon your arrival, you find a 25-year-old man who also complains of groin pain. After inspecting the penis and scrotum, your next step would be to: A) inspect the glans. B) lift the scrotum and inspect for swelling or lumps. C) palpate the testicles. D) take a urine sample. Answer: A Diff: 1 Page Ref: 134 Standard: Assessment (Secondary Assessment) Objective: 3 82) When evaluating any patient's genitalia, a paramedic must always: A) maintain privacy. B) use a lubricant. C) be of the same gender as the patient. D) perform a rectal exam, as well. Answer: A Diff: 1 Page Ref: 133-134 Standard: Assessment (Secondary Assessment) Objective: 6 83) A 45-year-old patient presents with abdominal pain in the right lower quadrant. Upon auscultation of bowel sounds, you hear high-pitched gurgles and clicks lasting around 10 seconds. This patient may have: A) normal sounds. B) hyperperistalsis. C) borborygmi. D) paralytic ileus. Answer: A Diff: 1 Page Ref: 130 Standard: Assessment (Secondary Assessment) Objective: 6 84) A complete neurologic exam includes assessment of mental status and speech, the motor and sensory systems, reflexes, and the: A) speed of peripheral nervous conduction. B) tympanic membrane. C) cranial nerves. D) visual acuity. Answer: C Diff: 1 Page Ref: 155 Standard: Assessment (Secondary Assessment) Objective: 6

85) Normal pediatric respiratory and heart rates ________ as children grow older. A) stay the same B) decrease C) increase D) increase, then decrease Answer: B Diff: 1 Page Ref: 118 Standard: Assessment (Secondary Assessment) Objective: 7 86) You are examining a 50-year-old male patient complaining of a fever. You inspect the tympanic membrane and note that it is a pearly, translucent gray color. You conclude that the patient has: A) otitis media. B) hemotympanum. C) a buildup of fluid behind the eardrum. D) a normal eardrum. Answer: D Diff: 2 Page Ref: 104 Standard: Assessment (Secondary Assessment) Objective: 9 87) Rales, or crackles, would be most typically auscultated in patients with which of the following conditions? A) Pulmonary embolus B) Congestive heart failure C) Asthma D) Pneumonia Answer: B Diff: 1 Page Ref: 117 Standard: Assessment (Secondary Assessment) Objective: 4 88) A patient who is experiencing dysphonia: A) has defective language caused by neurological damage. B) has defective speech caused by motor deficits. C) is speaking clearly and normally. D) has voice changes secondary to vocal cord problems. Answer: D Diff: 1 Page Ref: 80 Standard: Assessment (Secondary Assessment) Objective: 1

89) An elderly man is complaining of shortness of breath. You discover pitting edema that is 0.5 to 1 inch deep. This is ________ pitting edema. A) +2 B) +4 C) +1 D) +3 Answer: D Diff: 1 Page Ref: 127 Standard: Assessment (Secondary Assessment) Objective: 7 90) You are examining a patient's face. Upon observing the eyes, you notice a droop in the eyelids. This condition is known as: A) nystagmus. B) apoptosis. C) anisocoria. D) ptosis. Answer: D Diff: 1 Page Ref: 158 Standard: Assessment (Secondary Assessment) Objective: 1 91) Which of the following body systems would you gain the least information about during an abdominal exam? A) Musculoskeletal B) Reproductive C) Cardiovascular D) Digestive Answer: A Diff: 1 Page Ref: 127-132 Standard: Assessment (Secondary Assessment) Objective: 6 92) Pain or tenderness on palpation of the tragus could suggest: A) Ménière's disease. B) mastoiditis. C) cerumen impaction. D) perforated tympanic membrane. Answer: B Diff: 1 Page Ref: 104 Standard: Assessment (Secondary Assessment) Objective: 6

93) While speaking, your patient shifts rapidly from topic to topic without realizing that his thoughts are not connected. This might be a sign of any of the following conditions EXCEPT: A) psychosis. B) schizophrenia. C) manic episodes. D) depression. Answer: D Diff: 1 Page Ref: 80 Standard: Assessment (Secondary Assessment) Objective: 6 94) A person who has a visual acuity test result of 20/100 can see at ________ feet what a normal person sees at ________ feet. A) 10; 2 B) 20; 100 C) 100; 20 D) 100; 100 Answer: B Diff: 2 Page Ref: 99 Standard: Assessment (Secondary Assessment) Objective: 5 95) Lesions found on the lips may indicate: A) dehydration. B) anemia. C) allergic reaction. D) skin cancer. Answer: D Diff: 1 Page Ref: 109 Standard: Assessment (Secondary Assessment) Objective: 6 96) What procedure can you perform to determine additional signs of carpal tunnel syndrome? A) Ask the patient to extend his fingers forward for 60 seconds. B) Hold the patient's wrist in acute extension for 60 seconds. C) Ask the patient to gently wave his wrists for 60 seconds. D) Hold the patient's wrist in acute flexion for 60 seconds. Answer: D Diff: 1 Page Ref: 138 Standard: Assessment (Secondary Assessment) Objective: 8

97) Which of the following statements is FALSE regarding the S3 heart sound? A) It is commonly heard in children. B) It is a high-pitched sound heard at the end of diastole. C) It is the "dee" part of the "lub-dub-dee" cadence. D) It can develop with ventricular failure or ventricular volume overload. Answer: B Diff: 2 Page Ref: 123 Standard: Assessment (Secondary Assessment) Objective: 4 98) The hard and soft palates are normally colored ________ and ________, respectively. A) white; pink B) pink; white C) white; white D) pink; pink Answer: A Diff: 1 Page Ref: 110 Standard: Assessment (Secondary Assessment) Objective: 6 99) You are sent to the home of an insulin-dependent diabetic female patient. You ask her to state her name, the month, and her address. This would be an example of assessing the patient's: A) memory and attention. B) general fund of knowledge. C) judgment. D) mood. Answer: A Diff: 2 Page Ref: 80-81 Standard: Assessment (Secondary Assessment) Objective: 9 100) The technique of ________ involves careful, noninvasive, informed observation. A) auscultation B) percussion C) inspection D) palpation Answer: C Diff: 1 Page Ref: 73-74 Standard: Assessment (Secondary Assessment) Objective: 3

Chapter 6 Patient Monitoring Technology 1) Which of the following is NOT analyzed in arterial blood gas tests? A) SaO2 B) PaO2 C) pCO2 D) O2 Answer: D Diff: 1 Page Ref: 214 Standard: Assessment (Monitoring Devices) Objective: 11 2) You are working in the ED, caring for a 55-year-old female patient with a long history of COPD. She is more short of breath today than usual, and states that 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; when the report comes back, it shows that the patient has a PaO2 of 92 mmHg. Which of the following 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: 214 Standard: Assessment (Monitoring Devices) Objective: 13 3) An arterial blood gas analysis includes all of the following EXCEPT: A) perfusion. B) ventilation. C) electrolyte balance. D) acid-base balance. Answer: C Diff: 3 Page Ref: 214 Standard: Assessment (Monitoring Devices) Objective: 11 4) 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: 193 Standard: Assessment (Monitoring Devices) Objective: 4

5) Your patient is a 44-year-old woman, alert and oriented, in moderate distress and complaining of difficulty breathing. She gives a one-week history of fever and malaise, with shortness of breath developing three days ago. She also has left-sided chest pain with deep inspiration and a "phlegmy" cough. Physical examination reveals hot, pale, dry skin, and rhonchi and crackles throughout the left lung. The right lung sounds are clear. HR = 134, BP = 88/64, RR = 24, SaO2 = 92%. She has a history of two previous myocardial infarctions and takes nitroglycerin as needed. Which of the following is the best course of prehospital management? A) Endotracheal intubation, ventilation with supplemental oxygen, nebulized albuterol and Atrovent, and corticosteroids IV B) Albuterol via nebulizer with 100 percent oxygen C) Oxygen via nonrebreather mask D) Oxygen via CPAP Answer: C Diff: 3 Page Ref: 193 Standard: Assessment (Monitoring Devices) Objective: 13 6) 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: 194 Standard: Assessment (Monitoring Devices) Objective: 5 7) ETCO2 is recorded during phase ________ of the capnogram. A) I B) II C) III D) IV Answer: C Diff: 2 Page Ref: 195 Standard: Assessment (Monitoring Devices) Objective: 5

8) Your patient is a 62-year-old woman with a history of COPD. She is slightly more short of breath than usual today. She is alert and speaks three to four words between breaths. Her SpO2 is 93 percent on room air. Which of the following devices should be used for the administration of oxygen to this patient? A) Nonrebreather mask B) Nasal cannula C) CPAP D) BVM Answer: B Diff: 2 Page Ref: 197 Standard: Assessment (Monitoring Devices) Objective: 5 9) 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. What is the best way to interpret this finding? 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: A Diff: 3 Page Ref: 193 Standard: Assessment (Monitoring Devices) Objective: 13 10) In which of the following situations 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: 198 Standard: Assessment (Monitoring Devices) Objective: 6

11) 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: 198 Standard: Assessment (Monitoring Devices) Objective: 6 12) 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 mmHg, and the patient is afebrile. These findings are most consistent with: A) allergic reaction to codeine. B) COPD 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: 212 Standard: Assessment (Monitoring Devices) Objective: 13 13) A male patient with an acute exacerbation of his emphysema presents in severe distress with decreased air movement and diffuse inspiratory wheezes in all fields. HR = 132, BP = 142/88, RR =30, SaO2 = 88%. Which of the following blood gas values is most likely? A) pH of 7.6 B) PO2 of 100 mmHg C) PCO2 of 70 mmHg D) PCO2 of 35 mmHg Answer: C Diff: 2 Page Ref: 214 Standard: Assessment (Monitoring Devices) Objective: 11

14) The greater the concentration of hydrogen ions in arterial blood, the ________ the pH. A) more erratic B) higher C) more dangerous D) lower Answer: D Diff: 2 Page Ref: 214 Standard: Assessment (Monitoring Devices) Objective: 11 15) 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 that 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 action? 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: 198 Standard: Assessment (Monitoring Devices) Objective: 6 16) Lung perfusion depends on all of the following 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: 181 Standard: Assessment (Monitoring Devices) Objective: 4 17) Which of the following statements 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) It may be difficult to obtain a reading in patients experiencing peripheral vasoconstriction. Answer: B Diff: 1 Page Ref: 191 Standard: Assessment (Monitoring Devices) Objective: 4 64 Copyright © 2017 Pearson Education, Inc.

18) 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: 193 Standard: Assessment (Monitoring Devices) Objective: 4 19) Conditions that can cause an inaccurate pule oximetry ready include all EXCEPT? A) The presence of methemoglobinemia B) Hyperfusion C) Anemia D) Shivering Answer: B Diff: 2 Page Ref: 192 Standard: Assessment (Monitoring Devices) Objective: 4 20) The valve between the right atrium and right ventricle is the ________ valve. A) bicuspid B) pulmonic C) tricuspid D) aortic Answer: C Diff: 1 Page Ref: 175 Standard: Assessment (Monitoring Devices) Objective: 1 21) 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: 175 Standard: Assessment (Monitoring Devices) Objective: 3

22) The presence of inverted T waves on an ECG indicates: A) myocardial infarction. B) myocardial necrosis. C) myocardial ischemia. D) myocardial instability. Answer: C Diff: 2 Page Ref: 188 Standard: Assessment (Monitoring Devices) Objective: 3 23) 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: 178 Standard: Assessment (Monitoring Devices) Objective: 2 24) 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: 178 Standard: Assessment (Monitoring Devices) Objective: 2 25) Which of the following endocrine substances acts as a marker for congestive heart failure? A) BNP B) Angiotensin C) ACTH D) Troponin Answer: A Diff: 1 Page Ref: 211 Standard: Assessment (Monitoring Devices) Objective: 10

26) To detect life-threatening cardiac dysrhythmias, the paramedic must view the ECG in ________ lead(s). A) two B) one C) three D) twelve Answer: B Diff: 1 Page Ref: 177 Standard: Assessment (Monitoring Devices) Objective: 2 27) The total duration of ventricular depolarization is represented by the ________ on the ECG. A) QRS duration B) QT interval C) PQ interval D) R-R interval Answer: A Diff: 2 Page Ref: 178-179 Standard: Assessment (Monitoring Devices) Objective: 2 28) Which of the following 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 significant only in the presence of chest pain. Answer: C Diff: 2 Page Ref: 183 Standard: Assessment (Monitoring Devices) Objective: 2 29) The anterior surface of the heart is best viewed by ECG leads: A) II, III, aVF. B) V1-V4. C) I, aVL. D) aVR, aVL, aVF. Answer: B Diff: 2 Page Ref: 187-188 Standard: Assessment (Monitoring Devices) Objective: 3

30) Which of the following is affected by a properly working pacemaker? A) Automaticity B) Stroke volume C) Cardiac rhythm D) Ejection fraction Answer: C Diff: 2 Page Ref: 180 Standard: Assessment (Monitoring Devices) Objective: 2 31) An ECG monitor is useful for: A) determining cardiac output. B) evaluating the heart's electrical conduction system for abnormalities. C) determining stroke volume. D) evaluating the effectiveness of cardiac contractions. Answer: B Diff: 1 Page Ref: 176 Standard: Assessment (Monitoring Devices) Objective: 2 32) Which of the following 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: 175 Standard: Assessment (Monitoring Devices) Objective: 2 33) Your patient is a 73-year-old man 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 the following 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: B Diff: 2 Page Ref: 196 Standard: Assessment (Monitoring Devices) Objective: 13

34) The QRS complex represents: A) ventricular depolarization. B) atrial repolarization. C) atrial depolarization. D) ventricular repolarization. Answer: A Diff: 1 Page Ref: 179 Standard: Assessment (Monitoring Devices) Objective: 2 35) 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: 187 Standard: Assessment (Monitoring Devices) Objective: 3 36) The SA and AV nodes are perfused by the ________ artery. A) anterior descending B) right coronary C) left coronary D) circumflex coronary Answer: B Diff: 1 Page Ref: 183 Standard: Assessment (Monitoring Devices) Objective: 2 37) The mitral valve is open during: A) systole. B) cardiac standstill. C) diastole. D) repolarization. Answer: C Diff: 1 Page Ref: 175 Standard: Assessment (Monitoring Devices) Objective: 2

38) Which of the following 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: 175-176 Standard: Assessment (Monitoring Devices) Objective: 2 39) 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 the following? 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 right ventricle. D) The patient is experiencing ischemia and injury in her left ventricle and septum. Answer: C Diff: 3 Page Ref: 183 Standard: Assessment (Monitoring Devices) Objective: 3 40) 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: 183 Standard: Assessment (Monitoring Devices) Objective: 3

41) On a properly calibrated ECG machine, 1 mV is equivalent to a height of ________ boxes. A) five small B) ten small C) one large D) four large Answer: B Diff: 1 Page Ref: 178 Standard: Assessment (Monitoring Devices) Objective: 3 42) Which of the following is LEAST urgent when evaluating a patient suspected of suffering an acute myocardial infarction? A) Blood pressure B) ECG C) Pulse oximetry D) Breath sounds Answer: C Diff: 3 Page Ref: 182 Standard: Assessment (Monitoring Devices) Objective: 13 43) Which of the following is a traumatic mechanism by which a myocardial injury can be produced? A) Blunt chest trauma B) Penetrating chest trauma C) Traumatic brain injury D) Rapid deceleration Answer: A Diff: 1 Page Ref: 189 Standard: Assessment (Monitoring Devices) Objective: 13 44) A 12-lead ECG that reveals ST elevation in all of the precordial leads most indicates myocardial: A) injury to the right ventricle, left ventricle, and septum. B) injury to the right ventricle and septum. C) infarction to the left and right ventricles. D) ischemia to the left ventricle and septum. Answer: A Diff: 3 Page Ref: 183 Standard: Assessment (Monitoring Devices) Objective: 3

45) Which of the following can be determined by lead II cardiac monitoring? A) Positive deflection B) Chamber enlargement C) Axis deviation D) Presence of a myocardial infarction, but not its location Answer: A Diff: 1 Page Ref: 177 Standard: Assessment (Monitoring Devices) Objective: 3 46) An action potential begins in a myocardial cell when ________ enters the cell, giving it a ________ charge. A) calcium; positive B) sodium; positive C) sodium; negative D) calcium; negative Answer: B Diff: 2 Page Ref: 175 Standard: Assessment (Monitoring Devices) Objective: 2 47) Slowing of the electrical impulse at the AV node is necessary to allow time for the ________ to fill with blood. A) coronary sinus B) coronary arteries C) ventricles D) atria Answer: C Diff: 2 Page Ref: 175 Standard: Assessment (Monitoring Devices) Objective: 1 48) At standard speed, a 1 mm box on ECG paper represents ________ seconds. A) 0.12 B) 0.04 C) 0.08 D) 0.1 Answer: B Diff: 1 Page Ref: 178 Standard: Assessment (Monitoring Devices) Objective: 2

49) Ventricular repolarization of the myocardium is represented by the: A) T wave. B) beginning of the QRS complex to the apex of the T wave. C) ST segment. D) isoelectric line. Answer: A Diff: 1 Page Ref: 179 Standard: Assessment (Monitoring Devices) Objective: 2 50) Artifacts such as muscle tremors can make assessment of cardiac rhythm difficult because: A) an artifact can obscure the underlying rhythm. B) an artifact can cause the pacer to fire prematurely. C) the pacemaker may confuse the artifact with an electrical impulse and not fire. D) the QRS complexes may be obscured by the pacer spikes. Answer: A Diff: 2 Page Ref: 182 Standard: Assessment (Monitoring Devices) Objective: 2 51) There are three large boxes between R waves on an ECG tracing. What is the heart rate? A) 50 B) 75 C) 150 D) 100 Answer: D Diff: 2 Page Ref: 179 Standard: Assessment (Monitoring Devices) Objective: 2 52) Which of the following arteries supplies blood primarily to the left ventricle and posterior wall? A) Right coronary B) Left coronary C) Posterior descending D) Marginal Answer: B Diff: 1 Page Ref: 183 Standard: Assessment (Monitoring Devices) Objective: 1

53) The middle tissue layer of the heart is the: A) epicardium. B) endocardium. C) myocardium. D) pericardium. Answer: C Diff: 1 Page Ref: 174 Standard: Assessment (Monitoring Devices) Objective: 1 54) The precordial leads provide a view of the: A) lateral plane of the heart, including part of the right ventricle, most of the left ventricle, and the septum. B) horizontal plane of the heart, including the right ventricle and right atrium. C) inferior portion of the heart, including the entire right ventricle. D) horizontal plane of the heart, including the left ventricle and septum. Answer: D Diff: 2 Page Ref: 186 Standard: Assessment (Monitoring Devices) Objective: 3 55) A 45-year-old man is alert and oriented, complaining of chest pain. He describes a two-day history of worsening pain, described as a burning sensation below his left breast that radiates across his chest. He states that the pain seems to get better right after eating, but then worsens again. Medical history includes myocardial infarction, hypertension, and type 2 diabetes. His medications include Inderal, Vasotech, Glucotrol, and Lopid. Physical examination reveals cool, dry skin; clear lungs; and no JVD or peripheral edema. HR = 102, BP = 132/86, RR = 12, SaO2 = 98%. The patient is on oxygen by nasal cannula at 4 liters per minute. Which of the following should be done next? A) Give 81 mg aspirin by mouth. B) Start precautionary IV of normal saline and transport. C) Give 0.4 mg nitroglycerin sublingually. D) Do a 12-lead ECG. Answer: D Diff: 3 Page Ref: 182 Standard: Assessment (Monitoring Devices) Objective: 13

56) Which of the following describes the ability of a cardiac cell to propagate the electrical impulse to another cell? A) Conductivity B) Contractility C) Excitability D) Automaticity Answer: A Diff: 1 Page Ref: 174 Standard: Assessment (Monitoring Devices) Objective: 1 57) When oxygen is not bound to the iron molecule of hemoglobin, the iron molecule is in the ferrous (Fe2+) charge state, rather than when oxygen changes the charge of iron to the ferric (Fe3+) state. A dangerous form of hemoglobin that is unable to oxidize is: A) methemoglobin (MetHb). B) deoxyhemoglobin (DeoHb). C) oxyhemoglobin (OxHb). D) carboxyhemoglobin (COxHb). Answer: A Diff: 1 Page Ref: 201 Standard: Assessment (Monitoring Devices) Objective: 7 58) A patient who has SpMet readings of 40 percent would be expected to have signs and symptoms of methemoglobinemia, such as: A) all signs and symptoms normal—asymptomatic. B) headache, dyspnea, confusion, weakness, and chest pain. C) cyanosis, but otherwise asymptomatic. D) fatality. Answer: B Diff: 1 Page Ref: 201 Standard: Assessment (Monitoring Devices) Objective: 7 59) The normal range of hemoglobin (Hb) levels in the adult male patient would be closest to: A) 9.9-14.5 g/dL. B) 9.9-14.5 mg/dL. C) 14-17.4 g/dL. D) 14-17.4 mg/dL. Answer: C Diff: 2 Page Ref: 204 Standard: Assessment (Monitoring Devices) Objective: 8

60) Which of the following cells released from the islets of Langerhans produce glucagon, which increases the blood glucose levels? A) Alpha cells B) Beta cells C) Gamma cells D) Delta cells Answer: A Diff: 2 Page Ref: 205 Standard: Assessment (Monitoring Devices) Objective: 9 61) Which of the following cells released from the islets of Langerhans produce insulin, which decreases the blood glucose levels? A) Alpha cells B) Beta cells C) Gamma cells D) Delta cells Answer: B Diff: 2 Page Ref: 205 Standard: Assessment (Monitoring Devices) Objective: 9 62) Which of the following cells released from the islets of Langerhans produce somatostatin, which inhibits production of glucagon and insulin? A) Alpha cells B) Beta cells C) Gamma cells D) Delta cells Answer: D Diff: 2 Page Ref: 205 Standard: Assessment (Monitoring Devices) Objective: 9 63) The color of the blood tube that is usually first in sequence for filling and is without an anticoagulant (used for blood typing and cross-matching) is: A) blue. B) green. C) red. D) gray. Answer: C Diff: 2 Page Ref: 208 Standard: Assessment (Monitoring Devices) Objective: 10

64) Which of the following cardiac enzymes and biomarkers is NOT measured and analyzed to help confirm a myocardial infarction? A) Creatine kinase (CK-II MB) B) Myoglobin C) Troponin I D) B-natriuretic peptide (BNP) Answer: D Diff: 2 Page Ref: 210-211 Standard: Assessment (Monitoring Devices) Objective: 10 65) Which of the following uses for ultrasound is NOT indicated in the prehospital setting? A) Suprapubic, to identify the outline of the urinary bladder and uterus B) Cardiac, to identify the cardiac wall motion and pericardial space C) Umbilical, to identify the gestation age and sex of the fetus D) Left upper quadrant, to identify the diaphragm and the spleen Answer: C Diff: 2 Page Ref: 215 Standard: Assessment (Monitoring Devices) Objective: 12 Chapter 7 Patient Assessment in the Field 1) Forming a general impression as part of your primary assessment helps you to: A) determine baseline mental status. B) determine general clinical status and priority. C) make a determination about stabilization of the cervical spine. D) estimate vital signs. Answer: B Diff: 2 Page Ref: 224 Standard: Assessment (Primary Assessment) Objective: 2

2) Which of the following is the sequence of steps when assessing a major trauma patient? 1. Secondary assessment 2. Primary assessment 3. Reconsider mechanism of injury 4. History 5. Vital signs 6. Detailed physical exam A) 2, 5, 3, 1, 4 B) 2, 3, 1, 5, 4 C) 2, 6, 5, 3, 4 D) 2, 1, 3, 4, 5 Answer: B Diff: 2 Page Ref: 225 Standard: Assessment (Primary Assessment) Objective: 2 3) A fast, systematic assessment designed to identify other life-threatening injuries after the primary assessment is the: A) 1-minute exam. B) rapid secondary assessment. C) focused physical exam. D) detailed physical exam. Answer: B Diff: 1 Page Ref: 227 Standard: Assessment (Secondary Assessment) Objective: 4 4) Which of the following statements best describes proper history-taking technique in the assessment of a major trauma patient? A) Perform the history before assessing the patient. B) Complete a rapid history by using the SAMPLE acronym. C) Collect a comprehensive health history. D) Medical history is not a significant issue in the trauma patient and can be skipped. Answer: B Diff: 1 Page Ref: 232 Standard: Assessment (Secondary Assessment) Objective: 4 5) Which of the following patient conditions requires immediate transport? A) Neck pain following a motor vehicle collision B) Unresponsiveness to painful stimuli after ALS interventions C) Narcotic overdose D) Wrist fracture with diminished distal sensation Answer: B Diff: 2 Page Ref: 239 Standard: Assessment (Secondary Assessment) Objective: 2 78 Copyright © 2017 Pearson Education, Inc.

6) A 60-year-old man presents with altered mental status. There is no evidence of trauma. Which of the following is most likely to give you specific information about the underlying cause of the patient's condition? A) Pulse oximetry B) A Babinski reflex C) End-tidal carbon dioxide monitoring D) Blood glucose determination Answer: D Diff: 2 Page Ref: 238 Standard: Assessment (Secondary Assessment) Objective: 7 7) Evaluation of the pelvis in the rapid trauma assessment includes pressing on the symphysis pubis in which direction? A) Inferiorly B) Posteriorly C) Laterally D) Medially Answer: B Diff: 2 Page Ref: 230 Standard: Assessment (Secondary Assessment) Objective: 4 8) You are en route to a hospital with a patient who appears stable following a motor vehicle collision. To detect changes in the patient's condition, you should do which of the following during transport? A) Detailed physical examination B) Neurological assessment C) Repeat the primary assessment D) Rapid trauma assessment Answer: C Diff: 2 Page Ref: 242 Standard: Assessment (Secondary Assessment) Objective: 3 9) Special emphasis should be placed on which of the following during your rapid secondary assessment? A) Mental status B) Cranial nerve function C) Cardiovascular and respiratory systems D) Areas suggested by the chief complaint Answer: D Diff: 2 Page Ref: 242 Standard: Assessment (Secondary Assessment) Objective: 3 79 Copyright © 2017 Pearson Education, Inc.

10) You are evaluating a patient who was a restrained driver of a motor vehicle that crashed into the median barrier at 40 mph. He is awake, alert, and oriented, complaining of neck and back pain. There is a bruise across his upper abdomen in the shape of the seat belt. Based on this information, you should assume he is a ________ trauma patient, and transport him to ________. A) major; the closest hospital B) minor; the closest hospital C) minor; the patient's hospital of choice D) major; a trauma center Answer: D Diff: 2 Page Ref: 233 Standard: Assessment (Secondary Assessment) Objective: 4 11) Which of the following best describes why a focused history is important in responsive medical patients? A) It supports diagnostic impression. B) It allows treatments to be initiated immediately. C) It helps to formulate a field diagnosis. D) It identifies signs of medical complications. Answer: C Diff: 2 Page Ref: 235 Standard: Assessment (Secondary Assessment) Objective: 7 12) Why is a detailed physical exam rarely performed on critical trauma patients in the prehospital setting? A) It produces too much patient anxiety. B) It is used only on medical patients. C) The rapid trauma assessment performs the same function. D) It usually yields little immediately useful information. Answer: D Diff: 2 Page Ref: 225-226 Standard: Assessment (Secondary Assessment) Objective: 4 13) Which of the following may indicate either cardiac tamponade or tension pneumothorax? A) Cushing's reflex B) Hypertension C) Subcutaneous emphysema D) Distended neck veins Answer: D Diff: 2 Page Ref: 230 Standard: Assessment (Secondary Assessment) Objective: 2

14) Patterns of deterioration in patient condition may include all of the following EXCEPT: A) skin becomes cool, pale, and moist. B) the heart rate significantly increases or decreases. C) the respiratory rate significantly increases or decreases. D) the level of consciousness increases. Answer: D Diff: 1 Page Ref: 240-241 Standard: Assessment (Reassessment) Objective: 9 15) The careful, thorough process of eliciting a patient's history and conducting a physical exam is known as the: A) primary survey. B) rapid medical assessment. C) secondary assessment. D) ongoing assessment. Answer: C Diff: 1 Page Ref: 225 Standard: Assessment (Secondary Assessment) Objective: 3 16) Which of the following will provide the LEAST information about a patient complaining of abdominal pain? A) Checking for unusual breath odors B) Looking for Cullen's sign C) Assessing reaction of the pupils to light D) Performing a tilt test Answer: C Diff: 2 Page Ref: 238-239 Standard: Assessment (Secondary Assessment) Objective: 7 17) Reassessment should include which of the following? 1. Assess effects of interventions. 2. Check vital signs. 3. Assess skin condition. 4. Do detailed physical exam. 5. Check airway patency. A) 1, 2, 3, and 5 B) 2, 4, and 5 C) 1, 2, 4, and 5 D) 1, 3, and 4 Answer: A Diff: 2 Page Ref: 240-241 Standard: Assessment (Reassessment) Objective: 3 81 Copyright © 2017 Pearson Education, Inc.

18) Which of the following is NOT part of the medical history? A) Past injuries B) Type of health care insurance C) Current medications D) Current symptoms Answer: B Diff: 1 Page Ref: 235-236 Standard: Assessment (Secondary Assessment) Objective: 1 19) A patient is complaining of abdominal pain, nausea, and vomiting. Which of the following will provide you with the most immediately useful information? A) Checking for discoloration of the tongue B) Asking about any unusual taste in the mouth C) Asking about the presence of coffee-grounds emesis D) Finding out about any unusual stress in the patient's life Answer: C Diff: 2 Page Ref: 238 Standard: Assessment (Secondary Assessment) Objective: 7 20) Which of the following is NOT a reason that a reassessment is important? A) It allows you to detect trends in the patient's status. B) It determines changes in the patient's conditions. C) It reassures the patient you are taking good care of him. D) It allows you to assess the effects of interventions. Answer: C Diff: 1 Page Ref: 240-241 Standard: Assessment (Reassessment) Objective: 3 21) One of the best ways to minimize patient anxiety during a physical exam is to: A) never expose any of the patient's body parts. B) use a calm, professional approach. C) limit your exam to procedures that do not cause the patient anxiety. D) warm your hands and instruments before use. Answer: B Diff: 1 Page Ref: 227 Standard: Assessment (Secondary Assessment) Objective: 2

22) Which of the following is TRUE concerning the assessment of an unresponsive medical patient? A) The approach is the same as for responsive medical patients. B) You should perform a rapid medical assessment. C) A comprehensive history is performed prior to assessment. D) You should perform a detailed physical exam prior to transporting the patient. Answer: B Diff: 2 Page Ref: 225 Standard: Assessment (Secondary Assessment) Objective: 6 23) Trending vital signs is best accomplished by: A) estimating any values that are missing on the prehospital care record. B) comparing the prehospital vital signs to the patient's normal vital signs. C) having each set of vital signs verified by a second EMS provider. D) taking multiple sets of vital signs. Answer: D Diff: 1 Page Ref: 242 Standard: Assessment (Reassessment) Objective: 3 24) Components of a scene size-up include all of the following EXCEPT: A) patient's chief complaint. B) number of patients. C) mechanism of injury. D) dangers to bystanders. Answer: A Diff: 1 Page Ref: 223-224 Standard: Assessment (Scene Size-Up) Objective: 3 25) Your patient remains unresponsive after a painful stimulus is applied. The family reports that the patient was found unconscious in bed after complaining of a "terrible headache." Which of the following represents the correct sequence of actions in this situation? 1. Obtain a brief history from the family. 2. Conduct a rapid secondary assessment. 3. Perform a detailed exam. 4. Determine vital signs. 5. Perform a primary assessment. A) 5, 2, 3, 1 B) 5, 1, 2, 4 C) 5, 1, 3, 4 D) 5, 2, 1, 4 Answer: D Diff: 2 Page Ref: 239-240 Standard: Assessment (Secondary Assessment) Objective: 9 83 Copyright © 2017 Pearson Education, Inc.

26) An important aspect of the reassessment is to monitor and evaluate all of the following EXCEPT the: A) accumulation of charges for care. B) transport priority. C) effectiveness of interventions. D) vital signs. Answer: A Diff: 1 Page Ref: 240-241 Standard: Assessment (Reassessment) Objective: 3 27) A critical patient's vital signs should be reassessed at least every ________ minutes. A) 5 B) 10 C) 15 D) 20 Answer: A Diff: 1 Page Ref: 240 Standard: Assessment (Reassessment) Objective: 6 28) When responding to calls involving two-vehicle collisions, you must always suspect: A) multiple patients. B) patients with altered mental status. C) flail chest. D) severe lower extremity injuries. Answer: A Diff: 1 Page Ref: 233 Standard: Assessment (Secondary Assessment) Objective: 4 29) After the primary assessment of an unresponsive medical patient with stable vital signs, which of the following is the position in which the patient should be placed? A) Supine B) Lateral recumbent C) Semi-Fowler's D) Prone Answer: B Diff: 1 Page Ref: 239 Standard: Assessment (Secondary Assessment) Objective: 6

30) For which of the following patients should you conduct a focused physical exam? A) 35-year-old female roller skater with an ankle fractured after falling B) 22-year-old male with a gunshot wound to the abdomen C) 65-year-old male with an altered level of consciousness D) 15-year-old female pedestrian who was struck by a motor vehicle traveling at 25 mph Answer: A Diff: 2 Page Ref: 240 Standard: Assessment (Reassessment) Objective: 5 31) Rebound tenderness in the abdomen is a sign of potential: A) kidney stone. B) full urinary bladder. C) peritoneal irritation. D) food poisoning. Answer: C Diff: 1 Page Ref: 230 Standard: Assessment (Secondary Assessment) Objective: 7 32) During your focused physical exam of a patient with a suspected myocardial infarction, you should examine: A) peripheral perfusion status. B) range of motion in joints. C) extraocular movements. D) deep tendon reflexes. Answer: A Diff: 2 Page Ref: 236 Standard: Assessment (Secondary Assessment) Objective: 2 33) After considering the information you have collected, you determine the most likely cause of your patient's condition. This step in the critical decision-making process is called: A) reflecting on the incident. B) applying the principles. C) interpreting the data. D) forming a concept. Answer: C Diff: 1 Page Ref: 243 Standard: Clinical Behavior/Judgment (Assessment) Objective: 8

34) You arrive at a location and begin to read the scene by: A) approaching the patient. B) observing the immediate surroundings. C) conducting a focused exam. D) addressing life threats. Answer: B Diff: 1 Page Ref: 242 Standard: Clinical Behavior/Judgment (Assessment) Objective: 3 35) The first step in critical thinking is to: A) form a concept. B) conduct a focused exam. C) ascertain the chief complaint. D) determine statistically significant conditions. Answer: A Diff: 1 Page Ref: 242 Standard: Clinical Behavior/Judgment (Assessment) Objective: 8 36) During the reassessment of a stable patient, you should recheck vital signs every 15 minutes. This is an example of: A) evaluating. B) reviewing. C) reflecting. D) applying principles. Answer: A Diff: 2 Page Ref: 243-244 Standard: Clinical Behavior/Judgment (Assessment) Objective: 8 37) Using knowledge and experience to diagnose patients and plan their treatment is called clinical: A) judgment. B) intuition. C) practice. D) reflection. Answer: A Diff: 1 Page Ref: 244 Standard: Clinical Behavior/Judgment (Assessment) Objective: 8

38) After a call you discuss the patient with the ED physician, comparing diagnoses and care plans. This is an example of: A) reflecting. B) evaluating. C) applying principles. D) putting it all together. Answer: A Diff: 1 Page Ref: 244 Standard: Clinical Behavior/Judgment (Assessment) Objective: 8 39) Critical thinking is a thought process used to: A) defend one's actions in a CQI review process. B) establish credibility with an emergency physician. C) analyze and evaluate. D) focus on a situation's most important aspect. Answer: C Diff: 2 Page Ref: 242 Standard: Clinical Behavior/Judgment (Assessment) Objective: 8 40) Changing or stopping interventions that are NOT working is an example of: A) reviewing your performance. B) reading the patient. C) reevaluating. D) revising the management plan. Answer: D Diff: 1 Page Ref: 242 Standard: Clinical Behavior/Judgment (Assessment) Objective: 8 41) Paramedics treat patients with the same techniques as other clinicians, EXCEPT that they: A) perform these procedures in uncontrollable and unpredictable environments. B) are far less trained than other practitioners. C) treat life-threatening emergencies only. D) are not allowed to make independent decisions. Answer: A Diff: 1 Page Ref: 223 Standard: Assessment (Scene Size-Up) Objective: 2

42) The ability to critically evaluate a patient's condition and formulate a treatment plan rests on all of the following EXCEPT: A) an excellent working knowledge of anatomy and physiology. B) identifying and dealing with medical ambiguity. C) strictly following protocols. D) the ability to focus on large amounts of data. Answer: C Diff: 2 Page Ref: 223 Standard: Assessment (Scene Size-Up) Objective: 8 43) Which of the following characteristics is most similar between the prehospital setting and other medical care environments? A) The need to establish an airway early in patient care B) The absence of laboratory results to guide treatment C) Unpredictable circumstances D) The variety of uncontrolled environments Answer: A Diff: 1 Page Ref: 224 Standard: Assessment (Primary Assessment) Objective: 2 44) What is one way to read the patient in a primary assessment? A) Obtain the history from family members. B) Address life threats. C) Observe the mechanism of injury. D) Observe the level of consciousness. Answer: D Diff: 1 Page Ref: 224 Standard: Assessment (Primary Assessment) Objective: 2 45) With your field diagnosis in mind, you develop a treatment plan for your patient. This part of the critical decision-making process is called: A) evaluating the results. B) applying principles. C) forming a concept. D) interpreting the data. Answer: B Diff: 1 Page Ref: 243 Standard: Clinical Behavior/Judgment (Assessment) Objective: 8

46) As you survey the scene, you are gathering information about your patient and the scene. This step in the critical decision-making process is called: A) forming a concept. B) reflecting on the incident. C) evaluating results. D) interpreting the data. Answer: A Diff: 1 Page Ref: 242 Standard: Clinical Behavior/Judgment (Assessment) Objective: 8 47) Which of the following choices is the correct sequence of steps in critical thinking/decision making? 1. Interpreting the data 2. Evaluating results 3. Reflecting on the incident 4. Forming a concept 5. Applying the principles A) 4, 1, 5, 2, 3 B) 1, 2, 4, 5, 3 C) 4, 3, 5, 2, 1 D) 3, 4, 5, 1, 2 Answer: A Diff: 2 Page Ref: 242 Standard: Clinical Behavior/Judgment (Assessment) Objective: 8 48) Your 23-year-old female patient presents with relatively normal vital signs and is fully alert and oriented. Her only complaint is lower abdominal pain. If you assume she is pregnant, you are: A) applying principles. B) overgeneralizing. C) interpreting the data. D) evaluating. Answer: A Diff: 2 Page Ref: 243 Standard: Clinical Behavior/Judgment (Assessment) Objective: 8

Paramedic Care: Principles & Practice V. 1-5, 5e (Bledsoe)

Volume 3 Medical Emergencies Chapter 1 Pulmonology 1) Which of the following 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: 3 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: 8 Standard: Medicine (Respiratory) Objective: 1, 3 3) The diaphragm is controlled by the ________ nerve. A) vagus B) olfactory C) abducens D) phrenic Answer: D Diff: 1 Page Ref: 7-8 Standard: Medicine (Respiratory) Objective: 3, 4 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: 11 Standard: Medicine (Respiratory) Objective: 1, 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: 9 Standard: Medicine (Respiratory) Objective: 4 6) Which of the following patients are 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: 25 Standard: Medicine (Respiratory) Objective: 7 7) Normal tidal volume in an average 70 kg adult is approximately ________ e. A) 1,500 B) 1,000 C) 750 D) 500 Answer: D Diff: 1 Page Ref: 9 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: 9 Standard: Medicine (Respiratory) Objective: 4

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: 21-22 Standard: Medicine (Respiratory) Objective: 5, 6 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 called the ________ reflex. A) Cushing's B) Hering-Breuer C) Moro D) Cheyne-Stokes Answer: B Diff: 2 Page Ref: 10 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: 10 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 of the following 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: 10-11 Standard: Medicine (Respiratory) Objective: 3

13) Your ICU patient has ARDS with a pO2 of 62 mmHg, despite mechanical ventilation and oxygenation. Which of the following 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: 26-27 Standard: Medicine (Respiratory) Objective: 1, 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: 12 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: 14, 43 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: 7-8, 8-9 Standard: Medicine (Respiratory) Objective: 3

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: 13 Standard: Medicine (Respiratory) Objective: 4 18) Which of the following 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: 16 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: 15 Standard: Medicine (Respiratory) Objective: 6 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: 17 Standard: Medicine (Respiratory) Objective: 5, 6

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: 18 Standard: Medicine (Respiratory) Objective: 1, 5 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: 22 Standard: Medicine (Respiratory) Objective: 5 23) ETCO2 is recorded during phase ________ of the capnogram. A) I B) II C) III D) IV Answer: C Diff: 2 Page Ref: 23 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: 26 Standard: Medicine (Respiratory) Objective: 7

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 0.4 mg of 1:1000 epinephrine SQ and 50 mg diphenhydramine IV. D) administer 2.5 mg albuterol by nebulizer. Answer: C Diff: 2 Page Ref: 26 Standard: Medicine (Respiratory) Objective: 7 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: 30 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: 30-31 Standard: Medicine (Respiratory) Objective: 6 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: 32 Standard: Medicine (Respiratory) Objective: 6

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: 34 Standard: Medicine (Respiratory) Objective: 5, 6 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%. This presentation is most consistent with: A) pneumonia. B) tuberculosis. C) SARS. D) hantavirus pulmonary syndrome. Answer: C Diff: 3 Page Ref: 39 Standard: Medicine (Respiratory) Objective: 6 31) In which of the following situations 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: 41-42 Standard: Medicine (Respiratory) Objective: 5, 7

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%. 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: 31 Standard: Medicine (Respiratory) Objective: 6 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: 42 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: 43 Standard: Medicine (Respiratory) Objective: 6

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: 45 Standard: Medicine (Respiratory) Objective: 6, 7 36) Which of the following statements about 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 include pancreatitis, oxygen toxicity, sepsis, and tumor destruction. Answer: B Diff: 2 Page Ref: 27 Standard: Medicine (Respiratory) Objective: 7 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: 9 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: 44-45 Standard: Medicine (Respiratory) Objective: 4, 7

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: 32 Standard: Medicine (Respiratory) Objective: 6 40) An increased hydrogen ion concentration in the cerebrospinal fluid results in a(n) ________ respiratory rate. A) erratic B) decreased C) unchanged D) increased Answer: D Diff: 2 Page Ref: 10 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: 42 Standard: Medicine (Respiratory) Objective: 5, 8

42) Lung perfusion depends on all of the following 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: 11 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%. Which of the following is most likely? A) Spontaneous tension pneumothorax B) Pulmonary embolism C) Myocardial infarction D) Idiopathic congestive heart failure Answer: B Diff: 3 Page Ref: 43 Standard: Medicine (Respiratory) Objective: 6, 8 44) Which of the following statements 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: 20-21 Standard: Medicine (Respiratory) Objective: 5

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: 10 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: 6-7 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 must allow for a prolonged expiratory phase. D) She requires frequent, deep suctioning. Answer: C Diff: 3 Page Ref: 32 Standard: Medicine (Respiratory) Objective: 8, 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%. 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: 38 Standard: Medicine (Respiratory) Objective: 6 13 Copyright © 2017 Pearson Education, Inc.

49) Which of the following structures 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: 5-6 Standard: Medicine (Respiratory) Objective: 3 50) Which of the following 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: 3 Standard: Medicine (Respiratory) Objective: 3 51) Which of the following 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: 10 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: 38 Standard: Medicine (Respiratory) Objective: 6, 7

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: 3 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: 7 Standard: Medicine (Respiratory) Objective: 1, 3 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: 14 Standard: Medicine (Respiratory) Objective: 4 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: 9 Standard: Medicine (Respiratory) Objective: 3

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: 10 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: 10 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: 10-11 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: 12 Standard: Medicine (Respiratory) Objective: 3

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: 43 Standard: Medicine (Respiratory) Objective: 4, 6 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: 13 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: 14 Standard: Medicine (Respiratory) Objective: 4 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: 14 Standard: Medicine (Respiratory) Objective: 4

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: 15-16 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) Stridor Answer: C Diff: 1 Page Ref: 39 Standard: Medicine (Respiratory) Objective: 6, 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: 16 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: 17 Standard: Medicine (Respiratory) Objective: 5, 6

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: 18 Standard: Medicine (Respiratory) Objective: 5, 6 70) Paradoxical movement is associated with: A) tension pneumothorax. B) hemothorax. C) flail chest. D) simple pneumothorax. Answer: C Diff: 2 Page Ref: 18 Standard: Medicine (Respiratory) Objective: 5, 6 71) Upon examining your patient, you note that he has a 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: 19 Standard: Medicine (Respiratory) Objective: 6, 7 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: 26 Standard: Medicine (Respiratory) Objective: 1, 7

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: 27 Standard: Medicine (Respiratory) Objective: 8, 9 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: 27 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 in the fingers and new pitting edema. You should suspect: A) CHF. B) COPD. C) cor pulmonale. D) pulmonary neoplasm. Answer: C Diff: 3 Page Ref: 30 Standard: Medicine (Respiratory) Objective: 1, 7 76) You are performing a physical exam on a patient with emphysema. You note that the patient has a pink hue to her skin. You should suspect: A) cor pulmonale. B) polycythemia. C) methahemoglobinemia. D) carboxyhemoglobinemia. Answer: B Diff: 2 Page Ref: 30-31 Standard: Medicine (Respiratory) Objective: 6, 7

77) You are caring for a patient with chronic bronchitis. The patient has an SpO2 of 90%. 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: 32 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% 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: 34 Standard: Medicine (Respiratory) Objective: 7, 9 79) You are called to care for a patient with severe shortness of breath. The patient has an SpO2 of 88%, 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: 36 Standard: Medicine (Respiratory) Objective: 8, 9 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%, 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: 37-38 Standard: Medicine (Respiratory) Objective: 6, 9 21 Copyright © 2017 Pearson Education, Inc.

81) You are called to the scene of a patient who has just attempted suicide by ingesting detergent. You notice that the patient is coughing and has a hoarse voice. You suspect: A) tracheal rupture. B) laryngeal edema. C) subcutaneous emphysema. D) nothing, this is a normal finding for this patient. Answer: B Diff: 3 Page Ref: 41 Standard: Medicine (Respiratory) Objective: 8, 9 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) Hypobaric oxygen C) Neurosurgical capabilities D) Any hospital Answer: A Diff: 2 Page Ref: 42-43 Standard: Medicine (Respiratory) Objective: 8, 9 Chapter 2 Cardiology 1) Which of the following 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: 52 Standard: Medicine (Cardiovascular) Objective: 3 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: 52 Standard: Medicine (Cardiovascular) Objective: 2

3) The valve between the right atrium and right ventricle is the ________ valve. A) bicuspid B) pulmonic C) tricuspid D) aortic Answer: C Diff: 1 Page Ref: 55 Standard: Medicine (Cardiovascular) Objective: 4 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: 55 Standard: Medicine (Cardiovascular) Objective: 4 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: 55 Standard: Medicine (Cardiovascular) Objective: 4 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 the following 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: 140, 141 Standard: Medicine (Cardiovascular) Objective: 9, 20

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: 109 Standard: Medicine (Cardiovascular) Objective: 8 8) The presence of inverted T waves on an ECG indicates: A) myocardial infarction. B) myocardial necrosis. C) myocardial ischemia. D) myocardial injury. Answer: C Diff: 2 Page Ref: 73 Standard: Medicine (Cardiovascular) Objective: 8 9) The pressure in the left ventricle at the end of diastole is called: A) after. B) preload. C) ejection fraction. D) stroke volume. Answer: B Diff: 1 Page Ref: 58 Standard: Medicine (Cardiovascular) Objective: 1, 4 10) Typical stroke volume is about ________ of the volume of the left ventricle. A) one-third B) one-half C) two-thirds D) three-quarters Answer: C Diff: 1 Page Ref: 58 Standard: Medicine (Cardiovascular) Objective: 1, 4

11) Which of the following items is most likely to interfere with the function of an implanted cardiac pacemaker? A) Magnet B) Cellular telephone C) Television remote control D) Hair dryer Answer: A Diff: 1 Page Ref: 107, 108 Standard: Medicine (Cardiovascular) Objective: 8 12) The first phase of the cardiac cycle is: A) systole. B) diastole. C) contraction. D) ejection. Answer: B Diff: 1 Page Ref: 57 Standard: Medicine (Cardiovascular) Objective: 4 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: 63 Standard: Medicine (Cardiovascular) Objective: 1, 4 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: 58 Standard: Medicine (Cardiovascular) Objective: 1, 4

15) Beta-blockers generally have which of the following effects? A) Increased cardiac conduction B) Decreased myocardial contractility C) Vasoconstriction D) Increased myocardial contractility Answer: B Diff: 2 Page Ref: 61 Standard: Medicine (Cardiovascular) Objective: 4 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 the following 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: 76 Standard: Medicine (Cardiovascular) Objective: 8 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: 68 Standard: Medicine (Cardiovascular) Objective: 5 18) Which of the following 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: 58 Standard: Medicine (Cardiovascular) Objective: 4

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: 68 Standard: Medicine (Cardiovascular) Objective: 5 20) If the stroke volume decreased, which of the following 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: 58 Standard: Medicine (Cardiovascular) Objective: 4 21) You have administered a drug with potent beta-1 effects. Which of the following 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: 61 Standard: Medicine (Cardiovascular) Objective: 4 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 a ________ effect. A) negative dromotropic B) negative chronotropic C) positive dromotropic D) positive chronotropic Answer: A Diff: 2 Page Ref: 61, 62 Standard: Medicine (Cardiovascular) Objective: 4

23) Which of the following endocrine substances acts as a marker for congestive heart failure? A) BNP B) Angiotensin C) ACTH D) Troponin Answer: A Diff: 1 Page Ref: 62 Standard: Medicine (Cardiovascular) Objective: 4 24) To detect life-threatening cardiac dysrhythmias, the paramedic must view the ECG in ________ lead(s). A) two B) one C) three D) twelve Answer: B Diff: 1 Page Ref: 67 Standard: Medicine (Cardiovascular) Objective: 5 25) The total duration of ventricular depolarization is represented by the ________ on the ECG. A) QRS duration B) QT interval C) PQ interval D) R-R interval Answer: B Diff: 2 Page Ref: 71-72 Standard: Medicine (Cardiovascular) Objective: 6 26) Which of the following 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: 73 Standard: Medicine (Cardiovascular) Objective: 6

27) Which of the following 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: 141, 142 Standard: Medicine (Cardiovascular) Objective: 12 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: 73 Standard: Medicine (Cardiovascular) Objective: 6, 19 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: 76 Standard: Medicine (Cardiovascular) Objective: 7, 14 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%. Which of the following is NOT indicated? A) Adenosine B) Enalapril C) Morphine D) Nitroglycerin Answer: A Diff: 3 Page Ref: 120-122, 142 Standard: Medicine (Cardiovascular) Objective: 11, 20 29 Copyright © 2017 Pearson Education, Inc.

31) Which of the following 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: 139-140 Standard: Medicine (Cardiovascular) Objective: 12 32) The difference between apical and peripheral pulse rates that results from decreased cardiac output when the atria fail to contract is known as: A) pulsus paradoxus. B) pulse deficit. C) pulsus alternans. D) paroxysmal pulse pressure. Answer: B Diff: 2 Page Ref: 88, 116 Standard: Medicine (Cardiovascular) Objective: 10 33) Elastic and smooth muscle fibers are primarily found in the tunica ________ of blood vessels. A) collateralus B) media C) adventitia D) intima Answer: B Diff: 1 Page Ref: 57 Standard: Medicine (Cardiovascular) Objective: 4 34) ________ is 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: 142 Standard: Medicine (Cardiovascular) Objective: 12

35) Which of the following 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: 125 Standard: Medicine (Cardiovascular) Objective: 1, 12 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%. The monitor shows sinus tachycardia. Which of the following 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) Intubation Answer: D Diff: 3 Page Ref: 108 Standard: Medicine (Cardiovascular) Objective: 13, 20 37) Measures to treat cardiogenic shock include all of the following EXCEPT: A) reducing stroke volume. B) increasing the contractile force. C) improving preload. D) reducing peripheral resistance. Answer: A Diff: 2 Page Ref: 147 Standard: Medicine (Cardiovascular) Objective: 1, 13 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: 84 Standard: Medicine (Cardiovascular) Objective: 8

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 = 99%. In addition to monitoring his cardiac rhythm, administering oxygen, and starting an IV at a KVO rate, which of the following is most appropriate? A) Labetalol, IV B) Diazepam, IV C) Nitroglycerin, SL D) Morphine, IV Answer: A Diff: 3 Page Ref: 146 Standard: Medicine (Cardiovascular) Objective: 13, 20 40) Which of the following 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: 109 Standard: Medicine (Cardiovascular) Objective: 8 41) Which of the following is NOT considered a modifiable risk factor for coronary heart disease? A) Stress B) Gender C) Obesity D) Diet Answer: B Diff: 1 Page Ref: 52 Standard: Medicine (Cardiovascular) Objective: 3 42) Signs and symptoms of decreased tissue perfusion secondary to cardiogenic shock include all of the following EXCEPT: A) altered mental status. B) cold, diaphoretic skin. C) constricted pupils. D) tachypnea. Answer: C Diff: 2 Page Ref: 147 Standard: Medicine (Cardiovascular) Objective: 1, 12 32 Copyright © 2017 Pearson Education, Inc.

43) Which of the following 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: 92-93 Standard: Medicine (Cardiovascular) Objective: 7, 8 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 = 128, BP = 86/56, RR = 26, SaO2 = 92%. Which of the following is appropriate in the prehospital treatment of this patient? A) Dopamine B) Nitroglycerin C) Amiodarone D) Morphine Answer: A Diff: 3 Page Ref: 121 Standard: Medicine (Cardiovascular) Objective: 11, 15, 20 45) Which of the following is affected by a properly working pacemaker? A) Automaticity B) Stroke volume C) Cardiac rhythm D) Ejection fraction Answer: C Diff: 2 Page Ref: 105 Standard: Medicine (Cardiovascular) Objective: 7, 8 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: 66 Standard: Medicine (Cardiovascular) Objective: 5

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: 115-116 Standard: Medicine (Cardiovascular) Objective: 4, 10 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: 135 Standard: Medicine (Cardiovascular) Objective: 12 49) Which of the following 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: 61 Standard: Medicine (Cardiovascular) Objective: 4 50) Which of the following is the least likely cause of PEA? A) Hypertension B) Hypovolemia C) Cardiac tamponade D) Tension pneumothorax Answer: A Diff: 2 Page Ref: 108 Standard: Medicine (Cardiovascular) Objective: 8

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 the following is most appropriate? A) Valsalva maneuver B) IV adenosine C) Immediate synchronized cardioversion D) IV diltiazem Answer: C Diff: 3 Page Ref: 117 Standard: Medicine (Cardiovascular) Objective: 1, 11, 20 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: 94 Standard: Medicine (Cardiovascular) Objective: 8 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: 61 Standard: Medicine (Cardiovascular) Objective: 4 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: 73 Standard: Medicine (Cardiovascular) Objective: 7, 14

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: 116 Standard: Medicine (Cardiovascular) Objective: 10 56) Which of the following 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: 108-109 Standard: Medicine (Cardiovascular) Objective: 8 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: 58 Standard: Medicine (Cardiovascular) Objective: 4 58) The base of the heart lies at the level of the ________ rib. A) first B) third C) second D) fourth Answer: C Diff: 1 Page Ref: 53 Standard: Medicine (Cardiovascular) Objective: 4

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 the following 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: 84, 85 Standard: Medicine (Cardiovascular) Objective: 9, 20 60) Which of the following 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: 63 Standard: Medicine (Cardiovascular) Objective: 4 61) Poiseuille's law specifically states that blood flow through a vessel is directly proportional to the ________ of the vessel's radius. A) fourth power B) third power C) square D) tenth power Answer: A Diff: 1 Page Ref: 57 Standard: Medicine (Cardiovascular) Objective: 4 62) Which of the following 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: 133-136 Standard: Medicine (Cardiovascular) Objective: 12

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%. Which of the following 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: 156 Standard: Medicine (Cardiovascular) Objective: 13, 20 64) Your patient in atrial fibrillation has a heart rate of 108 on the monitor, but her radial pulse is 88. The patient is experiencing: A) paradoxical pulse. B) pulsus obliterans. C) pulse deficit. D) pulsus alternans. Answer: C Diff: 2 Page Ref: 88 Standard: Medicine (Cardiovascular) Objective: 12 65) Paramedics use all of the following interventions to treat congestive heart failure EXCEPT: A) sitting the patient upright. B) decreasing patient anxiety. C) administering oxygen D) administering fluid bolus to treat hypotension. Answer: D Diff: 2 Page Ref: 140-142 Standard: Medicine (Cardiovascular) Objective: 13, 20

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%. 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 the following 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: 121-122 Standard: Medicine (Cardiovascular) Objective: 11, 20 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: 58 Standard: Medicine (Cardiovascular) Objective: 1, 4 68) Signs and/or symptoms of a dissecting thoracic aneurysm include all of the following EXCEPT: A) hypotension. B) chest pain. C) palpable pulsating mass. D) difficulty breathing. Answer: C Diff: 2 Page Ref: 154, 156 Standard: Medicine (Cardiovascular) Objective: 1, 12 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 the following 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: 153 Standard: Medicine (Cardiovascular) Objective: 12 39 Copyright © 2017 Pearson Education, Inc.

70) The QRS complex represents: A) ventricular depolarization. B) atrial repolarization. C) atrial depolarization. D) ventricular repolarization. Answer: A Diff: 1 Page Ref: 69 Standard: Medicine (Cardiovascular) Objective: 6 71) Pharmacological interventions initiated by prehospital care providers in the treatment of congestive heart failure may include all of the following EXCEPT: A) dopamine. B) atropine. C) furosemide. D) nitroglycerin. Answer: B Diff: 2 Page Ref: 121-122 Standard: Medicine (Cardiovascular) Objective: 15 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: 58 Standard: Medicine (Cardiovascular) Objective: 4 73) Cardioversion can be used to treat all of the following rhythms EXCEPT: A) ventricular tachycardia with a pulse. B) rapid atrial fibrillation. C) ventricular fibrillation. D) supraventricular tachycardia. Answer: C Diff: 2 Page Ref: 125 Standard: Medicine (Cardiovascular) Objective: 11

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 the following is least helpful when determining the effectiveness of transcutaneous pacing? A) Evidence of mechanical capture B) Increased level of consciousness C) Evidence of electrical capture D) Increased blood pressure Answer: C Diff: 2 Page Ref: 125-128 Standard: Medicine (Cardiovascular) Objective: 8, 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: 154 Standard: Medicine (Cardiovascular) Objective: 1, 12 76) Common chief complaints and symptoms associated with cardiac disease include all of the following EXCEPT: A) dyspnea. B) syncope. C) chest pain. D) vertigo. Answer: D Diff: 1 Page Ref: 112-113 Standard: Medicine (Cardiovascular) Objective: 10, 12 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: 190 Standard: Medicine (Cardiovascular) Objective: 19

78) An accelerated junctional rhythm has a rate between ________ and ________. A) 40, 60 B) 20, 40 C) 100, 150 D) 60, 100 Answer: D Diff: 1 Page Ref: 96 Standard: Medicine (Cardiovascular) Objective: 8 79) Which of the following 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: 83 Standard: Medicine (Cardiovascular) Objective: 8, 12 80) The mitral valve is also known as the ________ valve. A) pulmonic B) right atrioventricular C) left atrioventricular D) tricuspid Answer: C Diff: 1 Page Ref: 53 Standard: Medicine (Cardiovascular) Objective: 4 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: 58 Standard: Medicine (Cardiovascular) Objective: 4

82) Your patient has a history of progressively worsening angina that comes on at rest. This most commonly indicates ________ angina. A) Prinzmetal's B) Ludwig's C) decubitus D) unstable angina Answer: D Diff: 1 Page Ref: 132 Standard: Medicine (Cardiovascular) Objective: 12 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: 109 Standard: Medicine (Cardiovascular) Objective: 7, 8 84) The intrinsic firing rate of the AV node is ________ to ________ beats per minute. A) 40, 60 B) 20, 40 C) 60, 80 D) 80, 100 Answer: A Diff: 1 Page Ref: 66 Standard: Medicine (Cardiovascular) Objective: 4 85) The predominant effect of a drug with primarily alpha properties would result in which of the following? A) Vasodilation B) Increased heart rate C) Decreased heart rate D) Vasoconstriction Answer: D Diff: 2 Page Ref: 61 Standard: Medicine (Cardiovascular) Objective: 4

86) Which of the following 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: 63-66 Standard: Medicine (Cardiovascular) Objective: 4 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 the following? 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 right ventricle. D) The patient is experiencing ischemia and injury in her left ventricle and septum. Answer: C Diff: 3 Page Ref: 169, 170 Standard: Medicine (Cardiovascular) Objective: 14, 19 88) The pericardial cavity normally holds about ________ mL of ________. A) 30, blood B) 1 to 2, serous fluid C) 100, blood D) 25, straw-colored lubricant Answer: D Diff: 1 Page Ref: 53 Standard: Medicine (Cardiovascular) Objective: 4

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%. The monitor shows a third-degree AV block. Which of the following 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: 125, 127, 128 Standard: Medicine (Cardiovascular) Objective: 11, 15, 20 90) Increased ________ does NOT occur due to increased venous return to the heart. A) myocardial stretch B) afterload C) stroke volume D) myocardial contraction Answer: B Diff: 2 Page Ref: 57-58 Standard: Medicine (Cardiovascular) Objective: 4 91) Which of the following 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: 153 Standard: Medicine (Cardiovascular) Objective: 18 92) Which of the following 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: 107 Standard: Medicine (Cardiovascular) Objective: 7, 8

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: 131-132 Standard: Medicine (Cardiovascular) Objective: 12 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: 52 Standard: Medicine (Cardiovascular) Objective: 2 95) Which of the following 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: 52 Standard: Medicine (Cardiovascular) Objective: 3 96) The right atrioventricular valve is referred to as the ________ valve. A) tricuspid B) bicuspid C) aortic D) pulmonary Answer: A Diff: 1 Page Ref: 53 Standard: Medicine (Cardiovascular) Objective: 4

97) The left atrioventricular valve is referred to as the ________ valve. A) tricuspid B) mitral C) aortic D) pulmonary Answer: B Diff: 1 Page Ref: 53 Standard: Medicine (Cardiovascular) Objective: 4 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: 54 Standard: Medicine (Cardiovascular) Objective: 4 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: 57 Standard: Medicine (Cardiovascular) Objective: 4 100) 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: 58 Standard: Medicine (Cardiovascular) Objective: 4

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: 58 Standard: Medicine (Cardiovascular) Objective: 4 102) 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: 58 Standard: Medicine (Cardiovascular) Objective: 4 103) 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: 58 Standard: Medicine (Cardiovascular) Objective: 4 104) Brain natriuretic peptide (BNP) levels are useful in determining: A) CAD. B) CVA. C) CHF. D) COPD. Answer: C Diff: 2 Page Ref: 62 Standard: Medicine (Cardiovascular) Objective: 4

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: 64 Standard: Medicine (Cardiovascular) Objective: 4 106) 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: 66 Standard: Medicine (Cardiovascular) Objective: 4 107) 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: 66 Standard: Medicine (Cardiovascular) Objective: 4 108) The intrinsic rate of the Purkinje system is: A) set by the sympathetic nervous system. B) 15-40 bpm. C) 60-100 bpm. D) 40-60 bpm. Answer: B Diff: 1 Page Ref: 66 Standard: Medicine (Cardiovascular) Objective: 4

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: 67 Standard: Medicine (Cardiovascular) Objective: 5 110) 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: 67 Standard: Medicine (Cardiovascular) Objective: 5 111) 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: 67 Standard: Medicine (Cardiovascular) Objective: 5 112) 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: 68 Standard: Medicine (Cardiovascular) Objective: 5

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: 68 Standard: Medicine (Cardiovascular) Objective: 5 114) 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: 69 Standard: Medicine (Cardiovascular) Objective: 6 115) 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: 69 Standard: Medicine (Cardiovascular) Objective: 6 116) 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: 69 Standard: Medicine (Cardiovascular) Objective: 6

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: 71 Standard: Medicine (Cardiovascular) Objective: 6 118) 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: 71 Standard: Medicine (Cardiovascular) Objective: 6 119) 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: 71 Standard: Medicine (Cardiovascular) Objective: 6 120) The five-step procedure for analyzing ECGs includes all of the following EXCEPT: A) rate. B) P wave. C) QRS complex. D) V1. Answer: D Diff: 1 Page Ref: 74 Standard: Medicine (Cardiovascular) Objective: 7

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: 77, 78 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: 76, 77 Standard: Medicine (Cardiovascular) Objective: 8, 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: 109 Standard: Medicine (Cardiovascular) Objective: 8 124) 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: 109 Standard: Medicine (Cardiovascular) Objective: 8

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: 112-113 Standard: Medicine (Cardiovascular) Objective: 10 126) A parasympatholytic agent used to treat symptomatic bradycardia is: A) Atrovent. B) atropine. C) epinephrine. D) Levophed. Answer: B Diff: 2 Page Ref: 120 Standard: Medicine (Cardiovascular) Objective: 11 127) 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: 121 Standard: Medicine (Cardiovascular) Objective: 11 128) 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: 131 Standard: Medicine (Cardiovascular) Objective: 12

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: 132 Standard: Medicine (Cardiovascular) Objective: 12 130) 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: 131 Standard: Medicine (Cardiovascular) Objective: 13 131) 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: 135 Standard: Medicine (Cardiovascular) Objective: 12 132) 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: 136 Standard: Medicine (Cardiovascular) Objective: 12

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: 136 Standard: Medicine (Cardiovascular) Objective: 13 134) 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: 149 Standard: Medicine (Cardiovascular) Objective: 12 135) Which of the following 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: 149 Standard: Medicine (Cardiovascular) Objective: 12 136) You are transporting a cardiac arrest 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: 121 Standard: Medicine (Cardiovascular) Objective: 11

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: 153 Standard: Medicine (Cardiovascular) Objective: 11, 18 138) 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: 170, 171 Standard: Medicine (Cardiovascular) Objective: 19, 20 139) 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: 170 Standard: Medicine (Cardiovascular) Objective: 19, 20

Chapter 3 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 Diff: 1 Page Ref: 229 Standard: Medicine (Neurology) Objective: 1, 7 2) Which of the following 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: 217 Standard: Medicine (Neurology) Objective: 1, 8 3) Which of the following 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: 225 Standard: Medicine (Neurology) Objective: 1, 4

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%. Which of the following 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: 222-223 Standard: Medicine (Neurology) Objective: 9 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: 206 Standard: Medicine (Neurology) Objective: 1, 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 the following 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: 221-222 Standard: Medicine (Neurology) Objective: 4, 6

7) You have been called for a 46-year-old female complaining of a headache. Which of the following 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: 224 Standard: Medicine (Neurology) Objective: 4, 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%. As you start to treat her, the patient has a generalized seizure lasting about 30 seconds. She is now unresponsive. Which of the following 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: 216-219 and 222 Standard: Medicine (Neurology) Objective: 8, 9 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%. Which of the following 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: 225 Standard: Medicine (Neurology) Objective: 6, 8

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%. Which of the following is most likely? A) Absence seizure B) Stroke C) Ménière's disease D) Transient ischemic attack Answer: D Diff: 2 Page Ref: 217-219 Standard: Medicine (Neurology) Objective: 8 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: 222 Standard: Medicine (Neurology) Objective: 1, 7 12) Which of the following 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: 230 Standard: Medicine (Neurology) Objective: 1, 7 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: 228 Standard: Medicine (Neurology) Objective: 1, 7

14) A seizure that begins as an electrical discharge in a small area of the brain but spreads to include the entire cerebral cortex is a ________ seizure. A) complex partial B) myoclonic C) generalized D) simple partial Answer: C Diff: 1 Page Ref: 220 Standard: Medicine (Neurology) Objective: 1, 7 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: 229-230 Standard: Medicine (Neurology) Objective: 1, 7 16) Which of the following should be suspected as a potential cause of syncope? A) Hypovolemia B) Cardiac arrhythmia C) Unknown cause D) All of the above Answer: D Diff: 2 Page Ref: 223 Standard: Medicine (Neurology) Objective: 1, 7 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 retained consciousness, lacked an aura, and had no pain associated with the episode. This most indicates a(n) ________ seizure. A) psychosomatic B) simple partial C) petit mal D) absence Answer: B Diff: 1 Page Ref: 221 Standard: Medicine (Neurology) Objective: 1, 7

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%. Which of the following is most likely? A) Subdural hematoma B) Transient cerebral attack C) Hypersensitivity of the carotid sinus D) Labyrinthitis Answer: D Diff: 1 Page Ref: 226 Standard: Medicine (Neurology) Objective: 5, 8 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 the following 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: 212 Standard: Medicine (Neurology) Objective: 7, 8 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: 209 Standard: Medicine (Neurology) Objective: 5 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 the ________ phase of a generalized seizure. A) hypertonic B) postictal C) clonic D) tonic Answer: A Diff: 2 Page Ref: 220 Standard: Medicine (Neurology) Objective: 5, 7 63 Copyright © 2017 Pearson Education, Inc.

22) A patient with speech impairment following a stroke would have involvement in the ________ lobe of the brain. A) frontal B) parietal C) temporal D) occipital Answer: C Diff: 2 Page Ref: 202 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 the following EXCEPT: A) pinpoint pupils. B) urinary incontinence. C) impaired respiration. D) increased oral secretions. Answer: A Diff: 2 Page Ref: 220 Standard: Medicine (Neurology) Objective: 7, 9 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: 225-226 Standard: Medicine (Neurology) Objective: 5, 7 25) Which of the following 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: 229 Standard: Medicine (Neurology) Objective: 1, 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: 203 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: 231 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 ________ seizure. A) absence B) simple partial C) complex partial D) pseudo Answer: D Diff: 2 Page Ref: 221 Standard: Medicine (Neurology) Objective: 5, 7 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: 224 Standard: Medicine (Neurology) Objective: 4, 7 65 Copyright © 2017 Pearson Education, Inc.

30) All of the following 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: 217, 219 Standard: Medicine (Neurology) Objective: 1, 7 31) Which of the following 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: 229 Standard: Medicine (Neurology) Objective: 1, 7 32) Which of the following 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: 229 Standard: Medicine (Neurology) Objective: 1, 7 33) The postsynaptic neurotransmitter of the sympathetic nerves is: A) dopamine. B) acetylcholine. C) norepinephrine. D) epinephrine. Answer: C Diff: 1 Page Ref: 198 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: 220-221 Standard: Medicine (Neurology) Objective: 1, 4, 7 35) Which of the following is NOT characteristic of a migraine? A) Vomiting B) Low back pain C) Photosensitivity D) Throbbing headache Answer: B Diff: 2 Page Ref: 224 Standard: Medicine (Neurology) Objective: 4, 7 36) Which of the following 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: 214 Standard: Medicine (Neurology) Objective: 6, 7, 9 37) Which of the following is characterized by involuntary muscle twitching? A) Ataxia B) Trismus C) Myoclonus D) Dystonia Answer: C Diff: 1 Page Ref: 230 Standard: Medicine (Neurology) Objective: 1, 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: 228 Standard: Medicine (Neurology) Objective: 1, 7 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 indicates a(n) ________ seizure. A) generalized B) absence C) pseudo D) simple partial Answer: B Diff: 1 Page Ref: 221 Standard: Medicine (Neurology) Objective: 1, 4, 7 40) A seizure that remains confined to a limited portion of the brain, causing localized dysfunction, is a(n) ________ seizure. A) tonic B) absence C) partial D) petit mal Answer: C Diff: 1 Page Ref: 221 Standard: Medicine (Neurology) Objective: 1, 7

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 the following 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: 223 Standard: Medicine (Neurology) Objective: 5, 6 42) Which of the following 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: 230 Standard: Medicine (Neurology) Objective: 1, 7 43) Which of the following 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: 219 Standard: Medicine (Neurology) Objective: 6, 8, 9 44) Which of the following 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: 208 Standard: Medicine (Neurology) Objective: 6, 8, 9 69 Copyright © 2017 Pearson Education, Inc.

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 the following 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: 222-223 Standard: Medicine (Neurology) Objective: 6, 9 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: 230 Standard: Medicine (Neurology) Objective: 7 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%. Which of the following 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: 223 Standard: Medicine (Neurology) Objective: 5, 7

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 the following pieces of information is it most critical to convey? A) History of hypertension B) SaO2 94% despite oxygen C) Time of symptom onset D) Blood pressure 168/82 mmHg Answer: C Diff: 2 Page Ref: 214-215 Standard: Medicine (Neurology) Objective: 5, 7 49) Atrial fibrillation is most associated with ________ strokes. A) hypoxic B) thrombotic C) embolic D) hemorrhagic Answer: C Diff: 2 Page Ref: 215 Standard: Medicine (Neurology) Objective: 6, 8 50) All of the following 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: 217, 219 Standard: Medicine (Neurology) Objective: 8 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 the following 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: 207-208 Standard: Medicine (Neurology) Objective: 5, 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 the following 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: 220 Standard: Medicine (Neurology) Objective: 4, 7 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: 221 Standard: Medicine (Neurology) Objective: 5, 7 54) While you are caring for a patient on the floor of her kitchen, she begins to have a generalized seizure. Which of the following 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: 222 Standard: Medicine (Neurology) Objective: 1, 7, 9 55) Which of the following 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: 217-219 Standard: Medicine (Neurology) Objective: 7, 8

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: 224, 227, 228 Standard: Medicine (Neurology) Objective: 5, 7 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: 230 Standard: Medicine (Neurology) Objective: 5, 7 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: 230 Standard: Medicine (Neurology) Objective: 1, 7 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: 200 Standard: Medicine (Neurology) Objective: 3

60) Which of the following 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: 228 Standard: Medicine (Neurology) Objective: 7 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: 197 Standard: Medicine (Neurology) Objective: 2 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: 197 Standard: Medicine (Neurology) Objective: 3 63) The entire central nervous system is covered by the: A) dura mater. B) meninges. C) peritoneum. D) pia mater. Answer: B Diff: 1 Page Ref: 200 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: 200 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: 204 Standard: Medicine (Neurology) Objective: 3 66) The primary neurotransmitter of the parasympathetic nervous system is: A) epinephrine. B) acetylcholine. C) reteplase. D) dopamine. Answer: B Diff: 1 Page Ref: 204 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: 206 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: 207 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: 209 Standard: Medicine (Neurology) Objective: 4, 5 70) Decreasing PaCO2 will cause: A) cerebral vasoconstriction. B) cerebral vasodilation. C) hyperventilation syndrome. D) ataxic respirations. Answer: A Diff: 2 Page Ref: 209 Standard: Medicine (Neurology) Objective: 4, 5 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: 210 Standard: Medicine (Neurology) Objective: 4, 5

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: 212 Standard: Medicine (Neurology) Objective: 6, 8 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: 213-214 Standard: Medicine (Neurology) Objective: 6 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: 213 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: 214 Standard: Medicine (Neurology) Objective: 7

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: 216 Standard: Medicine (Neurology) Objective: 8 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: 219 Standard: Medicine (Neurology) Objective: 8 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: 220 Standard: Medicine (Neurology) Objective: 7

Chapter 4 Endocrinology 1) Which of the following 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: 250-251 Standard: Medicine (Endocrine Disorders) Objective: 3 2) Which of the following statements 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: 255 Standard: Medicine (Endocrine Disorders) Objective: 3 3) Which of the following 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: 250 Standard: Medicine (Endocrine Disorders) Objective: 3 4) You encounter a patient complaining of polyuria, polyphagia, polydipsia, and abdominal pain. Based on these complaints, which of the following 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: 250 Standard: Medicine (Endocrine Disorders) Objective: 1, 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: 258 Standard: Medicine (Endocrine Disorders) Objective: 3 6) A type II diabetic with a blood glucose of 24 mg/dL would most likely be unconscious due to: A) insulin shock. B) cerebral hypoglycemia. C) gluconeogenesis. D) diabetic ketoacidosis. Answer: B Diff: 2 Page Ref: 250 Standard: Medicine (Endocrine Disorders) Objective: 3, 4 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 = 92%, 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: 256-257 Standard: Medicine (Endocrine Disorders) Objective: 4, 5, 6

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 = 82/52, 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: 255-256 Standard: Medicine (Endocrine Disorders) Objective: 4, 5, 6 9) Hyperglycemia is most likely a result of damage to the pancreatic ________ cells. A) alpha B) beta C) acinar D) delta Answer: B Diff: 2 Page Ref: 249 Standard: Medicine (Endocrine Disorders) Objective: 1, 2 10) A three-year-old male patient has a history of an underdeveloped cell-mediated immune system. Which of the following most likely contribute 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: 244 Standard: Medicine (Endocrine Disorders) Objective: 2, 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: 252 Standard: Medicine (Endocrine Disorders) Objective: 2, 3 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 D50 IV if the patient cannot follow simple commands. C) IV of NS. D) administration of oral glucose if the patient is able to swallow. Answer: A Diff: 3 Page Ref: 250-251 Standard: Medicine (Endocrine Disorders) Objective: 5, 6 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: 257 Standard: Medicine (Endocrine Disorders) Objective: 3, 6 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: 239 Standard: Medicine (Endocrine Disorders) Objective: 1, 2

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: 254-255 Standard: Medicine (Endocrine Disorders) Objective: 6 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: 256 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) 50 percent dextrose IV C) Synchronized cardioversion D) Propranolol Answer: D Diff: 3 Page Ref: 256 Standard: Medicine (Endocrine Disorders) Objective: 5, 6 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: 240 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: 243 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: 257 Standard: Medicine (Endocrine Disorders) Objective: 5, 6 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: 257 Standard: Medicine (Endocrine Disorders) Objective: 3, 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: 257 Standard: Medicine (Endocrine Disorders) Objective: 2, 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: 256 Standard: Medicine (Endocrine Disorders) Objective: 4 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 gm dextrose, IV. B) Start an IV and administer 0.3 mg glucagon, IV. C) Intubate the trachea, start an IV, and administer 25 gm dextrose. D) Administer glucagon, 1 mg IM. Answer: A Diff: 2 Page Ref: 250 Standard: Medicine (Endocrine Disorders) Objective: 4, 5, 6 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: 255 Standard: Medicine (Endocrine Disorders) Objective: 4, 5, 6 85 Copyright © 2017 Pearson Education, Inc.

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: 255 Standard: Medicine (Endocrine Disorders) Objective: 1, 3 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: 243 Standard: Medicine (Endocrine Disorders) Objective: 3, 4 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: 244 Standard: Medicine (Endocrine Disorders) Objective: 3, 4

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: 255, 256 Standard: Medicine (Endocrine Disorders) Objective: 4 30) Secretion of glucagon from the pancreas results in ________, which causes a(n) ________ in blood glucose levels. A) glucogenesis, decrease B) glycogenolysis, decrease C) glucogenesis, increase D) glycogenolysis, increase Answer: D Diff: 2 Page Ref: 245 Standard: Medicine (Endocrine Disorders) Objective: 2 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: 250 Standard: Medicine (Endocrine Disorders) Objective: 4, 5, 6

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, 1 to 2 L NS bolus, 25 g dextrose IV B) Oxygen by nonrebreather mask, NS at a KVO rate, 50 mEq sodium bicarbonate IV C) BVM ventilations with supplemental oxygen, NS at a KVO rate D) Intubate, 1 to 2 L NS bolus Answer: D Diff: 3 Page Ref: 250-252 Standard: Medicine (Endocrine Disorders) Objective: 4, 5, 6 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: 250, 254-255 Standard: Medicine (Endocrine Disorders) Objective: 3, 6 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%, 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 one-liter NS bolus IV. B) an IV of NS, 25 g dextrose IV, and 100 mg thiamine IV. C) a one-liter NS bolus, IV, and 25 g dextrose IV. D) 15 lpm oxygen by nonrebreather, IV of NS, 25 g dextrose. Answer: C Diff: 3 Page Ref: 258 Standard: Medicine (Endocrine Disorders) Objective: 5, 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: 254, 255 Standard: Medicine (Endocrine Disorders) Objective: 4 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: 244 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: 245 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: 245 Standard: Medicine (Endocrine Disorders) Objective: 3, 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: 242 Standard: Medicine (Endocrine Disorders) Objective: 2, 3 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: 246 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: 254, 255 Standard: Medicine (Endocrine Disorders) Objective: 2, 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: 247 Standard: Medicine (Endocrine Disorders) Objective: 3

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: 249 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: 249 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: 248-249 Standard: Medicine (Endocrine Disorders) Objective: 3, 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 ten 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: 249 Standard: Medicine (Endocrine Disorders) Objective: 3 91 Copyright © 2017 Pearson Education, Inc.

47) Which of the following statements about hyperglycemic hyperosmolar nonketotic coma (HHNK) is TRUE? A) Unlike diabetic ketoacidosis, HHNK is not life-threatening. B) Prehospital treatment of HHNK includes correcting metabolic acidosis. C) Aside from managing the ABCs, prehospital management is primarily aimed at correcting dehydration. D) Paradoxically, the definitive management of HHNK includes the administration of 50 percent dextrose. Answer: C Diff: 2 Page Ref: 252, 254 Standard: Medicine (Endocrine Disorders) Objective: 1, 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: 252 Standard: Medicine (Endocrine Disorders) Objective: 3, 5 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: 248-249 Standard: Medicine (Endocrine Disorders) Objective: 4

50) You have administered 25 g of 50 percent 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: 255 Standard: Medicine (Endocrine Disorders) Objective: 4, 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 25 g of 50 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: 255 Standard: Medicine (Endocrine Disorders) Objective: 5, 6 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 half an amp (12.5 g) of 50 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: 254-255 Standard: Medicine (Endocrine Disorders) Objective: 5, 6

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: 257 Standard: Medicine (Endocrine Disorders) Objective: 1, 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: 257 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: 256 Standard: Medicine (Endocrine Disorders) Objective: 3, 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: 239 Standard: Medicine (Endocrine Disorders) Objective: 2

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: 239 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: 243 Standard: Medicine (Endocrine Disorders) Objective: 2 59) The thyroid releases TSH to: A) promote shivering. B) protect the vascular system. C) increase metabolism. D) decrease insulin. Answer: C Diff: 1 Page Ref: 244 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: 245 Standard: Medicine (Endocrine Disorders) Objective: 2, 3

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, 100; respiratory rate 26; ETCO2 29; and you note an acetone odor. You suspect: A) HHNK. B) DKA. C) DNK. D) TNK. Answer: B Diff: 2 Page Ref: 250-252 Standard: Medicine (Endocrine Disorders) Objective: 4, 6 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. You suspect: A) DKA. B) HHNK. C) TNK. D) TPA. Answer: B Diff: 2 Page Ref: 252, 254 Standard: Medicine (Endocrine Disorders) Objective: 4, 6 63) You respond to an unresponsive patient. Upon exam, you get a finger stick blood glucose reading of "Lo." Treatment should include administration of: A) insulin. B) epinephrine. C) dextrose. D) ASA. Answer: C Diff: 2 Page Ref: 255 Standard: Medicine (Endocrine Disorders) Objective: 5, 6

Chapter 5 Immunology 1) Your patient is experiencing dyspnea and urticaria after ingesting penicillin. Auscultation of his lungs reveals diffuse expiratory wheezes. Which of the following medications will best help correct your patient's bronchospasm? A) Epinephrine 1:1000 SC B) Ranitidine 50 mg IV C) Solu-Medrol 125 mg IV D) 100 percent oxygen via nonrebreather mask 15 lpm Answer: A Diff: 2 Page Ref: 272 Standard: Medicine (Immunology) Objective: 3, 4, 5 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: 270, 271 Standard: Medicine (Immunology) Objective: 4, 7, 9 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 all of the following additional signs EXCEPT: A) laryngeal edema. B) bronchospasm. C) cyanosis. D) hypertension. Answer: D Diff: 1 Page Ref: 267-268 Standard: Medicine (Immunology) Objective: 3, 4 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: 271-272 Standard: Medicine (Immunology) Objective: 3, 4

5) Which of the following best describes 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: 264 Standard: Medicine (Immunology) Objective: 2 6) Which of the following 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: 270-271 Standard: Medicine (Immunology) Objective: 5, 6 7) The first medication administered to a patient experiencing an anaphylactic reaction should be: A) epinephrine. B) diphenhydramine. C) high-concentration oxygen. D) glucagon. Answer: C Diff: 2 Page Ref: 270-271 Standard: Medicine (Immunology) Objective: 5, 6

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%. 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 SC, 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 SC, diphenhydramine 25 mg IV, transport. D) transport only. Answer: B Diff: 3 Page Ref: 270 Standard: Medicine (Immunology) Objective: 4, 5, 6 9) Which of the following statements 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: 271 Standard: Medicine (Immunology) Objective: 3, 5, 6 10) Epinephrine administration results in all of the following EXCEPT: A) hypotension. B) increased cardiac contractile force. C) increased peripheral vasoconstriction. D) tachycardia. Answer: A Diff: 2 Page Ref: 270 Standard: Medicine (Immunology) Objective: 3, 5

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 SC. 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: 270 Standard: Medicine (Immunology) Objective: 4, 5, 6 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 = 98%. Which of the following 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 nonrebreather mask, IV crystalloid solution, 0.3 mg epinephrine SC, 25 mg diphenhydramine IV, albuterol 2.5 mg via nebulizer Answer: D Diff: 3 Page Ref: 268-271 Standard: Medicine (Immunology) Objective: 4, 5, 6 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: 271 Standard: Medicine (Immunology) Objective: 3, 5, 6

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 ________ immunity. A) secondary B) humoral C) antibody D) cellular Answer: B Diff: 2 Page Ref: 263 Standard: Medicine (Immunology) Objective: 1, 2 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: 270 Standard: Medicine (Immunology) Objective: 3, 5, 6 16) Which of the following 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: 264 Standard: Medicine (Immunology) Objective: 2

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: 264 Standard: Medicine (Immunology) Objective: 2, 6 18) Which of the following statements about the use of vasopressors in the treatment of anaphylaxis is TRUE? 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: 271 Standard: Medicine (Immunology) Objective: 3, 5, 6 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: 270 Standard: Medicine (Immunology) Objective: 5

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 include all of the following EXCEPT: A) epinephrine 1:1000 0.3 mg SC. 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: 270 Standard: Medicine (Immunology) Objective: 4, 5, 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%. 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 SC, diphenhydramine IV. D) IV with crystalloid solution such as lactated Ringer's or normal saline, epinephrine 1:1000 SC, diphenhydramine IV, nebulized albuterol. Answer: C Diff: 3 Page Ref: 270 Standard: Medicine (Immunology) Objective: 4, 5, 6 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 SC, 50 mg of diphenhydramine IV, and 1 L of NS. HR = 138; BP = 84/60; RR = 12/min, assisted with BVM; SaO2 = 94%. 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: 268-271 Standard: Medicine (Immunology) Objective: 4, 5, 6

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 more hoarse and she has developed expiratory wheezes in all lung fields. HR = 128, BP = 100/70, RR = 20, SaO2 = 99%. 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: 267-268, 270 Standard: Medicine (Immunology) Objective: 4, 5, 6 24) The two most common causes of fatal anaphylaxis are ________ and ________. A) shellfish, tree nuts B) hymenoptera stings, tree nuts C) hymenoptera stings, injected penicillin D) shellfish, sulfa drugs Answer: C Diff: 1 Page Ref: 263 Standard: Medicine (Immunology) Objective: 3 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: 265 Standard: Medicine (Immunology) Objective: 1, 3

26) Which of the following 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: 270 Standard: Medicine (Immunology) Objective: 2 27) The administration of a vaccine results in ________ immunity. A) induced passive B) natural passive C) natural induced D) active Answer: D Diff: 1 Page Ref: 264 Standard: Medicine (Immunology) Objective: 1, 2 28) Which of the following 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: 265-266 Standard: Medicine (Immunology) Objective: 2 29) Which of the following 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: 270 Standard: Medicine (Immunology) Objective: 5, 6 105 Copyright © 2017 Pearson Education, Inc.

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: 263 Standard: Medicine (Immunology) Objective: 1, 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 following 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: 271-272 Standard: Medicine (Immunology) Objective: 5 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: 266 Standard: Medicine (Immunology) Objective: 1, 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 the following 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: 263 Standard: Medicine (Immunology) Objective: 3, 4 34) The ________ system is a complicated body system responsible for combating infection. A) immune B) nervous C) respiratory D) cardiovascular Answer: A Diff: 1 Page Ref: 263 Standard: Medicine (Immunology) Objective: 1, 2 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: 264 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: 263 Standard: Medicine (Immunology) Objective: 1 107 Copyright © 2017 Pearson Education, Inc.

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: 266 Standard: Medicine (Immunology) Objective: 1, 2 38) Histamine causes the all of the following EXCEPT: A) bronchoconstriction. B) vasodilation. C) increased vascular permeability. D) increased intracranial pressure. Answer: D Diff: 1 Page Ref: 266 Standard: Medicine (Immunology) Objective: 1, 2 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: 266-268 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: 269 Standard: Medicine (Immunology) Objective: 5, 6

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: 270 Standard: Medicine (Immunology) Objective: 6 Chapter 6 Gastroenterology 1) All of the following 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: 287 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 2 2) All of the following 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: 290 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 3, 4 3) Your patient, who has a history of cholecystitis, is experiencing pain in her right shoulder. She is most likely experiencing ________ pain. A) somatic B) visceral C) referred D) peritoneal Answer: C Diff: 1 Page Ref: 278 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 5

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 the following 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: 279-280 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5, 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: 280 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 6, 7 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: 280 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5, 6

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%. Proper treatment of this patient would include all of the following 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: 283 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 6, 7 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 the following, 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: 291 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 5 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 the following 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: 284 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5, 7

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: 277 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 3 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%. 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: 282 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 6, 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 ________ pain. A) visceral B) referred C) somatic D) parietal Answer: A Diff: 1 Page Ref: 277 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 5 13) Which of the following 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: 281 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 2 112 Copyright © 2017 Pearson Education, Inc.

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: 292 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5 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%. Which of the following 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: 289-290 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 4, 6 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: 282-283 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 3, 4

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: 281 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 2, 4 18) Which of the following 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: 277-278 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 3 19) Pain that is well localized, allowing an examiner to pinpoint the area of irritation is ________ pain. A) parietal B) visceral C) referred D) somatic Answer: D Diff: 1 Page Ref: 278 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 3

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 the following 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: 282 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 4, 5 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 the following, 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: 293-294 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5, 7 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: 295 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 5

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: 294 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 2 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 the following, 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: 297 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 3, 5 25) The mortality rate of ruptured esophageal varices is ________ percent. A) over 35 B) 10 to 15 C) 20 to 30 D) 15 Answer: A Diff: 1 Page Ref: 282 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 4 26) Your 43-year-old male patient is alert and oriented and complaining of abdominal pain. He states that he is experiencing nausea and has vomited twice. Which of the following 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: 279 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5, 7

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 the following, 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: 292 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 4, 5 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 the following, 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: 295-296 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 4, 5 29) Which of the following 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: 279 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 3, 5

30) Gastrointestinal emergencies account for ________ percent of emergency room visits annually. A) 5 B) 10 C) 2.5 D) 7.5 Answer: A Diff: 1 Page Ref: 277 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 the following, 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: 282-283 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 4, 5 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 the following, 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: 283-284 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 4, 5

33) Your patient is a 25-year-old female who is complaining of pain in the midline of the lower abdomen. Which of the following 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: 279 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 3, 5 34) Which of the following 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: 296-297 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 3 35) Which of the following 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: 297 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 3 36) Which of the following 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: 296 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 4

37) Which of the following 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: 296 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 3, 4 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 ________ sign. A) Murphy's B) Cullen's C) McBurney's D) Grey-Turner's Answer: A Diff: 2 Page Ref: 295 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 5 39) Pain at McBurney's point is associated with: A) cholecystitis. B) kidney stones. C) appendicitis. D) pancreatitis. Answer: C Diff: 2 Page Ref: 294 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 3, 4 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 the following 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: 291 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 4, 5

41) Which of the following 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: 290 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 3, 4 42) Which of the following 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: 290 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 3, 4 43) A Mallory-Weiss tear is a disorder of the: A) stomach. B) liver. C) rectum. D) esophagus. Answer: D Diff: 1 Page Ref: 281 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 4 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: 283 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 4

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: 285 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 3, 4 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: 293 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 3, 4 47) Which of the following 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: 291-292 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 4, 5 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: 277 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 3

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: 278 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 3 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: 278 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 3 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: 280 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 5 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: 280 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 5

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: 279 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 3, 7 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: 281 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 2 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: 282 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 4, 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: 282 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 5, 6

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: 282 Standard: Medicine (Abdominal and Gastrointestinal Disorders) Objective: 1, 3, 4 Chapter 7 Urology and Nephrology 1) What 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: 320-321 Standard: Medicine (Genitourinary/Renal) Objective: 1, 2, 3 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: 320 Standard: Medicine (Genitourinary/Renal) Objective: 1, 2, 3 3) Of the following, which 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 Diff: 2 Page Ref: 314, 315 Standard: Medicine (Genitourinary/Renal) Objective: 1, 3 125 Copyright © 2017 Pearson Education, Inc.

4) Which of the following would most increase the likelihood 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: 320 Standard: Medicine (Genitourinary/Renal) Objective: 1, 3 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 pubis in lower UTI and at the flank in upper UTI. Answer: D Diff: 1 Page Ref: 322 Standard: Medicine (Genitourinary/Renal) Objective: 4 6) A patient undergoes neurological changes during hemodialysis. Of the following, which 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: 318 Standard: Medicine (Genitourinary/Renal) Objective: 3, 4 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: 319 Standard: Medicine (Genitourinary/Renal) Objective: 4

8) Treatment of a patient in acute renal failure may include all of the following EXCEPT: A) IV normal saline. B) dialysis. C) furosemide. D) potassium. Answer: D Diff: 2 Page Ref: 312-313 Standard: Medicine (Genitourinary/Renal) Objective: 5, 6 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: 304-305 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: 311-313 Standard: Medicine (Genitourinary/Renal) Objective: 1, 2, 3 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 5 on a scale of 0 to 10. Physical examination reveals tenderness on palpation of the lower abdomen bilaterally and warm, dry skin. HR = 88, BP = 126/78, RR = 12. The most appropriate action is: A) oxygen, IV fluids, morphine. B) Expedite transport in position of comfort. C) oxygen, IV fluids. D) IV fluids, morphine. Answer: B Diff: 2 Page Ref: 320-322 Standard: Medicine (Genitourinary/Renal) Objective: 5, 6 127 Copyright © 2017 Pearson Education, Inc.

12) Which of the following statements 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: 317 Standard: Medicine (Genitourinary/Renal) Objective: 1, 3, 6 13) In healthy individuals, which of the following 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: 306 Standard: Medicine (Genitourinary/Renal) Objective: 2 14) All of the following 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: 317 Standard: Medicine (Genitourinary/Renal) Objective: 4 15) Which of the following findings 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: 322 Standard: Medicine (Genitourinary/Renal) Objective: 3

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 the following EXCEPT: A) IV fluid therapy. B) fentanyl. C) Lasix IV. D) morphine. Answer: C Diff: 2 Page Ref: 320 Standard: Medicine (Genitourinary/Renal) Objective: 5, 6 17) All of the following may be associated with urinary tract infection EXCEPT: A) cystitis. B) cholecystitis. C) prostatitis. D) pyelonephritis. Answer: B Diff: 1 Page Ref: 321 Standard: Medicine (Genitourinary/Renal) Objective: 3 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% 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: 322 Standard: Medicine (Genitourinary/Renal) Objective: 4, 5, 6 19) Which of the following 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: 311-313 Standard: Medicine (Genitourinary/Renal) Objective: 1, 3 129 Copyright © 2017 Pearson Education, Inc.

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%. 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: 316 Standard: Medicine (Genitourinary/Renal) Objective: 4, 5 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: 321-322 Standard: Medicine (Genitourinary/Renal) Objective: 3, 11 22) Which of the following 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: 303-305 Standard: Medicine (Genitourinary/Renal) Objective: 3 23) Which of the following 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: 306 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: 310 Standard: Medicine (Genitourinary/Renal) Objective: 4 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%. 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: 311 Standard: Medicine (Genitourinary/Renal) Objective: 4, 5, 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: 303 Standard: Medicine (Genitourinary/Renal) Objective: 1, 4

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: 319 Standard: Medicine (Genitourinary/Renal) Objective: 4, 6 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%, 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 gm C) IV dextrose, 25 gm D) IV furosemide, 120 mg Answer: A Diff: 2 Page Ref: 316 Standard: Medicine (Genitourinary/Renal) Objective: 4, 5, 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: 302 Standard: Medicine (Genitourinary/Renal) Objective: 2

30) Which of the following statements 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: 314 Standard: Medicine (Genitourinary/Renal) Objective: 3, 5 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: 315 Standard: Medicine (Genitourinary/Renal) Objective: 5, 6 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 89%. After applying high-concentration oxygen, which of the following would 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: 315-316 Standard: Medicine (Genitourinary/Renal) Objective: 4, 5, 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: 317 Standard: Medicine (Genitourinary/Renal) Objective: 3 34) Which of the following 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: 317 Standard: Medicine (Genitourinary/Renal) Objective: 3 35) When assessing a fistula used for hemodialysis, which of the following 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: 317 Standard: Medicine (Genitourinary/Renal) Objective: 3, 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: 317 Standard: Medicine (Genitourinary/Renal) Objective: 4, 5, 6

37) Which of the following 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: 317-318 Standard: Medicine (Genitourinary/Renal) Objective: 1, 3, 5 38) Which of the following 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: 312 Standard: Medicine (Genitourinary/Renal) Objective: 1, 3 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: 314 Standard: Medicine (Genitourinary/Renal) Objective: 3, 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: 302 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: 302 Standard: Medicine (Genitourinary/Renal) Objective: 2 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: 306 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: 309 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: 310 Standard: Medicine (Genitourinary/Renal) Objective: 4

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: 311 Standard: Medicine (Genitourinary/Renal) Objective: 4 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: 311 Standard: Medicine (Genitourinary/Renal) Objective: 1, 3 47) Acute renal failure occurs when a patient loses ________ of the functioning nephrons. A) 80% B) 70% C) 60% D) 50% Answer: B Diff: 1 Page Ref: 314 Standard: Medicine (Genitourinary/Renal) Objective: 3 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: 315 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: 371-318 Standard: Medicine (Genitourinary/Renal) Objective: 1, 4 Chapter 8 Toxicology and Substance Abuse 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: 344-345 Standard: Medicine (Toxicology) Objective: 4, 7 2) Restoril and Ativan are examples of: A) benzodiazepines. B) barbiturates. C) opiates. D) narcotics. Answer: A Diff: 1 Page Ref: 362 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. Which of the following is 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: 361 Standard: Medicine (Toxicology) Objective: 7, 8

4) Your patient is a 40-year-old male who ingested 30 tablets of Lexapro and 24 tablets of Tylenol PM. Which of the following 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: 331 Standard: Medicine (Toxicology) Objective: 5, 6 5) Which of the following classes of drugs is commonly abused to produce hyperactivity and exhilaration? A) Amphetamines B) Barbiturates C) Alcohol D) Benzodiazepines Answer: A Diff: 1 Page Ref: 361 Standard: Medicine (Toxicology) Objective: 2, 6 6) Which of the following is the therapeutic effect of a cathartic? A) Vomiting B) Increased protein binding of drugs C) Alkalinization of the urine D) Diarrhea Answer: D Diff: 2 Page Ref: 330 Standard: Medicine (Toxicology) Objective: 6 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: 359 Standard: Medicine (Toxicology) Objective: 1, 2, 6

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: 358 Standard: Medicine (Toxicology) Objective: 7, 8 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: 348 Standard: Medicine (Toxicology) Objective: 3, 7, 8 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: 346-347 Standard: Medicine (Toxicology) Objective: 5, 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: 328 Standard: Medicine (Toxicology) Objective: 4

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%. Oxygen via a nonrebreather has been applied and an IV established. Which of the following 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: 332 Standard: Medicine (Toxicology) Objective: 5, 7, 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: 360 Standard: Medicine (Toxicology) Objective: 7, 8 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%. 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: 343, 344 Standard: Medicine (Toxicology) Objective: 5, 6

15) Lithium is used to treat: A) bipolar disorder. B) schizophrenia. C) depression. D) personality disorders. Answer: A Diff: 1 Page Ref: 348 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: 352 Standard: Medicine (Toxicology) Objective: 3, 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% 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: 348 Standard: Medicine (Toxicology) Objective: 5, 7

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 the following EXCEPT: A) activated charcoal. B) IV of normal saline. C) oxygen. D) transport. Answer: A Diff: 2 Page Ref: 351-352 Standard: Medicine (Toxicology) Objective: 7, 8 19) Your patient has ingested cyanide in a suicide attempt. Which of the following 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: 341-342 Standard: Medicine (Toxicology) Objective: 5, 6 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: 341-342 Standard: Medicine (Toxicology) Objective: 5, 7 21) LSD and PCP are examples of: A) amphetamines. B) hallucinogens. C) sedatives. D) narcotics. Answer: B Diff: 1 Page Ref: 362 Standard: Medicine (Toxicology) Objective: 6

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 of the following signs or symptoms 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: 343 Standard: Medicine (Toxicology) Objective: 5 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: 360 Standard: Medicine (Toxicology) Objective: 7, 8 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 an NS 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: 329-330 Standard: Medicine (Toxicology) Objective: 7 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: 359 Standard: Medicine (Toxicology) Objective: 1, 6 144 Copyright © 2017 Pearson Education, Inc.

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: 360 Standard: Medicine (Toxicology) Objective: 6, 7 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 the following 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: 330, 349 Standard: Medicine (Toxicology) Objective: 1, 7, 8 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%. 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: 342-343 Standard: Medicine (Toxicology) Objective: 7, 8 29) The order Hymenoptera includes: A) wasps. B) jellyfish. C) spiders. D) scorpions. Answer: A Diff: 1 Page Ref: 328, 353 Standard: Medicine (Toxicology) Objective: 6 145 Copyright © 2017 Pearson Education, Inc.

30) Which of the following cause(s) injury by inducing liquefaction necrosis? A) Caustics B) Alkalis C) Emulsifiers D) Acids Answer: B Diff: 2 Page Ref: 344 Standard: Medicine (Toxicology) Objective: 6 31) Mushrooms from the class ________ are responsible for over 90 percent of deaths from mushroom toxicity. A) Button B) Amanita C) Shiitake D) Galerina Answer: B Diff: 1 Page Ref: 352 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. Which of the following are 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: 349 Standard: Medicine (Toxicology) Objective: 5, 6 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: 332, 363 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%. 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: 349 Standard: Medicine (Toxicology) Objective: 5, 7, 8 35) Alcohol is classified as a(n): A) stimulant. B) anxiolytic. C) depressant. D) hallucinogen. Answer: C Diff: 1 Page Ref: 362-363 Standard: Medicine (Toxicology) Objective: 6 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: 355 Standard: Medicine (Toxicology) Objective: 5, 7, 8 37) The primary goal in the prehospital care of a patient who has been bitten by a pit viper is to: A) induce diuresis. B) slow absorption of the venom. C) alkalinize the urine. D) remove the venom from the surrounding tissue. Answer: B Diff: 2 Page Ref: 357 Standard: Medicine (Toxicology) Objective: 7 147 Copyright © 2017 Pearson Education, Inc.

38) Which of the following statements 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. Answer: D Diff: 2 Page Ref: 353-354 Standard: Medicine (Toxicology) Objective: 6, 7 39) "Rock" and "crack" are street names for: A) cocaine. B) marijuana. C) heroin. D) morphine. Answer: A Diff: 1 Page Ref: 361 Standard: Medicine (Toxicology) Objective: 6 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%, 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: 363-364 Standard: Medicine (Toxicology) Objective: 5, 7

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%. 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: 360 Standard: Medicine (Toxicology) Objective: 6, 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%. 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: 330, 332, 344-345 Standard: Medicine (Toxicology) Objective: 5, 7, 8 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: 330 Standard: Medicine (Toxicology) Objective: 1, 3, 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: 363-364 Standard: Medicine (Toxicology) Objective: 7 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: 363-364 Standard: Medicine (Toxicology) Objective: 6 46) Which of the following correctly pairs a toxin with its antidote? A) Benzodiazepine: naloxone B) Acetaminophen: N-acetylcysteine C) Carbon monoxide: amyl nitrite D) Aspirin: magnesium citrate Answer: B Diff: 2 Page Ref: 330 Standard: Medicine (Toxicology) Objective: 6, 8 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: 341, 342 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: 328 Standard: Medicine (Toxicology) Objective: 6 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: 333 Standard: Medicine (Toxicology) Objective: 6 50) You are presented with a 42-year-old male who is unconscious with snoring respirations after a heroin overdose. HR = 64, BP = 98/50, RR = 6 and shallow, SaO2 = 91%. 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: 361 Standard: Medicine (Toxicology) Objective: 5, 7 51) Prozac, Paxil, and Zoloft are all examples of: A) phenothiazines. B) monoamine oxidase inhibitors. C) selective serotonin reuptake inhibitors. D) tricyclic antidepressants. Answer: C Diff: 1 Page Ref: 347 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: 327 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: 361 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: 349-350 Standard: Medicine (Toxicology) Objective: 6 55) The pathophysiology of toxic inhalation involves: A) bronchodilation and destruction of cilia. B) irritation, edema, and destruction of alveolar tissue. C) pulmonary hypertension, alveolar atelectasis, and destruction of cilia. D) bronchoconstriction and dispersal of surfactant. Answer: B Diff: 2 Page Ref: 328 Standard: Medicine (Toxicology) Objective: 4, 6

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: 354-355 Standard: Medicine (Toxicology) Objective: 7, 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: 327 Standard: Medicine (Toxicology) Objective: 2 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 = 99%. Based on the clinical exam findings, treatment would consist of all of the following EXCEPT: A) O2 via nasal cannula 2 lpm. 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: 345 Standard: Medicine (Toxicology) Objective: 5, 7, 8 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: 360 Standard: Medicine (Toxicology) Objective: 7 153 Copyright © 2017 Pearson Education, Inc.

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 gm dextrose, transport D) 50 gm activated charcoal through an NG tube en route to the hospital Answer: A Diff: 3 Page Ref: 361 Standard: Medicine (Toxicology) Objective: 5, 7 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: 337 Standard: Medicine (Toxicology) Objective: 7 62) Which of the following is a narcotic? A) Mescaline B) Crack C) Cocaine D) Heroin Answer: D Diff: 1 Page Ref: 361 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: 359 Standard: Medicine (Toxicology) Objective: 1, 6 154 Copyright © 2017 Pearson Education, Inc.

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%. 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 gm 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 gm dextrose Answer: C Diff: 3 Page Ref: 332 Standard: Medicine (Toxicology) Objective: 5, 7, 8 65) Fifty percent of accidental poisonings occur in: A) adults. B) geriatric patients. C) pediatric patients. D) dementia patients. Answer: C Diff: 1 Page Ref: 327 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: 327 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: 328 Standard: Medicine (Toxicology) Objective: 4 155 Copyright © 2017 Pearson Education, Inc.

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: 328 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: 328 Standard: Medicine (Toxicology) Objective: 4 70) The three steps of decontamination are: A) reduce absorption, reduce metabolism, increase absorption by the kidney. B) water, elimination in urine, atropine. C) elimination in urine, water, oxygen. D) reduce intake of the toxin, reduce absorption, enhance elimination. Answer: D Diff: 1 Page Ref: 329-330 Standard: Medicine (Toxicology) Objective: 7 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: 330 Standard: Medicine (Toxicology) Objective: 1, 6

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: 332 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: 334 Standard: Medicine (Toxicology) Objective: 7, 8 74) The half-life of carboxyhemoglobin is reduced to approximately 22 minutes by using: A) 100% oxygen. B) 44% oxygen. C) hypobaric oxygen therapy. D) hyperbaric oxygen therapy. Answer: D Diff: 2 Page Ref: 335 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: 337 Standard: Medicine (Toxicology) Objective: 7, 8

Chapter 9 Hematology 1) Which of the following 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: 374 Standard: Medicine (Hematology) Objective: 3 2) Which of the following 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: 376-377 Standard: Medicine (Hematology) Objective: 1, 3 3) When a patient receives a laceration, the clotting process that occurs is primarily mediated by the ________ pathway. A) platelet B) common C) extrinsic D) intrinsic Answer: C Diff: 2 Page Ref: 376 Standard: Medicine (Hematology) Objective: 1, 3 4) Of the following, 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: 388 Standard: Medicine (Hematology) Objective: 5

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 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: 387 Standard: Medicine (Hematology) Objective: 6, 7 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: 387 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: 375 Standard: Medicine (Hematology) Objective: 5 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: 386 Standard: Medicine (Hematology) Objective: 3, 5

9) Which of the following 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: 384 Standard: Medicine (Hematology) Objective: 5 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%. Physical examination reveals cool, dry skin. Which of the following 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: 380 Standard: Medicine (Hematology) Objective: 5 11) In a patient with a hematological disease resulting in production of high numbers of abnormal red blood cells, which of the following would you be most likely to find? A) Splenomegaly B) Fever C) Hepatomegaly D) Florid skin Answer: A Diff: 2 Page Ref: 382 Standard: Medicine (Hematology) Objective: 5 12) Which of the following 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: 371-372 Standard: Medicine (Hematology) Objective: 3

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: 371 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: 385 Standard: Medicine (Hematology) Objective: 3, 5 15) Which of the following 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: 375 Standard: Medicine (Hematology) Objective: 1, 3 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: 377 Standard: Medicine (Hematology) Objective: 5

17) All of the following 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: 375 Standard: Medicine (Hematology) Objective: 3, 5 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 the following 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; corticosteriods C) DIC; fresh frozen plasma and platelet administration D) Idiopathic hemophilia; factor VIIa administration Answer: C Diff: 3 Page Ref: 388 Standard: Medicine (Hematology) Objective: 4, 6, 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: 375 Standard: Medicine (Hematology) Objective: 1, 3

20) Which of the following 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: 388 Standard: Medicine (Hematology) Objective: 1, 3, 5 21) Which of the following situations would result in erythropoietin secretion? A) CVA B) Hypoxia C) Alkalemia D) Hemophilia Answer: B Diff: 2 Page Ref: 372 Standard: Medicine (Hematology) Objective: 1, 3, 5 22) Which of the following 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: 375 Standard: Medicine (Hematology) Objective: 3 23) A patient has a hematocrit of 48 percent and a hemoglobin of 15 g/dl. Which of the following 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: 372-373 Standard: Medicine (Hematology) Objective: 5

24) Which of the following 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: 386 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: 376 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 the following 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: 375 Standard: Medicine (Hematology) Objective: 3 27) Which of the following 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: 373 Standard: Medicine (Hematology) Objective: 3

28) Which of the following 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: 376 Standard: Medicine (Hematology) Objective: 3 29) A male will express hemophilia if he acquires ________ chromosome(s). A) defective X and Y B) one defective X C) two defective X D) one defective Y Answer: B Diff: 2 Page Ref: 387 Standard: Medicine (Hematology) Objective: 2 30) For a patient with hemophilia B, which of the following 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: 387 Standard: Medicine (Hematology) Objective: 2 31) Which of the following 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: 375 Standard: Medicine (Hematology) Objective: 3

32) Which of the following 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: 383 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: 384-385 Standard: Medicine (Hematology) Objective: 5, 6, 7 34) Your patient is suffering from end-stage liver disease. In which of the following 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: 381 Standard: Medicine (Hematology) Objective: 5

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: 375 Standard: Medicine (Hematology) Objective: 5 36) Your patient is undergoing chemotherapy and is complaining of bleeding from the gums and blood in his stool. Which of the following 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: 382 Standard: Medicine (Hematology) Objective: 5, 6, 7 37) In an emergency situation if you administer blood to a patient whose blood type is unknown, you should administer type ________ blood. A) A positive B) O negative C) B positive D) A negative Answer: B Diff: 2 Page Ref: 377-378 Standard: Medicine (Hematology) Objective: 3, 7 38) Your patient has type A+ blood. Which of the following 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: 377-378 Standard: Medicine (Hematology) Objective: 3

39) In which of the following 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: 378 Standard: Medicine (Hematology) Objective: 3, 5 40) Which of the following 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: 379 Standard: Medicine (Hematology) Objective: 6, 7 41) Your patient has a history of pernicious anemia. If not treated, your primary concern for this patient should be: A) hypovolemia. B) prolonged blood clotting time. C) hypoxia. D) infection. Answer: C Diff: 2 Page Ref: 383-384 Standard: Medicine (Hematology) Objective: 5, 6, 7 42) Which of the following 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: 384 Standard: Medicine (Hematology) Objective: 2, 5

43) Your patient is an 18-year-old female suffering from sickle cell crisis. Which of the following 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: 384-385 Standard: Medicine (Hematology) Objective: 6, 7 44) Which of the following 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: 385 Standard: Medicine (Hematology) Objective: 5 45) Which of the following 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: 387 Standard: Medicine (Hematology) Objective: 2, 5 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: 384 Standard: Medicine (Hematology) Objective: 2

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: 384-385 Standard: Medicine (Hematology) Objective: 6, 19 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: 369 Standard: Medicine (Hematology) Objective: 1 49) Hemophilia A is an example of a ________ disorder. A) genetically acquired B) environmentally acquired C) intrinsically endued D) extrinsically endued Answer: A Diff: 1 Page Ref: 387 Standard: Medicine (Hematology) Objective: 1, 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: 370 Standard: Medicine (Hematology) Objective: 3

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: 371 Standard: Medicine (Hematology) Objective: 3 52) Causes of the inflammatory process include all of the following EXCEPT: A) infection. B) chemical exposure. C) trauma. D) psychosocial factors. Answer: D Diff: 1 Page Ref: 375 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: 376 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: 377 Standard: Medicine (Hematology) Objective: 3

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: 379 Standard: Medicine (Hematology) Objective: 4, 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: 379 Standard: Medicine (Hematology) Objective: 6, 7 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: 382 Standard: Medicine (Hematology) Objective: 4, 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: 384 Standard: Medicine (Hematology) Objective: 4, 5

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: 385 Standard: Medicine (Hematology) Objective: 4, 5 Chapter 10 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 the following 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: 399 Standard: Medicine (Infectious Diseases) Objective: 1, 5 2) Which of the following 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: 394-395 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 the following 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. 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: 408 Standard: Medicine (Infectious Diseases) Objective: 6, 10 4) Which of the following 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: 422 Standard: Medicine (Infectious Diseases) Objective: 6 5) For which of the following diseases is there no vaccine? A) Measles B) Croup C) Mumps D) Rubella Answer: B Diff: 1 Page Ref: 427 Standard: Medicine (Infectious Diseases) Objective: 6, 8 6) Which of the following 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: 396 Standard: Medicine (Infectious Diseases) Objective: 1, 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: 410 Standard: Medicine (Infectious Diseases) Objective: 8 8) Which of the following 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: 434 Standard: Medicine (Infectious Diseases) Objective: 8 9) Which of the following 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: 424 Standard: Medicine (Infectious Diseases) Objective: 8 10) Which of the following organisms causes mononucleosis? A) Epstein-Barr virus B) Pediculus humanus capitis C) Treponema D) Herpes zoster Answer: A Diff: 1 Page Ref: 426 Standard: Medicine (Infectious Diseases) Objective: 3, 8

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: 436-437 Standard: Medicine (Infectious Diseases) Objective: 7, 8 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: 425, 426 Standard: Medicine (Infectious Diseases) Objective: 7 13) Which of the following 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: 394 Standard: Medicine (Infectious Diseases) Objective: 2 14) Which of the following techniques destroys some, but not all, microorganisms? A) Cleaning B) Disinfection C) Decontamination D) Sterilization Answer: B Diff: 1 Page Ref: 407-408 Standard: Medicine (Infectious Diseases) Objective: 5, 9, 13

15) Which of the following 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: 413 Standard: Medicine (Infectious Diseases) Objective: 4, 7, 9 16) Your patient was bitten on the hand by a wild raccoon he tried to capture. Which of the following 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: 430-431 Standard: Medicine (Infectious Diseases) Objective: 9, 13 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: 413-414 Standard: Medicine (Infectious Diseases) Objective: 6 18) While working in the emergency department, you accidentally stick yourself with the stylette 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: 402-404 Standard: Medicine (Infectious Diseases) Objective: 6, 10

19) Which of the following 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: 399 Standard: Medicine (Infectious Diseases) Objective: 5 20) Which of the following 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: 399-400 Standard: Medicine (Infectious Diseases) Objective: 1, 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: 429 Standard: Medicine (Infectious Diseases) Objective: 3, 8 22) A memory or specific response is considered a(n) ________ response. A) cell-mediated B) inflammatory C) humoral D) immune Answer: C Diff: 2 Page Ref: 400 Standard: Medicine (Infectious Diseases) Objective: 1, 5

23) Which of the following 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: 396 Standard: Medicine (Infectious Diseases) Objective: 1, 4 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: 394 Standard: Medicine (Infectious Diseases) Objective: 2 25) Which of the following 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: 425 Standard: Medicine (Infectious Diseases) Objective: 6, 8 26) The alternate pathway that reacts quickly to foreign bodies and uses antibodies and inflammation to combat pathogens is the ________ system. A) complement B) lymphatic C) humoral D) cell-mediated Answer: A Diff: 2 Page Ref: 400 Standard: Medicine (Infectious Diseases) Objective: 1, 5

27) Which of the following is a mobile, single-celled, parasitic organism? A) Fungus B) Virus C) Protozoan D) Bacterium Answer: C Diff: 1 Page Ref: 396 Standard: Medicine (Infectious Diseases) Objective: 1, 3 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: 395-396 Standard: Medicine (Infectious Diseases) Objective: 1, 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%. 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: 414, 415 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: 420 Standard: Medicine (Infectious Diseases) Objective: 7 180 Copyright © 2017 Pearson Education, Inc.

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: 426 Standard: Medicine (Infectious Diseases) Objective: 8 32) Which of the following is classified as a helminth? A) Trichomonas B) Treponema C) Spirochete D) Fluke Answer: D Diff: 1 Page Ref: 393, 397 Standard: Medicine (Infectious Diseases) Objective: 1, 3 33) Which of the following 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: 422-423 Standard: Medicine (Infectious Diseases) Objective: 8 34) You are suspicious that a patient is suffering from active tuberculosis. Which of the following 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: 414-416 Standard: Medicine (Infectious Diseases) Objective: 6, 10

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 the following is most likely? A) Fatty liver B) Cirrhosis of the liver C) HIV D) Hepatitis B Answer: D Diff: 3 Page Ref: 412, 413 Standard: Medicine (Infectious Diseases) Objective: 7 36) Which of the following 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: 412 Standard: Medicine (Infectious Diseases) Objective: 8 37) Which of the following 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: 424 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: 414 Standard: Medicine (Infectious Diseases) Objective: 8

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%. Which of the following 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: 421-422 Standard: Medicine (Infectious Diseases) Objective: 9, 10 40) From which of the following 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: 431-432 Standard: Medicine (Infectious Diseases) Objective: 3, 8 41) Which of the following 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: 421 Standard: Medicine (Infectious Diseases) Objective: 3, 8 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: 421 Standard: Medicine (Infectious Diseases) Objective: 3, 8

43) Which of the following statements about Neisseria meningitidis is TRUE? A) The vaccine is recommended for health care workers. B) It is the bacteria that most often causes serious cases of meningitis. C) It is responsible for 90 percent of patients with a viral meningitis. D) Signs and symptoms of infection can take weeks to develop. Answer: B Diff: 1 Page Ref: 421 Standard: Medicine (Infectious Diseases) Objective: 3, 8 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: 414 Standard: Medicine (Infectious Diseases) Objective: 4, 8 45) Mushrooms and yeasts are examples of: A) parasites. B) fungi. C) helminthes. D) protozoa. Answer: B Diff: 1 Page Ref: 396 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: 422 Standard: Medicine (Infectious Diseases) Objective: 1, 7

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 the following is most likely? A) Legionnaire's disease B) Hantavirus infection C) Anthrax D) Scorpion bite Answer: B Diff: 3 Page Ref: 428 Standard: Medicine (Infectious Diseases) Objective: 7, 9, 13 48) Which of the following 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: 421 Standard: Medicine (Infectious Diseases) Objective: 8 49) Which of the following 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: 424 Standard: Medicine (Infectious Diseases) Objective: 8

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 the following is most likely? A) Bacterial meningitis B) Hantavirus pulmonary syndrome C) Mononucleosis D) Fifth disease Answer: C Diff: 2 Page Ref: 426 Standard: Medicine (Infectious Diseases) Objective: 7, 8, 9 51) While on a call you receive a laceration to your thigh from a jagged piece of metal. Which of the following 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 ten 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: 426, 431, 432 Standard: Medicine (Infectious Diseases) Objective: 6, 10 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: 439 Standard: Medicine (Infectious Diseases) Objective: 12

53) Which of the following is NOT a government organization involved with infectious diseases? A) CDC B) OSHA C) EPA D) FEMA Answer: C Diff: 1 Page Ref: 394-395 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: 395 Standard: Medicine (Infectious Diseases) Objective: 3 55) Which of the following 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: 397 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: 399 Standard: Medicine (Infectious Diseases) Objective: 5

57) Cell-mediated immunity generates: A) T lymphocytes. B) B lymphocytes. C) inflammation. D) histamine. Answer: A Diff: 1 Page Ref: 400 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: 400 Standard: Medicine (Infectious Diseases) Objective: 1, 5 59) The lymphatic system is comprised of all of the following EXCEPT: A) spleen. B) lymph nodes. C) thymus. D) liver. Answer: D Diff: 1 Page Ref: 400 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: 403 Standard: Medicine (Infectious Diseases) Objective: 6

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 three feet away. Answer: D Diff: 2 Page Ref: 404-405 Standard: Medicine (Infectious Diseases) Objective: 6, 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: 404 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: 408 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: 409 Standard: Medicine (Infectious Diseases) Objective: 5

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: 410 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: 412 Standard: Medicine (Infectious Diseases) Objective: 8 67) Hepatitis A is can exist on unwashed hands for: A) 5 days. B) 4 days. C) 6 hours. D) 4 hours. Answer: D Diff: 1 Page Ref: 412 Standard: Medicine (Infectious Diseases) Objective: 4, 8 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: 413 Standard: Medicine (Infectious Diseases) Objective: 4, 8

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: 415 Standard: Medicine (Infectious Diseases) Objective: 7, 8, 9 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: 416 Standard: Medicine (Infectious Diseases) Objective: 6, 10 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: 420 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: 421 Standard: Medicine (Infectious Diseases) Objective: 7, 9

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: 422 Standard: Medicine (Infectious Diseases) Objective: 7, 9 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: 422 Standard: Medicine (Infectious Diseases) Objective: 6, 10 75) Whooping cough is also known as: A) meningococcus. B) pertussis. C) varicella. D) pneumonia. Answer: B Diff: 1 Page Ref: 425 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: 427 Standard: Medicine (Infectious Diseases) Objective: 7, 9

77) You respond to a 2-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: 427 Standard: Medicine (Infectious Diseases) Objective: 7, 9 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: 438 Standard: Medicine (Infectious Diseases) Objective: 11 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: 439, 440 Standard: Medicine (Infectious Diseases) Objective: 7, 9 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: 440 Standard: Medicine (Infectious Diseases) Objective: 9, 12, 13

Chapter 11 Psychiatric and Behavioral Disorders 1) Which of the following 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: 446, 447 Standard: Medicine (Psychiatric) Objective: 2, 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%, blood glucose = 80 mg/dL. You offer him transport to the ED, which he accepts. Which of the following is most appropriate during transport of this patient? A) Apply a cardiac monitor, IV, oxygen 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: 450 Standard: Medicine (Psychiatric) Objective: 6, 11 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: 454 Standard: Medicine (Psychiatric) Objective: 3, 4

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 the following 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: 448-449 Standard: Medicine (Psychiatric) Objective: 3, 5, 11 5) Which of the following helps assess a patient's potential for violence? A) Gender B) Body language C) Ethnicity D) Age Answer: B Diff: 1 Page Ref: 447-448 Standard: Medicine (Psychiatric) Objective: 3 6) Which of the following 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: 448 Standard: Medicine (Psychiatric) Objective: 2, 6 7) Which of the following 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: 462 Standard: Medicine (Psychiatric) Objective: 10

8) Which of the following 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: 448-449 Standard: Medicine (Psychiatric) Objective: 3, 6 9) Which of the following 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: 459-460 Standard: Medicine (Psychiatric) Objective: 3, 6 10) Which of the following 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: 447-449 Standard: Medicine (Psychiatric) Objective: 3, 6 11) Which of the following 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: 460 Standard: Medicine (Psychiatric) Objective: 6, 11

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 the following 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: 456-457 Standard: Medicine (Psychiatric) Objective: 6, 11 13) Which of the following best describes perceived loss of physical functioning without medical or traumatic cause? A) Somatization disorder B) Conversion disorder C) Catatonia D) Body dismorphic disorder Answer: B Diff: 1 Page Ref: 454 Standard: Medicine (Psychiatric) Objective: 2, 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 the following is most consistent with this situation? A) Cocaine use B) Schizoaffective disorder C) Methamphetamine use D) Bipolar disorder Answer: D Diff: 2 Page Ref: 453 Standard: Medicine (Psychiatric) Objective: 2, 4

15) Your patient is a 32-year-old female who is depressed and tearful after a fight with her exhusband. Which of the following 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: 456-457 Standard: Medicine (Psychiatric) Objective: 5, 6, 11 16) Which of the following 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: 452 Standard: Medicine (Psychiatric) Objective: 1 17) Which of the following 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: 462 Standard: Medicine (Psychiatric) Objective: 10 18) Which of the following best describes the position or bearing of the body? A) Stature B) Facies C) Affect D) Posture Answer: D Diff: 1 Page Ref: 448 Standard: Medicine (Psychiatric) Objective: 1

19) Your patient is a 34-year-old male who is threatening to kill himself. Which of the following 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's being married Answer: D Diff: 2 Page Ref: 456-457 Standard: Medicine (Psychiatric) Objective: 5 20) Which of the following 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: 455 Standard: Medicine (Psychiatric) Objective: 1, 4 21) Which of the following best describes an emotional reaction characterized by rage? A) Emotional lability B) Anger C) Dread D) Irrationality Answer: B Diff: 1 Page Ref: 448 Standard: Medicine (Psychiatric) Objective: 1, 3

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%. He says, "See, I told you I'm fine. I don't need to go to the hospital." Which of the following 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: 453 Standard: Medicine (Psychiatric) Objective: 3, 4, 6 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 the following 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: 452-453 Standard: Medicine (Psychiatric) Objective: 6, 7

24) Which of the following 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: 462 Standard: Medicine (Psychiatric) Objective: 10, 11 25) Which of the following 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: 452 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 QRS, or something like that." Which of the following should you avoid in the treatment of this patient? A) Lorazepam B) Diazepam C) Droperidol D) Physical restraint Answer: C Diff: 2 Page Ref: 462 Standard: Medicine (Psychiatric) Objective: 4, 10, 11 27) Which of the following 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: 446-447 Standard: Medicine (Psychiatric) Objective: 2, 4 201 Copyright © 2017 Pearson Education, Inc.

28) Which of the following best describes a state of uneasiness, discomfort, apprehension, or restlessness? A) Depression B) Paranoia C) Anxiety D) Mania Answer: C Diff: 1 Page Ref: 451 Standard: Medicine (Psychiatric) Objective: 1, 2, 4 29) Which of the following is NOT an organic cause of a behavioral emergency? A) Tumor B) Hypoglycemia C) Alcoholic encephalopathy D) Dementia Answer: B Diff: 1 Page Ref: 446-447 Standard: Medicine (Psychiatric) Objective: 2, 4 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 the following 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: 456-457 Standard: Medicine (Psychiatric) Objective: 5, 11

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 the following is most appropriate? A) Oxygen, IV, nitroglycerin, aspirin, morphine B) IV, diazepam C) Oxygen D) IV, haloperidol Answer: B Diff: 2 Page Ref: 451 Standard: Medicine (Psychiatric) Objective: 3, 6 32) Which of the following best describes a state of disorientation or disorganized thought? A) Delusion B) Confabulation C) Neurosis D) Confusion Answer: D Diff: 1 Page Ref: 450 Standard: Medicine (Psychiatric) Objective: 1, 4 33) Which of the following 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: 446, 449 Standard: Medicine (Psychiatric) Objective: 4 34) Which of the following 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: 448 Standard: Medicine (Psychiatric) Objective: 1, 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 the following 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: 450-451 Standard: Medicine (Psychiatric) Objective: 3, 4 36) Which of the following 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: 461-462 Standard: Medicine (Psychiatric) Objective: 10 37) Which of the following 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: 461-462 Standard: Medicine (Psychiatric) Objective: 10 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: 461-462 Standard: Medicine (Psychiatric) Objective: 10, 11

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: 458-459 Standard: Medicine (Psychiatric) Objective: 9 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: 458-459 Standard: Medicine (Psychiatric) Objective: 9 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: 458-459 Standard: Medicine (Psychiatric) Objective: 9 42) Which of the following 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: 458-459 Standard: Medicine (Psychiatric) Objective: 9, 11

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 greens. C) behavioral emergency. D) personal assist. Answer: C Diff: 1 Page Ref: 446 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: 447 Standard: Medicine (Psychiatric) Objective: 1, 2 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: 447 Standard: Medicine (Psychiatric) Objective: 1, 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: 447-448 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: 448 Standard: Medicine (Psychiatric) Objective: 3 48) A mental status exam on a behavioral emergency should include all of the following EXCEPT: A) orientation. B) sensorium. C) mood and affect. D) time since diagnosis. Answer: D Diff: 1 Page Ref: 449 Standard: Medicine (Psychiatric) Objective: 3, 4 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: 450 Standard: Medicine (Psychiatric) Objective: 1, 4 50) The third leading cause of death for 15- to 24-year-olds is: A) trauma. B) drug abuse. C) suicide. D) accidents. Answer: C Diff: 1 Page Ref: 456 Standard: Medicine (Psychiatric) Objective: 5

51) Which of the following 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: 456-457 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: 457 Standard: Medicine (Psychiatric) Objective: 7, 11 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: 457 Standard: Medicine (Psychiatric) Objective: 7, 11 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: 457 Standard: Medicine (Psychiatric) Objective: 3, 4, 8

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: 457 Standard: Medicine (Psychiatric) Objective: 6, 8, 10, 11 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: 458 Standard: Medicine (Psychiatric) Objective: 9, 11 57) Which of the following 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: 458 Standard: Medicine (Psychiatric) Objective: 9, 11 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: 461 Standard: Medicine (Psychiatric) Objective: 10

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: 461 Standard: Medicine (Psychiatric) Objective: 10 Chapter 12 Diseases of the Eyes, Ears, Nose, and Throat 1) All of the following are symptoms of otitis media EXCEPT: A) pain. B) pressure. C) sinus infection. D) fever. Answer: C Diff: 2 Page Ref: 474 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 4 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: 475 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 4 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: 467, 468 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 4

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 of the following 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: 467 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 3, 4 5) The ________ of the eye controls the size of the pupil. A) lens B) iris C) eyelid D) cornea Answer: B Diff: 2 Page Ref: 467 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: 467 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2 7) Which of the following is NOT associated with the retina? A) Lens B) Photopigments C) Rods D) Cones Answer: A Diff: 2 Page Ref: 467, 468 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2

8) A defect of the ________ 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: 467-468 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: 467-468 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: 470 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2, 4 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 (Select all that apply): A) reassure the mother and transport the patient. B) make one attempt to remove the bean with tweezers. 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: B, D Diff: 2 Page Ref: 473 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 5, 6

12) The external ear ends at the: A) auricle. B) external auditory canal. C) tympanic membrane. D) tragus. Answer: C Diff: 2 Page Ref: 472 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2 13) What are the three tiny bones located in the middle ear? A) Pinnas B) Cerumen C) Cochleae D) Ossicles Answer: D Diff: 1 Page Ref: 473 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2 14) The ________ contain sensors that detect rotation of the head. A) vestibule B) semicircular canals C) incus D) cochlea Answer: B Diff: 1 Page Ref: 473 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: 473 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2

16) Which of the following is NOT a bone of the middle ear? A) Malleus B) Stapes C) Cochlea D) Incus Answer: C Diff: 1 Page Ref: 473 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: 473 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: 473-474 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: 475 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 4

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 pulse 124, respiration 20, and SpO2 100%. 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: 476 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 3, 5 21) Oral candidiasis, commonly called thrush, is a ________ infection of the mouth. A) bacterial B) viral C) fungal D) protozoan Answer: C Diff: 1 Page Ref: 480 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 4 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: 467 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: 467 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 2

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: 468 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 4, 5 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) atraumatic hyphema. C) cataract. D) papilledema. Answer: B Diff: 1 Page Ref: 470 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 5, 6 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: 474 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 4, 5 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: 475 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 4

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: 476 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 4 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: 480-481 Standard: Medicine (Diseases of the Eyes, Ears, Nose, and Throat) Objective: 4, 5, 6 Chapter 13 Nontraumatic Musculoskeletal Disorders 1) A common complaint from patients who are immobile is: A) decubitus ulcers B) cellulitis C) gangrene D) fasciitis Answer: A Diff: 2 Page Ref: 497 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4, 5 2) In which of the following 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: 498 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4, 5

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: 491 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4, 5 4) All of the following 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: 491 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 5, 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: 496 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 1, 4 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: 499 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 1, 4, 5 218 Copyright © 2017 Pearson Education, Inc.

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: 499 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4 8) A patient with a soft tissue infection can develop gangrene. Which of the following 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: 496-497 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: 496 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4, 5 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: 496-497 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 1, 4, 5

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: 493 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 1, 4 12) Which of the following 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: 495-496 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 1, 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: 496 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 1, 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: 494 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 1, 4

15) Which of the following is NOT a repetitive motion injury? A) Tennis elbow B) Tenosynovitis C) Carpal tunnel syndrome D) Osteoarthritis Answer: D Diff: 2 Page Ref: 491-493 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4 16) The most common form of bone disease is: A) osteoporosis. B) osteomyelitis. C) rheumatoid arthritis. D) osteoarthritis. Answer: A Diff: 1 Page Ref: 493 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 1, 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: 494 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 1, 4 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: 497 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 1, 4

19) Osgood-Schlatter disease is a painful swelling of the ________, 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: 499 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 1, 4 20) All of the following are malignant bone tumors EXCEPT: A) chondrosarcoma. B) osteosarcoma. C) rhabdomyosarcoma. D) fibrosarcoma. Answer: C Diff: 2 Page Ref: 498 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 1, 4 21) The knee is classified as a ________ joint. A) saddle B) gliding C) hinge D) ellipsoidal Answer: C Diff: 1 Page Ref: 487 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: 492 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: 487 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 2 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: 488 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 2 25) There are approximately how many skeletal muscles in the human body? A) 420 B) 400 C) 606 D) 700 Answer: D Diff: 1 Page Ref: 490 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: 491 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4, 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: 492 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4, 5 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: 493 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 3, 4 29) Your patient is complaining of a low-grade fever and increasing joint pain and swelling, but has normal lymph nodes. You suspect which of the following? A) DDD B) Osteoporosis C) Rheumatoid arthritis D) Lupus erythematosus Answer: C Diff: 2 Page Ref: 494 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4, 5 30) You are evaluating a patient with swollen lymph nodes, fever, swelling, and painful joints. You suspect which of the following? A) DDD B) Osteoporosis C) Rheumatoid arthritis D) Systemic lupus erythematosus Answer: D Diff: 2 Page Ref: 495 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4, 5

31) You are evaluating a patient complaining of swollen and exudative legs. The patient has a history of diabetes mellitus. You suspect which of the following? A) Lupus erythematosus B) Rheumatoid arthritis C) Fasciitis D) Cellulitis Answer: D Diff: 2 Page Ref: 496 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 4, 5 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: 496 Standard: Medicine (Nontraumatic Musculoskeletal Disorders) Objective: 5

Paramedic Care: Principles & Practice V. 1-5, 5e (Bledsoe)

Volume 4 Trauma Emergencies Chapter 1 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: 9-10 Standard: Trauma (Trauma Overview) Objective: 7 2) Which of the following accounts for the highest number of trauma deaths in the United States of America? A) Motor vehicle crashes B) Falls C) Assaults D) Firearms injuries Answer: A Diff: 2 Page Ref: 3 Standard: Trauma (Trauma Overview) Objective: 2 3) Which of the following acts 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: 4 Standard: Trauma (Trauma Overview) Objective: 8 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: 7-8 Standard: Trauma (Trauma Overview) Objective: 4 1 Copyright © 2017 Pearson Education, Inc.

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: 13 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: 11-12 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: 12 Standard: Trauma (Trauma Overview) Objective: 7 8) As a paramedic, your role in trauma care consists of all of the following, 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: 3 Standard: Trauma (Trauma Overview) Objective: 3

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: 14 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: 11 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: 3-4 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: 6 Standard: Trauma (Trauma Overview) Objective: 3

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: 7-8 Standard: Trauma (Trauma Overview) Objective: 4 14) Which of the following statements about trauma is FALSE? A) Life-threatening injuries may exist with little external evidence. B) Dramatic-appearing extremity injuries draw the paramedic's focus away from life-threatening 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: 4 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: 4 Standard: Trauma (Trauma Overview) Objective: 2 16) Which of the following patients 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: 11-12 Standard: Trauma (Trauma Overview) Objective: 7

17) Which of the following trauma patients 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: 10 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: 4 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 is a Level ________ trauma center. A) III B) I C) IV D) II Answer: D Diff: 2 Page Ref: 7-8 Standard: Trauma (Trauma Overview) Objective: 4 20) Which of the following 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: 13 Standard: Trauma (Trauma Overview) Objective: 3

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: 7-8 Standard: Trauma (Trauma Overview) Objective: 4 22) Which of the following mechanisms 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 travelling 5 miles/hour Answer: C Diff: 2 Page Ref: 4 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: 7-8 Standard: Trauma (Trauma Overview) Objective: 4 24) Which of the following patients 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: 7-8 Standard: Trauma (Trauma Overview) Objective: 4

25) Which of the following 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: 9 Standard: Trauma (Trauma Overview) Objective: 2 26) Which of the following is the only way to determine which patient care procedures benefit trauma patients? A) Surveillance B) Risk identification C) Implementation D) Evaluation Answer: D Diff: 2 Page Ref: 7 Standard: Trauma (Trauma Overview) Objective: 8 27) Which of the following is an acceptable way of reducing prehospital time to maximize the use of the "Golden Period" for trauma patients? A) Skip spinal immobilization 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: 11 Standard: Trauma (Trauma Overview) Objective: 6 28) Which of the following is a "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: 9 Standard: Trauma (Trauma Overview) Objective: 1

29) 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: 10 Standard: Trauma (Trauma Overview) Objective: 5 30) According to the Haddon Matrix, which of the following 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: 5 Standard: Trauma (Trauma Overview) Objective: 3 Chapter 2 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: 25 Standard: Trauma (Trauma Overview) Objective: 5 2) When assessing a patient with a crush injury, which of the following 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: 40 Standard: Trauma (Soft Tissue Trauma) Objective: 13

3) People in which of the following 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: 34 Standard: Trauma (Special Considerations in Trauma) Objective: 9 4) Which of the following 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: 40-41 Standard: Trauma (Soft Tissue Trauma) Objective: 13 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: 20-21 Standard: Trauma (Trauma Overview) Objective: 2 6) Which of the following injuries is MOST likely in a rear-end collision? A) Thoracic and abdominal injuries B) Head and neck injuries C) Pelvic fractures D) Lumbar spine injuries Answer: B Diff: 1 Page Ref: 29 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 the following 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: 20 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: 34 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9 9) Which of the following 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: 25 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 the following 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: 34 Standard: Trauma (Trauma Overview) Objective: 2

11) Which of the following 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: 32 Standard: Trauma (Special Considerations in Trauma) Objective: 6 12) Which of the following 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: 34 Standard: Trauma (Orthopedic Trauma) Objective: 9 13) Your patient, a 23-year-old woman who is 6 months pregnant, was the unrestrained driver of a vehicle that rear-ended a parked car. The air bag deployed. Considering the likelihood of organ collision, for which of the following injuries should you maintain a high index of suspicion? A) Cardiac contusion B) Anterior flail segment C) Abruptio placentae D) Fractured sternum Answer: C Diff: 3 Page Ref: 25-26 Standard: Trauma (Special Considerations in Trauma) Objective: 3 14) Which of the following 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: 20 Standard: Trauma (Trauma Overview) Objective: 2 11 Copyright © 2017 Pearson Education, Inc.

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: 27-28 Standard: Trauma (Trauma Overview) Objective: 6 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 the following 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: 27 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 6 17) Which of the following 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: 34 Standard: Trauma (Trauma Overview) Objective: 9 18) Which of the following 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: 31-32 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 8

19) For which of the following 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: 28 Standard: Trauma (Trauma Overview) Objective: 6 20) Which of the following 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: 20 Standard: Trauma (Trauma Overview) Objective: 1 21) Which of the following 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: 28 Standard: Trauma (Trauma Overview) Objective: 5 22) Which of the following 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: 33 Standard: Trauma (Trauma Overview) Objective: 8

23) Which of the following 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: 34 Standard: Trauma (Environmental Emergencies) Objective: 9 24) Which of the following 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: 20-21 Standard: Trauma (Environmental Emergencies) Objective: 2 25) Which of the following 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: 24-25 Standard: Trauma (Environmental Emergencies) Objective: 7 26) Which of the following 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: 21-22 Standard: Trauma (Environmental Emergencies) Objective: 2

27) Which two of the following 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: 21 Standard: Trauma (Multi-System Trauma) Objective: 17 28) Which of the following 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: 36 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: 27 Standard: Trauma (Environmental Emergencies) Objective: 3 30) Which of the following "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: 27 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 3

31) Which of the following 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: 28 Standard: Trauma (Multi-System Trauma) Objective: 6 32) Which of the following 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: 28 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 the following 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: 27 Standard: Trauma (Orthopedic Trauma) Objective: 6 34) Which of the following 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: 41 Standard: Trauma (Soft Tissue Trauma) Objective: 13

35) Which of the following 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: 34 Standard: Trauma (Special Considerations in Trauma) Objective: 9 36) Which of the following 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: 32-33 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: 26 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: 27-28 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 the following 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: 27-28 Standard: Trauma (Orthopedic Trauma) Objective: 6 40) Which of the following 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: 37 Standard: Trauma (Soft Tissue Trauma) Objective: 11 41) Which of the following 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: 32 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 8 42) Which of the following 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: 22 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 3

43) Which of the following 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: 28 Standard: Trauma (Trauma Overview) Objective: 6 44) Which of the following may result from aggressive ventilation of the blast patient? A) Emboli B) Pericardial tamponade C) Hemorrhage D) Acidosis Answer: A Diff: 1 Page Ref: 39 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: 28-29 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 the following 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: 40 Standard: Trauma (Special Considerations in Trauma) Objective: 12

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: 27-28 Standard: Trauma (Trauma Overview) Objective: 4 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: 20 Standard: Trauma (Trauma Overview) Objective: 1 49) Which of the following 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: 25-26 Standard: Trauma (Trauma Overview) Objective: 5 50) Which of the following 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: 35 Standard: Trauma (Multi-System Trauma) Objective: 10

51) Which of the following 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: 41 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 17 52) Your patient is an 8-year-old boy with a pencil impaled 2 centimeters inferior to the xiphoid process. You note that the pencil is pulsating. Which of the following 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: 53 Standard: Trauma (Chest Trauma) Objective: 20 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: 43 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 14 54) Which of the following 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: 47 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 17

55) Which of the following 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 non-elastic 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: 47 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 16 56) Your patient is a 50-year-old man with a gunshot wound to the right anterior chest. He is unresponsive. Which of the following 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: 52 Standard: Trauma (Chest Trauma) Objective: 19 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 the following 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: 52 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 17 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: 42-44 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 15 22 Copyright © 2017 Pearson Education, Inc.

59) Which of the following 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: 42-43 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 16 60) A penetrating injury to which of the following organs is LEAST likely to result in severe hemorrhage? A) Liver B) Kidney C) Spleen D) Ureter Answer: D Diff: 2 Page Ref: 48-50 Standard: Trauma (Bleeding) Objective: 17 61) Which of the following 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: 45-46 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 19 62) Which of the following 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: 47 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 15

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: 42 Standard: Trauma (Trauma Overview) Objective: 1 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 the following 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: 51-52 Standard: Trauma (Bleeding) Objective: 18 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: 51 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 16 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: 43 Standard: Trauma (Trauma Overview) Objective: 1

67) Which of the following 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: 44 Standard: Trauma (Trauma Overview) Objective: 19 68) Which of the following 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: 47 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 16 69) Which of the following 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: 46-47 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 16

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: 42-44 Standard: Trauma (Trauma Overview) Objective: 16 71) When you are assessing someone with a gunshot wound from a rifle, which of the following 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: 45 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 17 72) Which of the following 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: 48 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 19 73) Greater velocity of a bullet will cause a ________ path of travel and a ________ trajectory. A) wavier; straighter B) flatter; wavier C) more rounded; curved D) flatter; straighter Answer: D Diff: 1 Page Ref: 43 Standard: Trauma (Trauma Overview) Objective: 15

74) Which of the following 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: 47 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 17 75) Which of the following 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: 48 Standard: Trauma (Soft Tissue Trauma) Objective: 19 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 ________ times. A) 25 B) 100 C) 50 D) 80 Answer: B Diff: 1 Page Ref: 47 Standard: Trauma (Trauma Overview) Objective: 16 77) Which of the following 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: 45 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 16

78) Which of the following 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: 42 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 14 79) During the scene size-up on a call for a patient with penetrating trauma due to a stab wound, which of the following 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: 51-52 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 18 80) Which of the following 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: 41 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 17 81) Which of the following 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: 51 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 16

82) Which of the following 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: 47 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 1 83) Penetrating trauma to the face can complicate airway management by which of the following mechanisms? A) Laryngotracheal edema B) Airway obstruction C) Destruction of anatomical landmarks D) Both B and C Answer: D Diff: 2 Page Ref: 52 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 20 84) The primary assessment of a patient with a gunshot wound to the chest should focus on detecting which of the following? A) Pancreatitis B) Tension pneumothorax C) Cardiac contusion D) Peritonitis Answer: B Diff: 2 Page Ref: 53 Standard: Trauma (Chest Trauma) Objective: 20 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: 42 Standard: Trauma (Trauma Overview) Objective: 14

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: 42 Standard: Trauma (Trauma Overview) Objective: 16 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 the following 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: 53 Standard: Trauma (Soft Tissue Trauma) Objective: 20 88) Which of the following 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: 45 Standard: Trauma (Trauma Overview) Objective: 16 89) As the mass of an object increases, which of the following 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: 42 Standard: Trauma (Trauma Overview) Objective: 14

90) Which of the following 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: 42 Standard: Trauma (Trauma Overview) Objective: 16 91) Which of the following 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: 22 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 19 92) Which of the following 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: 42-44 Standard: Trauma (Trauma Overview) Objective: 16 93) As the energy from a medium- or high-velocity projectile pushes tissue from its path, which of the following 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: 46 Standard: Trauma (Trauma Overview) Objective: 17

94) Which of the following 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: 44 Standard: Trauma (Trauma Overview) Objective: 16 95) Which of the following is considered a high-velocity weapon? A) Shotgun B) Arrow C) Handgun D) Rifle Answer: D Diff: 2 Page Ref: 44-45 Standard: Trauma (Trauma Overview) Objective: 16 Chapter 3 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: 78 Standard: Trauma (Bleeding) Objective: 14 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: 68-69 Standard: Trauma (Bleeding) Objective: 13 32 Copyright © 2017 Pearson Education, Inc.

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: 65 Standard: Trauma (Bleeding) Objective: 4 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: 71-72 Standard: Trauma (Bleeding) Objective: 11 5) Managing a laceration with arterial bleeding most often requires: A) cauterization. B) a tourniquet. C) PASG. D) direct pressure. Answer: D Diff: 2 Page Ref: 64 Standard: Trauma (Bleeding) Objective: 6

6) Which of the following patients with hemorrhagic shock is likely to be internally bleeding, solely? 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: 67 Standard: Trauma (Bleeding) Objective: 7 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: 67 Standard: Trauma (Bleeding) Objective: 8 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: 60 Standard: Trauma (Bleeding) Objective: 1 9) A fracture of the femur may result in a hematoma that contains enough blood to make it a class ________ hemorrhage. A) I B) III C) IV D) II Answer: B Diff: 3 Page Ref: 65-67 Standard: Trauma (Bleeding) Objective: 8

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: 68-69 Standard: Trauma (Bleeding) Objective: 10 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: 61 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: 78 Standard: Trauma (Bleeding) Objective: 6 13) The phase of blood clotting in which the smooth muscle of an injured blood vessel contracts is known as the ________ phase. A) hemolytic B) hemostatic C) vascular D) ischemic Answer: C Diff: 1 Page Ref: 62 Standard: Trauma (Bleeding) Objective: 5

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: 68-69 Standard: Trauma (Bleeding) Objective: 10 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: 73 Standard: Trauma (Bleeding) Objective: 7 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: 63 Standard: Trauma (Bleeding) Objective: 5 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: 64 Standard: Trauma (Bleeding) Objective: 4

18) A hematoma resulting from a fracture of the humerus may contain enough blood to make it a class ________ hemorrhage. A) II B) IV C) III D) I Answer: D Diff: 3 Page Ref: 65-66 Standard: Trauma (Bleeding) Objective: 8 19) Which of the following does NOT indicate compensated shock? A) Anxiety B) Altered mental status C) Weakness D) Thirst Answer: B Diff: 1 Page Ref: 68-69 Standard: Trauma (Bleeding) Objective: 10 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: 64 Standard: Trauma (Bleeding) Objective: 14 21) Even with intervention, survival is unlikely with blood loss over ________ percent of the total blood volume. A) 25 B) 15 C) 50 D) 35 Answer: D Diff: 1 Page Ref: 66 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: 68-69 Standard: Trauma (Bleeding) Objective: 10 23) Red blood cells make up approximately ________ percent of whole blood volume. A) 45 B) 60 C) 30 D) 15 Answer: A Diff: 1 Page Ref: 61 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: 74 Standard: Trauma (Bleeding) Objective: 13 25) What method of controlling hemmorage 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: 64 Standard: Trauma (Bleeding) Objective: 6

26) The blood flowing to the heart best describes: A) contractility. B) afterload. C) preload. D) vascular phase. Answer: C Diff: 1 Page Ref: 60 Standard: Trauma (Bleeding) Objective: 2 27) Under normal circumstances, at any given moment most of the blood is in the ________ system. A) venous B) capillary C) hematopoietic D) arterial Answer: A Diff: 1 Page Ref: 61 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: 79 Standard: Trauma (Bleeding) Objective: 7 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: 65 Standard: Trauma (Bleeding) Objective: 5

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: 72-73 Standard: Trauma (Bleeding) Objective: 13 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: 70 Standard: Trauma (Bleeding) Objective: 12 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 non-vital 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: 67 Standard: Trauma (Bleeding) Objective: 9

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% sodium chloride solution D) A 0.45% sodium chloride solution Answer: B Diff: 2 Page Ref: 78-79 Standard: Trauma (Bleeding) Objective: 6 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: 70 Standard: Trauma (Bleeding) Objective: 12 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: 79 Standard: Trauma (Bleeding) Objective: 14 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: 60 Standard: Trauma (Bleeding) Objective: 2

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 a class ________ hemorrhage. A) III B) II C) IV D) I Answer: B Diff: 2 Page Ref: 67 Standard: Trauma (Bleeding) Objective: 8 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: 69 Standard: Trauma (Bleeding) Objective: 11 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: 67-68 Standard: Trauma (Bleeding) Objective: 9 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: 62 Standard: Trauma (Bleeding) Objective: 3

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: 66-67 Standard: Trauma (Bleeding) Objective: 13 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: 75-76 Standard: Trauma (Bleeding) Objective: 6 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: 59 Standard: Trauma (Bleeding) Objective: 1 44) Brighter red, slow, oozing blood flow is characteristic of which type of hemorrhage? A) Arterial B) Venous C) Capillary D) Arteriole Answer: C Diff: 1 Page Ref: 62 Standard: Trauma (Bleeding) Objective: 3

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: 67 Standard: Trauma (Bleeding) Objective: 9 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: 68-69 Standard: Trauma (Bleeding) Objective: 10 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: 70 Standard: Trauma (Bleeding) Objective: 12 48) What is the mechanism of TXA? A) Antifibrinolytic B) Coagulopathy C) Thrombocytopenia D) Development of metabolic acidosis Answer: A Diff: 1 Page Ref: 65 Standard: Trauma (Bleeding) Objective: 6

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: 60 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: 66 Standard: Trauma (Bleeding) Objective: 1 Chapter 4 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. D) crush injury. Answer: C Diff: 2 Page Ref: 91 Standard: Trauma (Soft Tissue Trauma) Objective: 1

2) You are assessing an assault victim and note a contusion over the abdomen. Which of the following 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: 89 Standard: Trauma (Soft Tissue Trauma) Objective: 10 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: 88-89 Standard: Trauma (Soft Tissue Trauma) Objective: 1 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: 99 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: 88 Standard: Trauma (Soft Tissue Trauma) Objective: 3 46 Copyright © 2017 Pearson Education, Inc.

6) Which of the following 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: 97-98 Standard: Trauma (Soft Tissue Trauma) Objective: 6 7) Which of the following 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: 89 Standard: Trauma (Soft Tissue Trauma) Objective: 1 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: 98 Standard: Trauma (Soft Tissue Trauma) Objective: 6 9) When caring for an amputated part, which of the following 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: 108 Standard: Trauma (Soft Tissue Trauma) Objective: 10 47 Copyright © 2017 Pearson Education, Inc.

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: 111 Standard: Trauma (Soft Tissue Trauma) Objective: 8 11) Which of the following are likely to accumulate in the bloodstream following a large crush injury? A) Myoglobin B) Potassium C) Lactic acid D) All of the above Answer: D Diff: 1 Page Ref: 89 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: 90 Standard: Trauma (Soft Tissue Trauma) Objective: 11

13) In which of the following 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: 85 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: 91 Standard: Trauma (Soft Tissue Trauma) Objective: 1 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: 110 Standard: Trauma (Soft Tissue Trauma) Objective: 10 16) The layer of skin that contains adipose tissue is the ________ layer. A) dermal B) connective C) epidermal D) subcutaneous Answer: D Diff: 1 Page Ref: 87 Standard: Trauma (Soft Tissue Trauma) Objective: 3

17) Which of the following medications 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: 109 Standard: Trauma (Soft Tissue Trauma) Objective: 10 18) For most open soft tissue wounds managed by the paramedic in the prehospital setting, which of the following is a desirable characteristic of the dressing applied? A) Occlusive B) Dry C) Adherent D) Nonabsorbent Answer: B Diff: 2 Page Ref: 99 Standard: Trauma (Soft Tissue Trauma) Objective: 7 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: 112 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: 92 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: 90 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: 109-110 Standard: Trauma (Soft Tissue Trauma) Objective: 10 23) Which of the following 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: 89 Standard: Trauma (Soft Tissue Trauma) Objective: 1 24) Which of the following 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: 105 Standard: Trauma (Soft Tissue Trauma) Objective: 8

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 the following at this time? A) Compartment syndrome B) Volkmann's ischemic contracture C) Crush syndrome D) Degloving injury Answer: A Diff: 2 Page Ref: 110 Standard: Trauma (Soft Tissue Trauma) Objective: 6 26) The bacteria most often associated with infection of open soft tissue injury is: A) Pasteurella multocida. B) Pseudomonas aeruginosa. C) Staphylococcus. D) Clostridium tetani. Answer: C Diff: 1 Page Ref: 94 Standard: Trauma (Soft Tissue Trauma) Objective: 4 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: 90 Standard: Trauma (Soft Tissue Trauma) Objective: 1 28) Your patient is a 45-year-old type 2 diabetic man who has a non-healing 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 the following should you suspect? A) MRSA B) Gangrene C) Tetanus D) Compartment syndrome Answer: B Diff: 2 Page Ref: 95 Standard: Trauma (Soft Tissue Trauma) Objective: 6 52 Copyright © 2017 Pearson Education, Inc.

29) One in ________ open wounds becomes infected. A) 5 B) 10 C) 15 D) 20 Answer: C Diff: 1 Page Ref: 94 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: 104 Standard: Trauma (Soft Tissue Trauma) Objective: 9 Chapter 5 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: 124 Standard: Trauma (Soft Tissue Trauma) Objective: 4 2) Which of the following 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: 118 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: 126 Standard: Trauma (Soft Tissue Trauma) Objective: 1 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: 133 Standard: Trauma (Soft Tissue Trauma) Objective: 9 5) An area of burned tissue that is not painful is MOST likely a ________ burn injury. A) second-degree B) full thickness C) superficial D) partial thickness Answer: B Diff: 1 Page Ref: 127 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 the following categories? A) Superficial B) Critical C) Minor D) Moderate Answer: B Diff: 2 Page Ref: 132-133 Standard: Trauma (Soft Tissue Trauma) Objective: 9

7) Which of the following stages 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: 120-121 Standard: Trauma (Soft Tissue Trauma) Objective: 1 8) Which tissue layer(s) is (are) affected by partial thickness burns? 1. Epidermis 2. Dermis 3. Subcutaneous 4. Muscle A) 1, 2, 3, and 4 B) 1 and 2 C) 1, 2, and 3 D) 1 Answer: B Diff: 1 Page Ref: 126 Standard: Trauma (Soft Tissue Trauma) Objective: 3 9) Contact with strong alkalis results in burns involving ________ necrosis of the tissue. A) coagulation B) liquefaction C) thermal D) ischemic Answer: B Diff: 1 Page Ref: 123 Standard: Trauma (Soft Tissue Trauma) Objective: 4 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 the following 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: 135-136 Standard: Trauma (Soft Tissue Trauma) Objective: 10 55 Copyright © 2017 Pearson Education, Inc.

11) Which of the following body areas warrant special attention when burned? A) Legs B) Arms C) Abdomen D) Feet Answer: D Diff: 1 Page Ref: 132 Standard: Trauma (Soft Tissue Trauma) Objective: 6 12) Which of the following patient factors 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: 133 Standard: Trauma (Soft Tissue Trauma) Objective: 6 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: 127 Standard: Trauma (Soft Tissue Trauma) Objective: 6 14) Which of the following agents 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: 134-135 Standard: Trauma (Soft Tissue Trauma) Objective: 10

15) The type of electricity supplied to homes is ________ current. Contact with this type of current may result in ________. A) indirect; rhabdomyolysis B) direct; rhabdomyolysis C) direct; muscle tetany D) alternating; muscle immobolization Answer: D Diff: 1 Page Ref: 121-122 Standard: Trauma (Soft Tissue Trauma) Objective: 4 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: 135 Standard: Trauma (Soft Tissue Trauma) Objective: 10 17) According to Jackson's theory of thermal wounds, which of the following zones has suffered the greatest damage? A) Coagulation B) Hyperemia C) Stasis D) Disintegration Answer: A Diff: 1 Page Ref: 120 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: 123 Standard: Trauma (Soft Tissue Trauma) Objective: 4

19) Which of the following 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: 125 Standard: Trauma (Soft Tissue Trauma) Objective: 4 20) Which of the following 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: 127 Standard: Trauma (Soft Tissue Trauma) Objective: 4 21) For which of the following 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: 134 Standard: Trauma (Soft Tissue Trauma) Objective: 10 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: 133 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 of the following guidelines 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: 127 Standard: Trauma (Soft Tissue Trauma) Objective: 6 24) Which of the following 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: 121 Standard: Trauma (Soft Tissue Trauma) Objective: 3 25) Cool-water immersion of a burned part effectively reduces burning only when done within which of the following 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: 134 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 ________ mA. A) 60 B) 100 C) 20 D) 5 Answer: C Diff: 1 Page Ref: 122 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: 138 Standard: Trauma (Soft Tissue Trauma) Objective: 10 28) Which of the following best describes 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, are destroyed through combustion. Answer: A Diff: 1 Page Ref: 120 Standard: Trauma (Soft Tissue Trauma) Objective: 4 29) Which of the following 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: 127 Standard: Trauma (Soft Tissue Trauma) Objective: 6 30) The voltage of a bolt of lightning may be as much as ________ volts, and its temperature 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: 137 Standard: Trauma (Soft Tissue Trauma) Objective: 4

31) Most inhalation injuries in burn patients are due to which of the following? 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: 124-125 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: 121 Standard: Trauma (Soft Tissue Trauma) Objective: 4 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: 131 Standard: Trauma (Soft Tissue Trauma) Objective: 8 34) Which of the following body structures is the best electricity conductor? A) Bones B) Nerves C) Muscle D) Skin Answer: B Diff: 1 Page Ref: 122 Standard: Trauma (Soft Tissue Trauma) Objective: 4

35) Which of the following 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: 133 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 of the following complications? A) Hypovolemia B) Organ failure C) Infection D) Hypothermia Answer: C Diff: 2 Page Ref: 135 Standard: Trauma (Soft Tissue Trauma) Objective: 7 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: 122 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 the following 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: 131 Standard: Trauma (Soft Tissue Trauma) Objective: 10

39) The seriousness of burns in the pediatric population is put into perspective by realizing that burns are the ________ leading cause of death in children under age 12 years. A) first B) second C) third D) fourth Answer: B Diff: 1 Page Ref: 118 Standard: Trauma (Soft Tissue Trauma) Objective: 2 40) Which of the following 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: 138 Standard: Trauma (Soft Tissue Trauma) Objective: 10 Chapter 6 Head, Neck, and Spinal Trauma 1) Which of the following 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 decreased tissue edema. D) It is detrimental, because vasoconstriction results in decreased cerebral perfusion. Answer: D Diff: 2 Page Ref: 171 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 the following has the most potential to negatively impact the patient? A) Retrograde intubation B) Oral intubation under direct laryngoscopy C) Nasotracheal intubation D) A non-visualized dual-lumen airway Answer: C Diff: 3 Page Ref: 183 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9 63 Copyright © 2017 Pearson Education, Inc.

3) Which of the following medications may be indicated in the prehospital management of the patient with traumatic brain injury? A) Methylprednisolone B) Diazoxide C) Mannitol D) Furosemide Answer: C Diff: 2 Page Ref: 198-199 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10 4) Circulation to the face is provided by the ________ artery. A) external carotid B) internal carotid C) midfacial D) mandibular Answer: A Diff: 2 Page Ref: 152 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 5) Which of the following 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: 145 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 2

6) Which of the following 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: 187 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10 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 the following conditions? A) Extrusion of the eyeball B) Subconjunctival hemorrhage C) Hyphema D) Retinal detachment Answer: D Diff: 2 Page Ref: 185 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 the following 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: 186 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9 9) Which of the following 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: 145 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 2 65 Copyright © 2017 Pearson Education, Inc.

10) Your patient has received blunt facial trauma due to an assault. For which of the following 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: 182 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 8 11) The ________ 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: 181 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 2 12) Which of the following patients fit the criteria for application of spinal 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 pain 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) None of the above Answer: D Diff: 2 Page Ref: 195-196 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 the following 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: 181 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9

14) Which of the following skull fractures is most common? A) Linear B) Basilar C) Depressed D) Comminuted Answer: A Diff: 1 Page Ref: 180-181 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 2 15) Which of the following 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: 146 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 16) Your patient is a 7-year-old male pedestrian who was struck by a vehicle. Your assessment reveals bleeding from the right auditory canal. Which of the following 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: 181 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: 195-196 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9 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 the following 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: 182 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 8 19) Which of the following 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: 145 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: 187 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 6

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 the following 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: 189-190 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: 156 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 the following types of injuries? A) Cervical hyperextension B) Cervical hyperflexion C) Axial distraction D) Axial loading Answer: D Diff: 2 Page Ref: 167 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 4

24) Recent research has provided evidence of which of the following 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: 194-196 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9 25) Which of the following 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: 173-175 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 4 26) Which of the following 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: 193 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9

27) Which of the following 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: 199 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 which of the following? A) Aphasia B) Retrograde amnesia C) Decorticate disorientation D) Anterograde amnesia Answer: D Diff: 2 Page Ref: 172 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 5 29) Which of the following are the two most important prehospital considerations for head injury patients? A) Cervical spine immobilization and ventilation B) ICP monitoring and administering corticosteroids C) Ventilation and administering corticosteroids D) Ventilation and maintaining adequate blood pressure Answer: D Diff: 2 Page Ref: 187-188 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10

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 the following structures? A) Falx cerebri B) Reticular activating system C) Third cranial nerve D) Cerebellum Answer: D Diff: 2 Page Ref: 148 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 5 31) Which of the following 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: 190 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9 32) Which of the following is the largest element of the nervous system? A) Cerebellum B) Pons C) Medulla oblongata D) Cerebrum Answer: D Diff: 1 Page Ref: 147 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 33) Which of the following 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: 190 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 9

34) The cerebral perfusion pressure is represented by which of the following equations? A) CPP = MAP - CVP B) CPP = CVP - ICP C) CPP = MAP - ICP D) CPP = ICP - MAP Answer: C Diff: 1 Page Ref: 150 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 35) Which of the following 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: 171 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 6 36) Which of the following 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: 188 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3

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 and is alert on your arrival. You note that he is becoming drowsy and has a strong radial pulse of 60, a blood pressure of 140/70, and a respiratory rate of 12. Which of the following 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: 168-169 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 the following types of brain injury? A) Direct, diffuse B) Indirect, diffuse C) Indirect, focal D) Direct, focal Answer: A Diff: 2 Page Ref: 167-169 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 4 39) A concussion is best described as which of the following types of brain injuries? A) Indirect, diffuse B) Indirect, focal C) Direct, focal D) Direct, diffuse Answer: D Diff: 2 Page Ref: 169 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 5

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: 198 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 the following to maintain CPP and cerebral perfusion? A) Decreases blood pressure B) Increases blood pressure C) Decreases intracranial pressure D) Increases intracranial pressure Answer: B Diff: 1 Page Ref: 150 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 6 42) Which of the following 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: 190 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10

43) Which of the following 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: 197 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10 44) Which of the following 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: 178 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: 167-168 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 5 46) Anterior cord syndrome is caused by which of the following 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: 177 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 7

47) The diaphragm is controlled by peripheral nerve roots ________ through ________. A) C-3; C-7 B) C-3; C-5 C) C-1; C-7 D) C-1; C-5 Answer: D Diff: 1 Page Ref: 165 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 48) The spinal cord is continuous from the brain to the level of: A) T-12 or T-13. B) L-5 or L-6. C) the coccyx. D) L-1 or L-2. Answer: D Diff: 1 Page Ref: 186 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: 168 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 5 50) You have intubated a 5-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: 187 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10 77 Copyright © 2017 Pearson Education, Inc.

51) The phrenic nerve consists of peripheral nerve roots ________ through ________. A) C-1; C-3 B) C-5; C-8 C) C-3; C-5 D) C-1; C-8 Answer: C Diff: 1 Page Ref: 164-165 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 the following is MOST likely? A) The patient has a spinal-cord injury at T-1. 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: 192 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: 173 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 7 54) Which of the following 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: 176 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: 173 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: 177 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) T-10 B) T-4 C) L-1 D) T-8 Answer: A Diff: 1 Page Ref: 165 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 7 58) Which of the following 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: 166 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3

59) All of the following 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: 197 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: 165 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 3 61) Which of the following 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: 189 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 7 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: 147 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: 178 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 the following 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: 177-178 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 7 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: 169 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 5 66) Concussion is a(n) ________ injury. A) direct. B) indirect. C) diffuse. D) delayed. Answer: C Diff: 2 Page Ref: 169 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 5 81 Copyright © 2017 Pearson Education, Inc.

67) Which of the following 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: 178 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 7 68) When providing fluid resuscitation for a 1-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: 198 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 10 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: 177 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 7 70) A ________ 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: 182 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 8 82 Copyright © 2017 Pearson Education, Inc.

71) Intracranial Volume = Brain Volume + CSF Volume + Blood Volume is the basis behind which of the following? A) Cerebral perfusion pressure B) Monroe-Kellie doctrine C) Mean arterial pressure D) Traumatic brain injury Answer: B Diff: 1 Page Ref: 150 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 1 72) Which of the following 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: 179 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 2 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: 159 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: 151 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: 184 Standard: Trauma (Head, Facial, Neck, and Spine Trauma) Objective: 1 Chapter 7 Chest Trauma 1) Which of the following 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: 207 Standard: Trauma (Chest Trauma) Objective: 3 2) The morbidity associated with simple pneumothorax is primarily due to which of the following? 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: 215 Standard: Trauma (Chest Trauma) Objective: 4 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: 223 Standard: Trauma (Chest Trauma) Objective: 3

4) Which of the following 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: 207-208 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: 208 Standard: Trauma (Chest Trauma) Objective: 3 6) Which of the following 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 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: 216 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 the following 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: 232 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. Which of the following should you do first? A) Apply oxygen by nonrebreather. B) Cover the wound with your gloved hand. C) Prepare an occlusive dressing. D) Perform a needle thoracostomy. Answer: C Diff: 3 Page Ref: 230 Standard: Trauma (Chest Trauma) Objective: 8 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: 220-221 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: 210 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: 220 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 the posterior axillary line of both ribs. Answer: D Diff: 2 Page Ref: 212 Standard: Trauma (Chest Trauma) Objective: 4 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 non-guarded and non-tender. Which of the following best explains the presentation of this patient? A) Simple pneumothorax B) Tension pneumothorax C) Pericardial tamponade D) Hemothorax Answer: D Diff: 3 Page Ref: 223, 227 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 non-guarded and non-tender. Which of the following 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: 230-231 Standard: Trauma (Chest Trauma) Objective: 8 15) Which of the following is TRUE of pulmonary contusion? 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: 218-219 Standard: Trauma (Chest Trauma) Objective: 5 16) Which of the following 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: 229 Standard: Trauma (Chest Trauma) Objective: 5

17) Which of the following 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: 223 Standard: Trauma (Chest Trauma) Objective: 5 18) Which of the following 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: 213-214 Standard: Trauma (Chest Trauma) Objective: 2 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: 223 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 the following 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: 225 Standard: Trauma (Chest Trauma) Objective: 8 89 Copyright © 2017 Pearson Education, Inc.

21) Traumatic asphyxia is a(n) ________ type of injury. A) compression B) deceleration C) decompression D) acceleration Answer: A Diff: 1 Page Ref: 223 Standard: Trauma (Chest Trauma) Objective: 5 22) Which of the following 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: 229 Standard: Trauma (Chest Trauma) Objective: 6 23) Which of the following 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: 215 Standard: Trauma (Chest Trauma) Objective: 5 24) Which of the following findings 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: 216-217 Standard: Trauma (Chest Trauma) Objective: 5

25) Hemothorax is primarily a problem of: A) blood loss. B) impaired ventilation. C) ventilation/perfusion mismatch. D) increased intrathoracic pressure. Answer: A Diff: 2 Page Ref: 218 Standard: Trauma (Chest Trauma) Objective: 6 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: 220 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: 231-232 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: 210 Standard: Trauma (Chest Trauma) Objective: 4 29) Thoracic trauma accounts for approximately ________ 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: 232 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: 218 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 of the following types of injury in this patient? A) Compression B) Compression and acceleration C) Compression and deceleration D) Deceleration Answer: C Diff: 2 Page Ref: 218 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) posterior surface of the associated rib. C) superior margin of the associated rib. D) lower rib margin of the associated rib. Answer: D Diff: 1 Page Ref: 210 Standard: Trauma (Chest Trauma) Objective: 3 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 patient is coughing up some bloody sputum. He has no other complaints, and a rapid trauma survey reveals no additional life-threatening injuries. Which of the following 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 keepopen 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: 228-232 Standard: Trauma (Chest Trauma) Objective: 8 34) Which of the following 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: 220 Standard: Trauma (Chest Trauma) Objective: 2

35) The angle of Louis serves as a landmark for performing 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: 207 Standard: Trauma (Chest Trauma) Objective: 3 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: 208 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 the following 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: 217 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: 216 Standard: Trauma (Chest Trauma) Objective: 5

39) Which of the following is LEAST likely to be a sign of an open pneumothorax? A) Large, open thoracic wound B) Frothy blood around the opening C) Jugular vein distention D) Dyspnea Answer: C Diff: 2 Page Ref: 216 Standard: Trauma (Chest Trauma) Objective: 5 40) Which of the following 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: 217 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: 217, 220 Standard: Trauma (Chest Trauma) Objective: 7 42) Which of the following 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: 229 Standard: Trauma (Chest Trauma) Objective: 8

43) Which of the following 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: 212 Standard: Trauma (Chest Trauma) Objective: 4 44) You are treating a patient whose open chest wound has been sealed by EMTs on the scene before your arrival. 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 of the following 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: 230 Standard: Trauma (Chest Trauma) Objective: 8 Chapter 8 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) 4 D) 1, 3, 4 Answer: A Diff: 2 Page Ref: 237 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 4

2) Which of the following changes 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: 240-241 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 3 3) The ________ is a double peritoneal fold containing blood vessels, lymphatic vessels, nerves, and fatty tissue. A) retroperitoneal space B) pancreas C) peritoneum D) mesentery Answer: D Diff: 2 Page Ref: 242 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 1 4) Which of the following best describes 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: 237, 244 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 5 5) The liver is injured ________ percent of the time with penetrating abdominal trauma. A) 10 B) 40 C) 25 D) 75 Answer: B Diff: 1 Page Ref: 243 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: 248 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 6 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) All of the above Answer: D Diff: 1 Page Ref: 237 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 2 8) Which of the following is TRUE of abdominal trauma? A) A soft, non-tender, non-distended 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, non-tender, non-distended 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: 244 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 5

9) Which of the following describes definitive care of the patient with traumatic intraabdominal hemorrhage? A) Admission to the ICU for observation B) Aggressive oxygenation and fluid resuscitation C) Administration of blood or blood products D) Rapid surgical intervention Answer: D Diff: 1 Page Ref: 252-253 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: 248-249 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 6 11) Which of the following is 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) All of the above are special considerations. Answer: D Diff: 1 Page Ref: 247, 252 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 of the following 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: 249 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 6 13) Which of the following guidelines applies to prehospital fluid resuscitation of hypotensive patients with intraabdominal hemorrhage? A) In most cases, fluid administration should be limited to 3 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: 253 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 7 14) Which of the following organs is NOT part of the digestive system? A) Liver B) Spleen C) Stomach D) Pancreas Answer: B Diff: 1 Page Ref: 238 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: 245 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 3 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. Which of the following 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: 253 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 7 17) Which of the following may affect the pattern of injury in abdominal trauma? A) A full-term uterus B) A full stomach C) A full bladder D) All of the above Answer: D Diff: 1 Page Ref: 248-252 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 4

18) Which of the following 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: 237 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 2 19) Which of the following 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: 243 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: 244 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 immobilizing the patient on a long backboard, you begin transport. As you perform a detailed examination, the patient complains of developing right shoulder pain. Which of the following 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: 245 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 6 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: 252 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: 237 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: 250 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 4 103 Copyright © 2017 Pearson Education, Inc.

25) Which of the following 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: 249-250 Standard: Trauma (Abdominal and Genitourinary Trauma) Objective: 6 Chapter 9 Orthopedic Trauma 1) Which of the following is NOT part of the axial skeleton? A) Sacrum B) Pubis C) Sternum D) Mandible Answer: B Diff: 2 Page Ref: 263 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 of the following 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: 280-281 Standard: Trauma (Orthopedic Trauma) Objective: 10

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 of the following types of fractures? A) Oblique B) Spiral C) Impacted D) Comminuted Answer: B Diff: 2 Page Ref: 272 Standard: Trauma (Orthopedic Trauma) Objective: 5 4) Which of the following 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: 277 Standard: Trauma (Orthopedic Trauma) Objective: 7 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: 262 Standard: Trauma (Orthopedic Trauma) Objective: 1 6) Which of the following is a consideration in preventing orthopedic injury? A) Proper footwear B) Well-designed railings C) Appropriate stepladder use D) All of the above Answer: D Diff: 1 Page Ref: 259 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 of the following 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: 271 Standard: Trauma (Orthopedic Trauma) Objective: 5 8) Tendons connect ________ to ________. A) muscles; bones B) bones; bones C) cartilage; bones D) muscles; fascia Answer: A Diff: 1 Page Ref: 269 Standard: Trauma (Orthopedic Trauma) Objective: 4 9) The use of a binder is indicated in the treatment of which of the following musculoskeletal injuries? A) Bilateral tibia/fibula fractures B) Knee dislocation C) Lumbar vertebral compression fracture D) Pelvic fracture Answer: D Diff: 2 Page Ref: 277 Standard: Trauma (Orthopedic Trauma) Objective: 9 10) Which of the following 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: 263 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: 271 Standard: Trauma (Orthopedic Trauma) Objective: 1 12) A fracture in which significant energy exchange shatters or splinters bone, creating many fragments, is called a(n) ________ fracture. A) impacted B) comminuted C) oblique D) spiral Answer: B Diff: 1 Page Ref: 272 Standard: Trauma (Orthopedic Trauma) Objective: 5 13) Your patient is a seven-year-old boy with a fracture of the proximal tibia. Which of the following 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: 273-274 Standard: Trauma (Orthopedic Trauma) Objective: 6 14) Which of the following 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: 261 Standard: Trauma (Orthopedic Trauma) Objective: 4

15) A dislocated knee is MOST likely to damage which of the following vascular structures? A) Femoral vein B) Popliteal artery C) Femoral artery D) Great saphenous vein Answer: B Diff: 1 Page Ref: 289 Standard: Trauma (Orthopedic Trauma) Objective: 5 16) Which of the following types of fractures occurs in pediatric age groups but not in adults? A) Oblique B) Transverse C) Greenstick D) Impacted Answer: C Diff: 1 Page Ref: 273 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 the following 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) Apply PASG. D) Apply a traction splint. Answer: B Diff: 2 Page Ref: 280-283 Standard: Trauma (Orthopedic Trauma) Objective: 8 18) Not considering other injuries, which of the following 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: 285 Standard: Trauma (Orthopedic Trauma) Objective: 7 108 Copyright © 2017 Pearson Education, Inc.

19) Your patient is an 80-year-old woman who fractured a vertebra while coughing. This type of fracture is best described as a(n) ________ fracture. A) pathological B) greenstick C) epiphyseal D) comminuted Answer: A Diff: 1 Page Ref: 274 Standard: Trauma (Orthopedic Trauma) Objective: 1 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 ________ inch(es) of the joint. A) 3 B) 2 C) 1 D) 6 Answer: A Diff: 1 Page Ref: 280 Standard: Trauma (Orthopedic Trauma) Objective: 7 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: 270 Standard: Trauma (Orthopedic Trauma) Objective: 7 22) A sprain is an injury best defined as which of the following? 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: 271 Standard: Trauma (Orthopedic Trauma) Objective: 1

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 the following structures? A) Thenar eminence B) Medial malleolus C) Lateral malleolus D) Styloid process Answer: B Diff: 2 Page Ref: 266 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: 261 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: 263 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: 280-284 Standard: Trauma (Orthopedic Trauma) Objective: 10 110 Copyright © 2017 Pearson Education, Inc.

Chapter 10 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: 299 Standard: Trauma (Environmental Emergencies) Objective: 1 2) Heat loss occurs in all the following ways EXCEPT: A) conduction. B) evaporation. C) convection. D) ingestion. Answer: D Diff: 2 Page Ref: 299 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: 300 Standard: Trauma (Environmental Emergencies) Objective: 3 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: 303-304 Standard: Trauma (Environmental Emergencies) Objective: 4 111 Copyright © 2017 Pearson Education, Inc.

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: 304 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: 304 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: 306 Standard: Trauma (Environmental Emergencies) Objective: 1 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: 306 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: 306 Standard: Trauma (Environmental Emergencies) Objective: 5 10) All of the following are signs of mild hypothermia EXCEPT: A) tachycardia. B) vasodilation. C) impaired judgment. D) fatigue. Answer: B Diff: 1 Page Ref: 308 Standard: Trauma (Environmental Emergencies) Objective: 5 11) In which of the following patients 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: 308 Standard: Trauma (Environmental Emergencies) Objective: 2 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: 309 Standard: Trauma (Environmental Emergencies) Objective: 5

13) Active rewarming should not be attempted in the field unless the emergency department is more than ________ minutes away. A) 10 B) 30 C) 45 D) 15 Answer: D Diff: 1 Page Ref: 311 Standard: Trauma (Environmental Emergencies) Objective: 5 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 is about ________ degrees F or higher. A) 86 B) 90 C) 96 D) 80 Answer: A Diff: 1 Page Ref: 312 Standard: Trauma (Environmental Emergencies) Objective: 5 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: 312 Standard: Trauma (Environmental Emergencies) Objective: 5 16) The portion of skin affected by superficial frostbite is the ________ layer. A) epidermal B) subdural C) intradural D) subcutaneous Answer: A Diff: 1 Page Ref: 312 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: C Diff: 2 Page Ref: 313 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: 313 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: 313 Standard: Trauma (Environmental Emergencies) Objective: 2 20) Which of the following 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: 298 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: 315 Standard: Trauma (Environmental Emergencies) Objective: 1 22) The amount of fluid that enters the lungs in a drowning case is: A) < 30 mL. B) > 30 mL. C) < 20 mL. D) > 20 mL. Answer: A Diff: 1 Page Ref: 315 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: 314 Standard: Trauma (Environmental Emergencies) Objective: 7 24) All of the following 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: 314 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: 316 Standard: Trauma (Environmental Emergencies) Objective: 7 26) Boyle's law states that ________ the pressure of a gas will ________ its volume. A) decreasing; decrease B) decreasing; increase C) increasing; increase D) increasing; decrease Answer: D Diff: 1 Page Ref: 317 Standard: Trauma (Environmental Emergencies) Objective: 8 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: 317 Standard: Trauma (Environmental Emergencies) Objective: 8 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: 318 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: 318 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: 320 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 the following 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: 321 Standard: Trauma (Environmental Emergencies) Objective: 9 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: 321 Standard: Trauma (Environmental Emergencies) Objective: 9 118 Copyright © 2017 Pearson Education, Inc.

33) To eliminate the risk of altitude illness, climbers should climb below ________, where highaltitude 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: 322 Standard: Trauma (Environmental Emergencies) Objective: 11 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: 322 Standard: Trauma (Environmental Emergencies) Objective: 11 35) Which of the following 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: 323 Standard: Trauma (Environmental Emergencies) Objective: 11 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: 302 Standard: Trauma (Environmental Emergencies) Objective: 6

37) Which of the following is NOT a measure to take 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: 308 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: 321 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: 320-321 Standard: Trauma (Environmental Emergencies) Objective: 12 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: 309 Standard: Trauma (Environmental Emergencies) Objective: 12

Chapter 11 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 the following? 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: 344 Standard: Trauma (Special Considerations in Trauma) Objective: 7 2) All the following 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: 349 Standard: Trauma (Special Considerations in Trauma) Objective: 10 3) Your patient is a 55-year-old man with a gunshot wound to the abdomen. Which of the following 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 Answer: C Diff: 1 Page Ref: 334 Standard: Trauma (Special Considerations in Trauma) Objective: 3 4) Which of the following 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: 340 Standard: Trauma (Special Considerations in Trauma) Objective: 4 121 Copyright © 2017 Pearson Education, Inc.

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. Which of the following most accurately describes how to best remove the patient from the vehicle? A) Place a cervical collar, maintain manual stabilization of the cervical spine, place a vest-type extrication device, and remove the patient onto a long backboard. B) Place a cervical collar, assist the patient in standing up, and then use a "standing take-down" to place him on a long backboard. C) Place a cervical collar, place a long backboard on the stretcher, and position it next to the driver's door. Instruct the patient to slide onto the board as you maintain manual stabilization of the cervical spine. D) Place a cervical collar, maintain manual stabilization of the cervical spine, and have the patient take several rest breaks, then move onto a long backboard. Answer: A Diff: 3 Page Ref: 350 Standard: Trauma (Special Considerations in Trauma) Objective: 9 6) Which of the following 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: 331 Standard: Trauma (Special Considerations in Trauma) Objective: 2 7) Paramedics should do everything possible to ensure that they are on the scene of a traumatic emergency for no more than ________ minutes. A) 15 B) 20 C) 10 D) 25 Answer: C Diff: 2 Page Ref: 350 Standard: Trauma (Special Considerations in Trauma) Objective: 9 122 Copyright © 2017 Pearson Education, Inc.

8) Which of the following offers a valuable model for EMS to consider when trying to reduce injury-related 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: 331 Standard: Trauma (Special Considerations in Trauma) Objective: 2 9) The uncritical use of which of the following 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: 361 Standard: Trauma (Special Considerations in Trauma) Objective: 2 10) The elderly patient in shock may be less likely to exhibit which of the following expected manifestations of shock? A) Cardiac arrhythmias B) Hypothermia C) Altered mental status D) Tachycardia Answer: D Diff: 1 Page Ref: 357-358 Standard: Trauma (Special Considerations in Trauma) Objective: 11 11) Which of the following statements 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 than in an adult. Answer: B Diff: 2 Page Ref: 351 Standard: Trauma (Special Considerations in Trauma) Objective: 11 123 Copyright © 2017 Pearson Education, Inc.

12) Which of the following best describes the significance of finding an abrasion during the prehospital assessment of the pediatric trauma patient? 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: 351 Standard: Trauma (Special Considerations in Trauma) Objective: 8 13) A thorough inspection of the trauma patient can be best performed if which of the following 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: 341 Standard: Trauma (Special Considerations in Trauma) Objective: 5 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: 355-356 Standard: Trauma (Special Considerations in Trauma) Objective: 8

15) Which of the following 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: 331 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: 342 Standard: Trauma (Special Considerations in Trauma) Objective: 9 17) A critical trauma patient should be reassessed every ________ minute(s) en route to the trauma center. A) 5 B) 10 C) 15 D) 1 Answer: A Diff: 1 Page Ref: 347 Standard: Trauma (Special Considerations in Trauma) Objective: 6

18) Assuming that none of the following patients has any neurologic deficits, which patient requires cervical spinal immobilization? 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: 350 Standard: Trauma (Special Considerations in Trauma) Objective: 9 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: 356 Standard: Trauma (Special Considerations in Trauma) Objective: 11 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: 331 Standard: Trauma (Special Considerations in Trauma) Objective: 2 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: 333-334 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: 334 Standard: Trauma (Special Considerations in Trauma) Objective: 3 23) All of the following are components of 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: 346 Standard: Trauma (Special Considerations in Trauma) Objective: 7 24) Which of the following 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: 344 Standard: Trauma (Special Considerations in Trauma) Objective: 4 25) Which of the following patients' mechanisms 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: 344-346 Standard: Trauma (Special Considerations in Trauma) Objective: 9

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: 337, 350 Standard: Trauma (Special Considerations in Trauma) Objective: 9 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 ________ mmHg. A) 70 B) 80 C) 60 D) 100 Answer: B Diff: 2 Page Ref: 348 Standard: Trauma (Multi-System Trauma) Objective: 9 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: 341 Standard: Trauma (Special Considerations in Trauma) Objective: 5

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, assuming that his condition does NOT improve with intervention? A) 10 mL/kg B) 20 mL/kg C) 30 mL/kg D) 40 mL/kg Answer: B Diff: 3 Page Ref: 354 Standard: Trauma (Special Considerations in Trauma) Objective: 11 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: 333-336 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: 356 Standard: Trauma (Special Considerations in Trauma) Objective: 11 32) Bariatric trauma patients have a mortality of up to ________ times greater than normal weight patients. A) two B) six C) three D) four Answer: B Diff: 3 Page Ref: 356 Standard: Trauma (Special Considerations in Trauma) Objective: 11

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: 355 Standard: Trauma (Special Considerations in Trauma) Objective: 11 34) ________ refers to a reduction in blood pressure caused by cardiac, vascular, neurogenic, or volume problems to a level that is lower than normal for the patient. A) Hypotension B) Hypovolemia C) Hypoperfusion D) Hypothermia Answer: A Diff: 1 Page Ref: 348 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: 358-359 Standard: Trauma (Special Considerations in Trauma) Objective: 12 36) Which of the following is a 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: 359-360 Standard: Trauma (Special Considerations in Trauma) Objective: 13

Paramedic Care: Principles & Practice V. 1-5, 5e (Bledsoe)

Volume 5 Special Considerations and Operations Chapter 1 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 endometriosis is 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: 12 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: 12 Standard: Medicine (Gynecology) Objective: 1 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. C) It is associated with ovulation. D) It is a sign of ectopic pregnancy. Answer: C Diff: 1 Page Ref: 12 Standard: Medicine (Gynecology) Objective: 1

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: 13 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: 12 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: 6 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: 5 Standard: Medicine (Gynecology) Objective: 2

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. 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: 11 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 3 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: 11-12 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: 12 Standard: Medicine (Gynecology) Objective: 3

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: 13 Standard: Medicine (Gynecology) Objective: 3 12) A 22-year-old woman presents with severe abdominal pain and 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: 12-13 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: 13 Standard: Medicine (Gynecology) Objective: 3

14) Your patient is a 42-year-old woman who is alert and upset, complaining of vaginal bleeding. She states that the bleeding began ten 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: 13 Standard: Medicine (Gynecology) Objective: 3 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: 13 Standard: Medicine (Gynecology) Objective: 4 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: 13 Standard: Medicine (Gynecology) Objective: 4

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: 13 Standard: Medicine (Gynecology) Objective: 4 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: 12-13 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 too. Answer: D Diff: 1 Page Ref: 14 Standard: Medicine (Gynecology) Objective: 5 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: 14 Standard: Medicine (Gynecology) Objective: 5

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: 14 Standard: Medicine (Gynecology) Objective: 5 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: 13 Standard: Medicine (Gynecology) Objective: 6 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: 13 Standard: Medicine (Gynecology) Objective: 6

24) Your patient is an 18-year-old woman who is alert and in moderate distress, complaining of abdominal pain and light-headedness. 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: 12-13 Standard: Medicine (Gynecology) Objective: 6 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 be "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: 12 Standard: Medicine (Gynecology) Objective: 6 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: 13 Standard: Medicine (Gynecology) Objective: 6

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 ten 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: 11-12 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: 13 Standard: Medicine (Gynecology) Objective: 6 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: 13 Standard: Medicine (Gynecology) Objective: 6

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: 13 Standard: Medicine (Gynecology) Objective: 6 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: 13 Standard: Medicine (Gynecology) Objective: 6 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 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%. 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: 12 Standard: Medicine (Gynecology) Objective: 3

Chapter 2 Obstetrics 1) 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: 28 Standard: Special Patient Populations (Obstetrics) Objective: 1 2) 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: 20 Standard: Special Patient Populations (Obstetrics) Objective: 1 3) 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: 23 Standard: Special Patient Populations (Obstetrics) Objective: 1 4) 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: 36 Standard: Special Patient Populations (Obstetrics) Objective: 1

5) 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: 21 Standard: Special Patient Populations (Obstetrics) Objective: 2 6) 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: 22 Standard: Special Patient Populations (Obstetrics) Objective: 2 7) A 30-year-old woman complains of swelling in both of 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: 22 Standard: Special Patient Populations (Obstetrics) Objective: 2

8) 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: 24 Standard: Special Patient Populations (Obstetrics) Objective: 2 9) 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: 25 Standard: Special Patient Populations (Obstetrics) Objective: 2 10) 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: 26 Standard: Special Patient Populations (Obstetrics) Objective: 3

11) 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: 29 Standard: Special Patient Populations (Obstetrics) Objective: 3 12) 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: 32-33 Standard: Special Patient Populations (Obstetrics) Objective: 3 13) 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: 32-33 Standard: Special Patient Populations (Obstetrics) Objective: 3

14) 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: 29 Standard: Special Patient Populations (Obstetrics) Objective: 4 15) 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: 31 Standard: Special Patient Populations (Obstetrics) Objective: 3 16) 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: 31-32 Standard: Special Patient Populations (Obstetrics) Objective: 3

17) 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 respiratory rate of 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: 33 Standard: Special Patient Populations (Obstetrics) Objective: 4 18) 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: 47 Standard: Special Patient Populations (Obstetrics) Objective: 4 19) 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: 27 Standard: Special Patient Populations (Obstetrics) Objective: 4 20) 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: 35-36 Standard: Special Patient Populations (Obstetrics) Objective: 5 16 Copyright © 2017 Pearson Education, Inc.

21) 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: 36 Standard: Special Patient Populations (Obstetrics) Objective: 6 22) You are caring for a woman in labor. She has had three previous deliveries and states that her contractions are approximately 3 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: 38 Standard: Special Patient Populations (Obstetrics) Objective: 6 23) 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: 39, 40 Standard: Special Patient Populations (Obstetrics) Objective: 7 24) 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: 41 Standard: Special Patient Populations (Obstetrics) Objective: 7

25) 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: 41 Standard: Special Patient Populations (Obstetrics) Objective: 7 26) 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: 43 Standard: Special Patient Populations (Obstetrics) Objective: 8 27) 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: 43 Standard: Special Patient Populations (Obstetrics) Objective: 8 28) 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: 45 Standard: Special Patient Populations (Obstetrics) Objective: 8

29) 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) Trendelenberg position and administration of magnesium sulfate. D) low-flow oxygen and position of comfort. Answer: B Diff: 2 Page Ref: 45 Standard: Special Patient Populations (Obstetrics) Objective: 8 30) 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: 46 Standard: Special Patient Populations (Obstetrics) Objective: 8 31) 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: 47-48 Standard: Special Patient Populations (Obstetrics) Objective: 8 32) 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: 41 Standard: Special Patient Populations (Obstetrics) Objective: 8

33) 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: 35 Standard: Special Patient Populations (Obstetrics) Objective: 8 34) 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: 40 Standard: Special Patient Populations (Obstetrics) Objective: 7 Chapter 3 Neonatology 1) In some cases, the spinal cord and associated structures of a newborn may be exposed. This abnormality is called a: A) Tetralogy of Fallot. B) meningomyelocele. C) omphalocele. D) choanal atresia. Answer: B Diff: 2 Page Ref: 59 Standard: Special Patient Populations (Neonatal Care) Objective: 1 2) Which of the following 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 arteriosis fails to close completely C) Repeat febrile seizures within the first 6 months of life D) Persistent pneumonia following meconium aspiration Answer: A Diff: 2 Page Ref: 59 Standard: Special Patient Populations (Neonatal Care) Objective: 1 20 Copyright © 2017 Pearson Education, Inc.

3) Which of the following 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: 55 Standard: Special Patient Populations (Neonatal Care) Objective: 2 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: 55 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: 55 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 the following 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: 59-60 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%. 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: C Diff: 2 Page Ref: 60 Standard: Special Patient Populations (Neonatal Care) Objective: 5 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: 67 Standard: Special Patient Populations (Neonatal Care) Objective: 7 9) Which of the following 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: 64-65 Standard: Special Patient Populations (Neonatal Care) Objective: 5 10) Which of the following 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; cardiac output depends mostly on heart rate. Answer: D Diff: 2 Page Ref: 64 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 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: 70-71 Standard: Special Patient Populations (Neonatal Care) Objective: 3 12) At 90 seconds after birth, based on the following 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: 64-65 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 the following is the most appropriate action to take at this point? A) Begin CPR at a rate of 3 compressions to 1 ventilation. B) Intubate the trachea, ventilate, reassess, and prepare to transport to a NICU. C) Begin bag-valve-mask ventilations and establish intravenous access. D) Continue to warm and dry the infant for an additional 30 seconds, while preparing to intubate. Answer: A Diff: 3 Page Ref: 60 Standard: Special Patient Populations (Neonatal Care) Objective: 5 14) Immediately after delivery, a neonate is crying and moving his arms and legs, but is centrally cyanotic. 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: 60-61 Standard: Special Patient Populations (Neonatal Care) Objective: 3 23 Copyright © 2017 Pearson Education, Inc.

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: 64-65 Standard: Special Patient Populations (Neonatal Care) Objective: 5 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: 76 Standard: Special Patient Populations (Neonatal Care) Objective: 5 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 of the following 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: 75 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 primapara. 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. Which of the following should you suspect? A) Neonatal abstinence syndrome B) Spinal cord damage C) Fractured clavicle D) Caput succedaneum Answer: C Diff: 2 Page Ref: 76 Standard: Special Patient Populations (Neonatal Care) Objective: 6 24 Copyright © 2017 Pearson Education, Inc.

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: 61 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: 73 Standard: Special Patient Populations (Neonatal Care) Objective: 5 21) You are called to a residence to care for a 3-hour-old infant in respiratory distress. Your physical exam reveals retractions, grunting, and tachypnea, along with rhonchi and crackles in the lungs. The midwife reports that the amniotic fluid had "thin meconium." Which of the following 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: 70 Standard: Special Patient Populations (Neonatal Care) Objective: 7

22) You respond to an apartment for a "sick child." You arrive to find a 2-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: 73-74 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: 72-73 Standard: Special Patient Populations (Neonatal Care) Objective: 7 24) A first-time mother has called 911 because her 5-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: 74 Standard: Special Patient Populations (Neonatal Care) Objective: 8

25) A 4-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. Which of the following 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: 74-75 Standard: Special Patient Populations (Neonatal Care) Objective: 7 26) Which of the following is the correct dosage of epinephrine in neonatal resuscitation? A) 0.1 to 0.3 mg/kg, 1:1,000 B) 0.01 to 0.03 mg/kg, 1:1,000 C) 0.01 to 0.03 mg/kg, 1:10,000 D) 1 to 3 mg/kg, 1:10,000 Answer: B Diff: 2 Page Ref: 64 Standard: Special Patient Populations (Neonatal Care) Objective: 5 27) Which of the following statements 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: 55 Standard: Special Patient Populations (Neonatal Care) Objective: 7 28) Which of the following statements 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: 57 Standard: Special Patient Populations (Neonatal Care) Objective: 7 27 Copyright © 2017 Pearson Education, Inc.

29) The appearance of your newborn patient leads you to suspect that he has Pierre Robin syndrome. Which of the following 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: 59 Standard: Special Patient Populations (Neonatal Care) Objective: 7 30) You suspect that a newborn has choanal atresia. Which of the following signs 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: 59 Standard: Special Patient Populations (Neonatal Care) Objective: 7 31) Which of the following conditions 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: 55 Standard: Special Patient Populations (Neonatal Care) Objective: 7 32) Which of the following 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: 62 Standard: Special Patient Populations (Neonatal Care) Objective: 5

33) Which of the following 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: 73 Standard: Special Patient Populations (Neonatal Care) Objective: 7 34) Which of the following 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: 74 Standard: Special Patient Populations (Neonatal Care) Objective: 8 35) Which of the following 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: 72 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: 57 Standard: Special Patient Populations (Neonatal Care) Objective: 4 29 Copyright © 2017 Pearson Education, Inc.

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: 58 Standard: Special Patient Populations (Neonatal Care) Objective: 4 Chapter 4 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: 81 Standard: Special Patient Populations (Pediatrics) Objective: 1 2) Which of the following 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: 82 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 the following 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." Answer: A Diff: 2 Page Ref: 82-83, 86 Standard: Special Patient Populations (Pediatrics) Objective: 3 30 Copyright © 2017 Pearson Education, Inc.

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: 82-83 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: 83 Standard: Special Patient Populations (Pediatrics) Objective: 3 6) At which of the following ages 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: 84 Standard: Special Patient Populations (Pediatrics) Objective: 4

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. Which of the following 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: 84-85 Standard: Special Patient Populations (Pediatrics) Objective: 3 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: 86 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 the following 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: 100 Standard: Special Patient Populations (Pediatrics) Objective: 6

10) Your patient is a 9-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 the following 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: 113 Standard: Special Patient Populations (Pediatrics) Objective: 6 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 the following 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: 126-127 Standard: Special Patient Populations (Pediatrics) Objective: 7 12) Which of the following 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: 105 Standard: Special Patient Populations (Pediatrics) Objective: 7

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 the following 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: 126-127 Standard: Special Patient Populations (Pediatrics) Objective: 7 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 the following 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: 117 Standard: Special Patient Populations (Pediatrics) Objective: 8 15) As the pediatric patient progresses from respiratory distress to respiratory failure, which of the following occurs? A) Hyperactivity B) Increased arterial carbon dioxide tension C) Peripheral cyanosis D) Muscular rigidity Answer: B Diff: 2 Page Ref: 117 Standard: Special Patient Populations (Pediatrics) Objective: 8

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: 117 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: 121 Standard: Special Patient Populations (Pediatrics) Objective: 7 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: 139-140 Standard: Special Patient Populations (Pediatrics) Objective: 9 19) Your 12-month-old patient has burns covering the full length of both lower extremities circumferentially. Which of the following 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: 139-140 Standard: Special Patient Populations (Pediatrics) Objective: 9

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: 122 Standard: Special Patient Populations (Pediatrics) Objective: 8 21) Which of the following 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: 121 Standard: Special Patient Populations (Pediatrics) Objective: 9 22) Which of the following 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: 139 Standard: Special Patient Populations (Pediatrics) Objective: 9

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: 124 Standard: Special Patient Populations (Pediatrics) Objective: 9 24) Which of the following conditions does NOT cause an upper airway obstruction? A) Epiglottitis B) Croup C) Bacterial tracheitis D) Asthma Answer: D Diff: 1 Page Ref: 118-120 Standard: Special Patient Populations (Pediatrics) Objective: 7 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 the following 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: 124 Standard: Special Patient Populations (Pediatrics) Objective: 9 26) All of the following 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: 140 Standard: Special Patient Populations (Pediatrics) Objective: 10 37 Copyright © 2017 Pearson Education, Inc.

27) Which of the following 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: 140 Standard: Special Patient Populations (Pediatrics) Objective: 10 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: 141 Standard: Special Patient Populations (Pediatrics) Objective: 10 29) Your patient is an 11-year-old male quadriplegic who depends on a phrenic nerve stimulator to stimulate contraction of his diaphragm and allow him to breathe. You are called to the home during a thunderstorm that has caused a power outage. Which of the following 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: 144, 104 Standard: Special Patient Populations (Pediatrics) Objective: 11 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: 146 Standard: Special Patient Populations (Pediatrics) Objective: 12 38 Copyright © 2017 Pearson Education, Inc.

31) You arrive at an MCI. You see a non-ambulatory 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: 146-147 Standard: Special Patient Populations (Pediatrics) Objective: 12 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 the following 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: 113 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 the following 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: 85 Standard: Special Patient Populations (Pediatrics) Objective: 13

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 the following 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: 100-102 Standard: Special Patient Populations (Pediatrics) Objective: 13 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 the following 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: 130 Standard: Special Patient Populations (Pediatrics) Objective: 6 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 the following 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: 141 Standard: Special Patient Populations (Pediatrics) Objective: 13 40 Copyright © 2017 Pearson Education, Inc.

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. Which of the following 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: 125 Standard: Special Patient Populations (Pediatrics) Objective: 13 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: 86 Standard: Special Patient Populations (Pediatrics) Objective: 13 39) You have been called for a 1-week-old infant who is sick. Assessment reveals him to have a fever and rhonchi in the left lower lobe. Which of the following 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: 121 Standard: Special Patient Populations (Pediatrics) Objective: 13

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: 130 Standard: Special Patient Populations (Pediatrics) Objective: 13 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% concentration. B) administer 1 mg of IV glucagon. C) administer 1 mg of IM glucagon. D) administer IV dextrose at 25% concentration. Answer: D Diff: 3 Page Ref: 132 Standard: Special Patient Populations (Pediatrics) Objective: 13 42) A 16-year-old girl has been complaining of abdominal pain, nausea, polyuria, and polydipsia for the past 4 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: 132 Standard: Special Patient Populations (Pediatrics) Objective: 13

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: 113 Standard: Special Patient Populations (Pediatrics) Objective: 13 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: 126-127 Standard: Special Patient Populations (Pediatrics) Objective: 13 45) Which of these is not a component of the airway examination in the primary assssment? 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: 91 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: 94-95 Standard: Special Patient Populations (Pediatrics) Objective: 5

Chapter 5 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: 160 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: 154 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: 154 Standard: Special Patient Populations (Geriatrics) 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: 154 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: 160 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: 154-156 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: 155 Standard: Special Patient Populations (Geriatrics) Objective: 2

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: 159 Standard: Special Patient Populations (Geriatrics) Objective: 2 9) Which of the following 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: 187 Standard: Special Patient Populations (Geriatrics) Objective: 7 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%. 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: 160 Standard: Special Patient Populations (Geriatrics) Objective: 5

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: 160-161 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: 188 Standard: Special Patient Populations (Geriatrics) Objective: 6 13) A 78-year-old woman complains of dizziness, visual disturbances, fatigue, and loss of appetite. Which of the following medications would be most likely to cause these symptoms? A) Coumadin B) Enalapril C) Pradaxa D) Digitalis Answer: D Diff: 2 Page Ref: 188-189 Standard: Special Patient Populations (Geriatrics) Objective: 7

14) Which of the following statements 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: 187 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. Which of the following is the best course of action? 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: 162 Standard: Special Patient Populations (Geriatrics) Objective: 5 16) Which of the following statements 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) All of the above are true. Answer: B Diff: 2 Page Ref: 161 Standard: Special Patient Populations (Geriatrics) Objective: 6

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. Which of the following 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: 183 Standard: Special Patient Populations (Geriatrics) Objective: 9 18) Which of the following is NOT a complication caused by incontinence? A) Skin ulcer B) Urinary tract infection C) Diverticulosis D) Sepsis Answer: C Diff: 2 Page Ref: 162 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: 156 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) "What medications are you taking?" C) "Do you have a history of medical problems?" D) "Have you ever been diagnosed with dementia?" Answer: A Diff: 2 Page Ref: 161-162 Standard: Special Patient Populations (Geriatrics) Objective: 9

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: 183 Standard: Special Patient Populations (Geriatrics) Objective: 9 22) Which of the following statements 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: 168-169 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: 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 and other neurological diseases. Answer: A Diff: 2 Page Ref: 155 Standard: Special Patient Populations (Geriatrics) Objective: 5 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: 192 Standard: Special Patient Populations (Geriatrics) Objective: 8 50 Copyright © 2017 Pearson Education, Inc.

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: 160 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: 156 Standard: Special Patient Populations (Geriatrics) Objective: 9 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: 170 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 of the following 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: 155, 156 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: 193 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: 193 Standard: Special Patient Populations (Geriatrics) Objective: 5 31) Which of the following statements regarding traumatic injuries and the elderly is TRUE? A) Hip fractures are responsible for 85% 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: 161-162 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: 161 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 91%, 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: 173 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: 163 Standard: Special Patient Populations (Geriatrics) Objective: 9

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: 178 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 the following possibilities? A) Myocardial infarction B) Thyroid storm C) Cerebrovascular accident D) COPD Answer: A Diff: 3 Page Ref: 175 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: 179 Standard: Special Patient Populations (Geriatrics) Objective: 5

38) Which of the following actions of the paramedic may lead to decubitus ulcer development in the elderly patient? A) Failing to pad the backboard for a patient in need of spinal immobilization 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 the above Answer: D Diff: 1 Page Ref: 183-184 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: 193-194 Standard: Special Patient Populations (Geriatrics) Objective: 5 40) Which of the following 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: 193-194 Standard: Special Patient Populations (Geriatrics) Objective: 2

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: 193-194 Standard: Special Patient Populations (Geriatrics) Objective: 5 42) Which of these factors 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: 160 Standard: Special Patient Populations (Geriatrics) Objective: 4 43) Which of these is the least important physical requirement for effective continence? A) Anatomically correct GI/GU tract B) Adequate tissue perfusion C) Competent sphincter mechanism D) Adequate cognition and mobility Answer: B Diff: 2 Page Ref: 162 Standard: Special Patient Populations (Geriatrics) Objective: 4

Chapter 6 Abuse, Neglect, and Assault 1) Which of the following 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: 209-210 Standard: Special Patient Populations (Patients with Special Needs) Objective: 1 2) Which of the following would constitute child neglect? A) Spanking a 5-year-old as a form of punishment B) Denying a 9-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: 206-207 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: 203 Standard: Special Patient Populations (Patients with Special Needs) 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: 207 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: 203 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: 201 Standard: Special Patient Populations (Patients with Special Needs) Objective: 3 7) Which of the following 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: 204 Standard: Special Patient Populations (Patients with Special Needs) Objective: 3 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: 208 Standard: Special Patient Populations (Patients with Special Needs) Objective: 3

9) You are transporting a 5-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: 207 Standard: Special Patient Populations (Patients with Special Needs) Objective: 3 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. Which of the following 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: 210 Standard: Special Patient Populations (Patients with Special Needs) Objective: 8 11) When caring for a victim of partner abuse, which of the following statements 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 Diff: 2 Page Ref: 202-203 Standard: Special Patient Populations (Patients with Special Needs) Objective: 8

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: 202-203 Standard: Special Patient Populations (Patients with Special Needs) Objective: 8 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 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: 207 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: 207 Standard: Special Patient Populations (Patients with Special Needs) Objective: 6 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: 205 Standard: Special Patient Populations (Patients with Special Needs) Objective: 6 60 Copyright © 2017 Pearson Education, Inc.

16) Which of the following 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: 205 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: 204-205 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) Circumferential D) Scald Answer: B Diff: 2 Page Ref: 206 Standard: Special Patient Populations (Patients with Special Needs) Objective: 4 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: 209 Standard: Special Patient Populations (Patients with Special Needs) Objective: 8

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: 209 Standard: Special Patient Populations (Patients with Special Needs) Objective: 8 21) Which of the following are common 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: 208 Standard: Special Patient Populations (Patients with Special Needs) Objective: 5 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: 208 Standard: Special Patient Populations (Patients with Special Needs) Objective: 5 23) What group is NOT commonly affected by hate crimes? A) Racial minorities B) Religious groups C) Low-income individuals D) Disabled individuals Answer: C Diff: 1 Page Ref: 211 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: 211 Standard: Special Patient Populations (Patients with Special Needs) Objective: 6 25) When providing a verbal handoff of a sexual assault victim, which of the following sets of 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: 209 Standard: Special Patient Populations (Patients with Special Needs) Objective: 6 26) Which of these 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: 210 Standard: Special Patient Populations (Patients with Special Needs) Objective: 7

Chapter 7 The Challenged Patient 1) Which of the following 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: 216 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: 216 Standard: Special Patient Populations (Patients with Special Needs) 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: 217 Standard: Special Patient Populations (Patients with Special Needs) Objective: 1 4) Which of the following is NOT a common cause of vision loss? A) Multiple sclerosis B) Diabetes C) Premature birth D) Cytomegalovirus Answer: A Diff: 1 Page Ref: 217 Standard: Special Patient Populations (Patients with Special Needs) Objective: 2

5) An injury to which cervical vertebra(e) may prevent a person from breathing? A) C-5—C-7 B) C-1—C-3 C) C-1 only D) C-3—C-5 Answer: D Diff: 1 Page Ref: 221 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: 216 Standard: Special Patient Populations (Patients with Special Needs) Objective: 2 7) Which of the following best describes the etiology 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: 224 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: 218 Standard: Special Patient Populations (Patients with Special Needs) Objective: 3 65 Copyright © 2017 Pearson Education, Inc.

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: 217 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: 224 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 of the following strategies 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: 222 Standard: Special Patient Populations (Patients with Special Needs) Objective: 5

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. Which of the following considerations 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: 220 Standard: Special Patient Populations (Patients with Special Needs) Objective: 5 13) Which of the following statements 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 non-latex 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: 227 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. Which of the following is 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: 217 Standard: Special Patient Populations (Patients with Special Needs) Objective: 5

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. Which of the following 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: 221 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: 218 Standard: Special Patient Populations (Patients with Special Needs) Objective: 5 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: 224 Standard: Special Patient Populations (Patients with Special Needs) Objective: 5

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: 227 Standard: Special Patient Populations (Patients with Special Needs) Objective: 4 19) A school nurse has called EMS because an 8-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: 227-228 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: 228 Standard: Special Patient Populations (Patients with Special Needs) Objective: 4

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. Which of the following is the best way to document this information on your patient care report? A) "Patient refuses to answer questions." B) "Patient is non-verbal, 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: 222 Standard: Special Patient Populations (Patients with Special Needs) Objective: 5 Chapter 8 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: 237 Standard: Special Patient Populations (Patients with Special Needs) Objective: 1 2) What does PEEP stand for? 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: 243 Standard: Special Patient Populations (Patients with Special Needs) Objective: 1 3) Which of the following 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 Diff: 1 Page Ref: 247 Standard: Special Patient Populations (Patients with Special Needs) Objective: 1

4) Your patient has Guillain-Barré syndrome. Which of the following 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: 235 Standard: Special Patient Populations (Patients with Special Needs) Objective: 1 5) Which of the following 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: 233 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: 233 Standard: Special Patient Populations (Patients with Special Needs) Objective: 2

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: 237 Standard: Special Patient Populations (Patients with Special Needs) Objective: 4 8) Which of the following 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 caregiver D) Change in condition Answer: B Diff: 1 Page Ref: 234 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: 249 Standard: Special Patient Populations (Patients with Special Needs) Objective: 6

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%. 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: 244 Standard: Special Patient Populations (Patients with Special Needs) Objective: 6 11) Which of the following 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: 237 Standard: Special Patient Populations (Patients with Special Challenges) Objective: 6 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: 242 Standard: Special Patient Populations (Patients with Special Needs) Objective: 8

13) When you arrive on the scene of an incident in which a home health care provider is present, which of the following is the best way to deal with the situation? 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: 238 Standard: Special Patient Populations (Patients with Special Needs) Objective: 7 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 of the following statements 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: 236 Standard: Special Patient Populations (Patients with Special Needs) Objective: 7 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: 250 Standard: Special Patient Populations (Patients with Special Needs) Objective: 6

16) What might you notice before entering a residence that would lead you to assume that a home health care situation might exist? 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) All of the above Answer: D Diff: 1 Page Ref: 234 Standard: Special Patient Populations (Patients with Special Needs) Objective: 9 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: 252-253 Standard: Special Patient Populations (Patients with Special Needs) Objective: 9 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. 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: 244-245 Standard: Special Patient Populations (Patients with Special Needs) Objective: 3

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 of the following questions 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: 256 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: 251 Standard: Special Patient Populations (Patients with Special Needs) Objective: 9 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: 253-254 Standard: Special Patient Populations (Patients with Special Needs) Objective: 6

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: 251 Standard: Special Patient Populations (Patients with Special Needs) Objective: 9 23) Which of the following 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: 251 Standard: Special Patient Populations (Patients with Special Challenges) Objective: 5 Chapter 9 Ground Ambulance Operations 1) Which of the following best describes "peak load"? A) The maximum amount of energy draw an ambulance's electrical system can handle B) The highest volume of calls at a given time C) The maximum amount of responses an agency can handle D) The maximum weight a stretcher can carry Answer: B Diff: 1 Page Ref: 264 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 1 2) Which of the following documents details the regulations regarding ambulance design? A) OHSA KKK specs B) SSS 1288D specs C) DOT KKK 1822E specs D) The DOT standards Answer: C Diff: 1 Page Ref: 261 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 1 77 Copyright © 2017 Pearson Education, Inc.

3) Which of the following best describes the concept of due regard? A) The higher standard of safety that guides the operation of emergency vehicles B) The set of laws that allow emergency vehicles to exceed the speed limit C) Slowing down as much as possible before going through a red light or stop sign D) The standards that guide the use of lights and sirens when driving an emergency vehicle Answer: A Diff: 1 Page Ref: 267 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 1 4) Which government agency is responsible for creating guidelines that mandate the use of disinfecting agents, sharps containers, red bags, HEPA masks, and personal protective equipment? A) NHTSA B) DOT C) OSHA D) State EMSA Answer: C Diff: 1 Page Ref: 262 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 2 5) Ambulances are required to carry certain medications and supplies in order to provide a minimum standard of care. This equipment is referred to as: A) essential equipment. B) required stock. C) equipment protocol. D) general equipment. Answer: A Diff: 2 Page Ref: 261 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 2 6) Which of the following best describes a type III ambulance? A) Conventional truck cab-chassis with a modular ambulance body B) Specialty van, forward control integral cab-body ambulance C) A standard van, forward control integral cab-body ambulance system D) A medium-duty ambulance rescue vehicle Answer: B Diff: 1 Page Ref: 261 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 2

7) The Commission on Accreditation of Ambulance Services (CAAS) provides which of the following? A) Mandatory regulations for ambulance operations B) A legally enforceable standard for ambulance equipment C) Voluntary guidelines for ambulance equipment and supplies D) Detailed protocols for ambulance maintenance Answer: C Diff: 1 Page Ref: 263 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 2 8) How often should a thorough check of equipment on the ambulance be made? A) Beginning of every shift B) Monthly C) Daily D) Weekly Answer: A Diff: 1 Page Ref: 263-264 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 3 9) Which of the following tasks would NOT typically be included in a daily vehicle/equipment checklist? A) Washing the ambulance B) Checking the fuel level C) Siren function evaluation D) Oxygen pressure level assessment Answer: A Diff: 1 Page Ref: 263-264 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 3 10) Some EMS agencies use a system for ambulance deployment that involves placing ambulances in strategic locations to best meet the demands of call volume and ensure response times. This system is called: A) minimum deployment plan. B) system status management. C) assisted computerized deployment. D) system response protocol. Answer: B Diff: 1 Page Ref: 265 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 4

11) Most collisions involving ambulances occur: A) when exiting the station. B) in residential areas. C) on the highway. D) at intersections. Answer: D Diff: 1 Page Ref: 266 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 5 12) You are leaving the scene of a medical call and realize that a civilian has parked in front of you, blocking your egress. Which of the following is an appropriate response? A) Send law enforcement to find the owner of the vehicle. B) Using side- and rear-view mirrors, back up a few feet until you can clear the vehicle. C) Using a spotter, back up the ambulance until you are able to safely exit the area. D) Wait until the owner of the vehicle returns and ask the owner to pull forward. Answer: C Diff: 1 Page Ref: 266 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 5 13) Which of the following is TRUE regarding the use of lights and sirens during ambulance operations? A) It greatly reduces transport time to the hospital. B) It poses significant risks to you, the patient, and other drivers. C) Sirens should not be used during inclement weather. D) Lights and sirens can be used whenever it is convenient. Answer: B Diff: 1 Page Ref: 268 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 5 14) Which of the following describes a system that uses a number of agencies, responder levels, and delivery vehicles? A) A multiple agency system B) A tiered system C) An alarm system D) A multijurisdictional response system Answer: B Diff: 1 Page Ref: 265 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 1, 4

15) You are driving with lights and siren to an emergency call. As you approach a busy intersection, you see that the light is red and there are cars stopped in all lanes of traffic. You should: A) sound the horn as you approach, wait for the light to turn, and then proceed with lights and siren. B) change the tone of the siren as you approach, sound the horn, and wait for motorists to move. C) move into the oncoming lane, proceed without stopping in the intersection. D) announce over your loudspeaker that motorists should exit the intersection to allow you to pass. Answer: A Diff: 1 Page Ref: 268 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 5 16) At the scene of a potential hazmat incident, where should the ambulance be parked? A) Downhill and downwind B) Near the warm zone for patient transport C) Uphill and upwind D) At least 500 yards away from the incident Answer: C Diff: 1 Page Ref: 269 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 5 17) You are the first on scene at a vehicle accident on a busy highway. You should: A) park the ambulance on the far side of the accident, leaving emergency lights on. B) park the ambulance on the near side of the accident, leaving emergency light on. C) park directly to the side of the accident, leaving only the side floodlights on. D) park past the accident, turning off emergency lights to avoid confusing motorists. Answer: A Diff: 1 Page Ref: 269 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 5 18) Which of the following was identified by data from New York State as the most common type of crash involving an ambulance? A) Lateral impact at an uncontrolled intersection with low visibility B) Rollover due to high speed on a wet roadway C) Rear-end collision at low speed with no weather issues D) Lateral impact at a controlled intersection with no weather issues Answer: D Diff: 1 Page Ref: 266 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 5

19) Which of these is a computerized personnel and ambulance deployment system designed to meet service demands with fewer resources and to ensure appropriate response times and vehicle locations? A) tiered response system B) reserve capacity C) system status management D) PAR Answer: C Diff: 1 Page Ref: 265 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 4 20) The ability to muster additional crews when all ambulances are on call or when a system’s resources are taxed by a multiple-casualty incident is: A) reserve capacity. B) deployment. C) peak load. D) congestion. Answer: A Diff: 1 Page Ref: 265 Standard: EMS Operations (Principles of Safely Operating a Ground Ambulance) Objective: 4 Chapter 10 Air Medical Operations 1) What type of flight rules can be characterized by the pilot(s) relying almost exclusively on line of sight? A) Traditional flight rules B) Visual flight rules C) Emergency flight rules D) Instrument flight rules Answer: B Diff: 1 Page Ref: 280 Standard: EMS Operations (Air Medical) Objective: 1

2) Which of the following patients would NOT be a candidate for transport via fixed-wing aircraft? A) 3-hour-old neonate requiring transport from a community hospital to a higher-level NICU B) 42-year-old man who is sedated and intubated, being transported from a rural area to a university hospital C) 32-year-old man requiring prolonged extrication following a vehicle accident D) 12-year-old burn victim who has been stabilized at a local ED and now needs transport to a burn center Answer: C Diff: 1 Page Ref: 278-279 Standard: EMS Operations (Air Medical) Objective: 5 3) Which one of the following is NOT a typical use for a rotor-wing aircraft? A) Scene response for patient transport B) Search and rescue C) Organ procurement D) Transport over very long distances Answer: D Diff: 1 Page Ref: 280 Standard: EMS Operations (Air Medical) Objective: 4 4) During which conflict did helicopter evacuation of wounded U.S. soldiers become standard practice? A) World War I B) Korean War C) World War II D) Vietnam War Answer: B Diff: 2 Page Ref: 277 Standard: EMS Operations (Air Medical) Objective: 3 5) During which conflict did helicopter transport of U.S. soldiers evolve from strict evacuation to in-flight medical care? A) World War I B) Korean War C) World War II D) Vietnam War Answer: D Diff: 2 Page Ref: 277 Standard: EMS Operations (Air Medical) Objective: 3

6) Which piece of legislation authorized the U.S. military to use simultaneous helicopter evacuation and medical care to augment existing U.S. civilian EMS? A) Military Assistance to Safety and Traffic B) Army Combat and Civilian Cooperation C) Civilian Air Medical Program D) Military Cooperative Evacuation Protocol Answer: A Diff: 1 Page Ref: 277 Standard: EMS Operations (Air Medical) Objective: 3 7) Which of the following is a benefit of fixed-wing aircraft over rotor-wing aircraft? A) Fixed-wing aircraft offer greater flexibility in landing area. B) Fixed-wing aircraft can transport over longer distances. C) Fixed-wing aircraft can carry nurses while helicopters cannot. D) Fixed-wing aircraft can fly in heavy rain. Answer: B Diff: 1 Page Ref: 278 Standard: EMS Operations (Air Medical) Objective: 4 8) You are on the scene of a motor vehicle collision on a rural roadway. It is 0130 and there is significant low cloud cover. The patient is a 45-year-old man who weighs 91 kg and is unresponsive. The patient has been intubated and has two large-bore IVs established. Which of the following would be a limiting factor when considering air medical transport of this patient? A) Rural area B) Cloud cover C) Patient size D) Time of day Answer: B Diff: 2 Page Ref: 280 Standard: EMS Operations (Air Medical) Objective: 5 9) Which of the following is TRUE if the ground transport time is equal to air medical transport time? A) The patient should be transported by air, as all helicopters have a nurse onboard. B) The patient should be transported by ground, as it is safer for the patient and crew. C) Medical direction should be obtained to determine the preferred method of transport. D) Air transport should be used only if an IV is already established. Answer: B Diff: 2 Page Ref: 280 Standard: EMS Operations (Air Medical) Objective: 5

10) In most instances, modern medical helicopters are staffed by: A) a four-person crew including two paramedics, a pilot, and copilot. B) a three-person crew including a paramedic, nurse, and pilot. C) a two-person crew including a pilot and nurse. D) a three-person crew including 2 paramedics and a pilot. Answer: B Diff: 2 Page Ref: 285 Standard: EMS Operations (Air Medical) Objective: 6 11) Responsibilities of a landing zone officer include all of the following EXCEPT: A) selection of site. B) site preparation. C) determining safe flying conditions. D) air-to-ground communication. Answer: C Diff: 2 Page Ref: 286 Standard: EMS Operations (Air Medical) Objective: 7 12) Which of the following is the ideal size of a helicopter landing zone during daytime conditions? A) 100 square ft B) 100 square yd C) 200 square ft D) 200 square yd Answer: A Diff: 2 Page Ref: 286 Standard: EMS Operations (Air Medical) Objective: 7 13) You are preparing a landing zone for an incoming air medical helicopter. The chosen landing zone is dirt and it is a hot and dry day. You should: A) inform the incoming helicopter that there may be dust upon landing. B) choose a different landing zone. C) ask the fire department to wet down the area. D) widen the landing zone by 50 feet. Answer: C Diff: 2 Page Ref: 286 Standard: EMS Operations (Air Medical) Objective: 7

14) When is it appropriate to approach a landed helicopter? A) After the rotors stop spinning B) After a 5-minute "cooling off" period C) When the flight crew signals you to approach D) When the landing zone officer indicates it is safe Answer: C Diff: 2 Page Ref: 288 Standard: EMS Operations (Air Medical) Objective: 7 15) An air medical transport crew has just arrived at the scene where you are providing care for a patient with a suspected AMI. You should: A) move the patient to the door of the helicopter and prepare to load the patient. B) wait for the flight crew to make contact with you and give them a report. C) ask over the radio if the crew is ready to receive the patient. D) send a BLS provider to make contact with the flight crew. Answer: B Diff: 2 Page Ref: 288 Standard: EMS Operations (Air Medical) Objective: 7 16) When training a new provider in air medical operations, which of the following statements would be appropriate? A) "Never approach an aircraft from the rear." B) "Only patients under 90 kg can be transported in a helicopter." C) "Fixed-wing aircraft are only used by critical care transport teams." D) "It is your responsibility to determine safe flying conditions after receiving a call." Answer: A Diff: 2 Page Ref: 287-288 Standard: EMS Operations (Air Medical) Objective: 6 17) Which of the following is a responsibility of the paramedic during helicopter take-off? A) Determining wind direction and speed B) Continuous communication with the pilot and flight crew C) Visually assessing for straps left hanging out of aircraft doors D) Notifying the receiving hospital that the flight crew is departing Answer: C Diff: 2 Page Ref: 286 Standard: EMS Operations (Air Medical) Objective: 7

18) If necessary to provide guidance to the approaching aircraft, use clock-based directional terms. Always consider the point of reference for the pilot (the nose of the aircraft) to be the: A) 3 o'clock position. B) 12 o'clock position. C) 6 o'clock position. D) 9 o'clock position. Answer: B Diff: 2 Page Ref: 288 Standard: EMS Operations (Air Medical) Objective: 6 19) Which of the following patients would most likely benefit from air ambulance transport? A) Term infant born in a rural area B) 19-year-old male multisystem trauma patient C) 42-year-old female with 10/10 abdominal pain D) 2-year-old boy with febrile seizures Answer: B Diff: 2 Page Ref: 283 Standard: EMS Operations (Air Medical) Objective: 8 20) Which of these is not a way in which helicopters and airplanes have proved to be vital assets in the emergent transport of the ill or injured patients? A) Ongoing education B) Organ procurement C) Specialty care D) Scene responses Answer: A Diff: 1 Page Ref: 275 Standard: EMS Operations (Air Medical) Objective: 2 Chapter 11 Multiple-Casualty Incidents and Incident Management 1) Which of the following incidents would be classified as a "closed incident"? A) A two-vehicle collision B) A building fire C) A grain storage bin collapse D) Persons sprayed with mace at a club Answer: A Diff: 1 Page Ref: 300 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 1

2) Which of the following incidents would be classified as an "open incident"? A) A collapse of a grocery store roof in a heavy rain B) People shot by a coworker at a factory C) A three-vehicle collision on a highway D) A gas pipeline explosion along a stretch of rural road Answer: A Diff: 1 Page Ref: 300 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 1 3) Which of the following is the best definition of a multiple-casualty incident? A) Any incident with more than one patient B) A situation in which more than one ambulance is needed C) Any incident in which situational demands overwhelm resources D) A situation in which there are more than three patients Answer: C Diff: 1 Page Ref: 294 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 1 4) Which of the following scenarios would benefit from pre-incident planning in anticipation of a possible MCI? A) Outdoor music festival with expected attendance of 10,000 B) Major road closure due to construction C) Increasing incidence of national terrorist activity D) The first winter storm of the season Answer: A Diff: 1 Page Ref: 318 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 2 5) The Incident Command System was initially developed as a management tool for: A) natural disasters. B) large-scale fires. C) urban violent crimes. D) rural EMS agencies. Answer: B Diff: 2 Page Ref: 297 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 3

6) The major functional areas of the National Incident Management System include all of the following EXCEPT: A) command. B) logistics. C) planning. D) execution. Answer: D Diff: 2 Page Ref: 297 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 4 7) Which of the following is TRUE regarding incident commanders? A) They make decisions in conjunction with the medical director. B) They hold full legal authority for decision making. C) They must clear all decisions with the logistics coordinator. D) They are not liable for decisions made during an MCI. Answer: D Diff: 2 Page Ref: 299 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 6 8) Span of control refers to: A) the number of individuals a supervisor can safely manage. B) the geographical area an incident covers. C) how many incident commanders are needed for a given MCI. D) how many division leaders an incident commander appoints. Answer: A Diff: 2 Page Ref: 299 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 1, 4 9) You and your EMT partner arrive at the scene of a vehicle collision and find that the collision involved a large van and a school bus full of children. Your first action should be to: A) begin triaging patients. B) declare an MCI and establish yourself as incident commander. C) call for an air ambulance. D) inform dispatch that you may need additional resources. Answer: B Diff: 2 Page Ref: 299 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 8

10) Which of the following BEST describes the National Incident Management System? A) A uniform, yet flexible, system B) A rigid set of protocols C) The minimum acceptable standard for MCI operations D) A recommended list of job tasks for MCIs Answer: A Diff: 1 Page Ref: 298 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 4 11) The site from which civil government officials exercise direction and control in an emergency or disaster is called the: A) mutual aid coordination center (MACC). B) emergency aid and operations center (EAOC). C) incident command center (ICC). D) mobile dispatch coordination center (MDCC). Answer: A Diff: 1 Page Ref: 298 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 5 12) Under the Incident Command System, who is responsible for monitoring all on-scene actions and ensuring that they do not create any potentially harmful conditions? A) Incident commander B) Safety officer C) Tactical liaison D) OSHA representative Answer: B Diff: 2 Page Ref: 303 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 6 13) During an MCI, which section is responsible for procuring and distributing equipment and supplies? A) Operations B) Equipment C) Logistics D) Finance Answer: C Diff: 1 Page Ref: 304-305 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 7

14) During an MCI, which section collects information such as weather reports, documents incident actions, and develops contingency plans? A) Operations B) Logistics C) Finance D) Planning Answer: D Diff: 1 Page Ref: 305 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 7 15) Which of the following is NOT a functional unit of the EMS branch during a multiplecasualty incident? A) Triage B) Treatment C) Morgue D) Staging Answer: C Diff: 1 Page Ref: 306 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 7 16) Which of the following is NOT a stage of typical disaster management? A) Planning B) Response C) Recovery D) Investigation Answer: D Diff: 1 Page Ref: 316 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 10 17) Which of the following supervisors is responsible for coordinating placement of ambulances waiting to transport patients? A) Staging officer B) Treatment supervisor C) Transport unit supervisor D) EMS officer Answer: A Diff: 1 Page Ref: 314-315 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 8

18) You are responsible for leading the triage team at the scene of an explosion at a local shopping mall. Which of the following should be your FIRST action when beginning the triage process? A) Tag all deceased patients as Black. B) Task two responders with triaging all children. C) Ask anyone who can walk to come to you. D) Ask the treatment officer to prepare to receive patients. Answer: C Diff: 2 Page Ref: 307 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 9 19) While triaging patients at a MCI, you find a 19-year-old female patient who is awake and breathing 32 times/minute. She has a rapid radial pulse and what appears to be partial thickness burns on both legs. According to the START triage system, how should this patient be categorized? A) Red B) Green C) Yellow D) Black Answer: A Diff: 2 Page Ref: 307 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 9 20) While triaging patients at a MCI, you find a 22-year-old man who is not breathing. After you open the airway, the patient takes a breath. You should: A) tag as "immediate" and move on. B) apply oxygen and move on. C) assess perfusion status. D) assess mental status. Answer: A Diff: 2 Page Ref: 307 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 9 21) A 56-year-old man is breathing 20 times per minute and has a weak radial pulse. He is confused but able to follow commands. According to the START triage system, how should this patient be categorized? A) Minor B) Delayed C) Immediate D) Urgent Answer: B Diff: 2 Page Ref: 307 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 9 92 Copyright © 2017 Pearson Education, Inc.

22) Which of the following best describes scene size-up for an MCI? A) Constructing a diagram of the scene for use by incident command B) An assessment of how many patients are in need of priority care C) A quick assessment of the incident type and any immediately obvious hazards D) The exact description of the incident and how many resources are needed to mitigate it Answer: C Diff: 1 Page Ref: 299-300 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 8 23) Which of the following would NOT be an appropriate decision for the transportation unit supervisor? A) Placing two critical patients in one ambulance B) Sending a less critical patient to hospital in another county C) Communicating directly with staged ambulance crews D) Tracking the number of patients sent to each hospital Answer: C Diff: 2 Page Ref: 315 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 8 24) When transferring incident command, which of the following must be done? A) Signed handover of command. B) All sector commanders must agree on the transfer. C) Approval must be obtained from the medical director. D) A face-to-face transfer. Answer: D Diff: 2 Page Ref: 302-303 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 8 25) You have responded to an explosion on a subway train. Because you are a paramedic, the incident commander tells you to report to the treatment unit. Which of the following treatment areas would be the most appropriate location for you to report to? A) Immediate, "red" area B) Delayed, "yellow" area C) Critical, "black" area D) Non-urgent, "green" area Answer: A Diff: 2 Page Ref: 306-307 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 8

26) How long should it take you to triage one patient during an MCI? A) Less than 10 seconds B) As long as it takes to obtain a set of vital signs C) Less than 30 seconds D) Less than 1 minute Answer: C Diff: 1 Page Ref: 312 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 8 27) You are the first to arrive on the scene of a collapse of a balcony at an apartment building. You are met by a man whose arm is nearly severed, and you can see exposed bone and muscle tissue. Bleeding seems to be minimal. What is your next course of action? A) This is a life-threating injury, so treat it immediately and call for additional resources. B) This is an "open incident," so using START he is a "green" patient. Have him sit in a safe area, apply a basic dressing to control bleeding, and, if possible, find someone to monitor him. Perform the scene size-up and triage. C) This is a "closed incident." Perform a scene size-up and treat this patient. Any other incoming units can continue treating people as they are found. D) Take him to the ambulance. Answer: B Diff: 3 Page Ref: 307-308 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 9 28) Which of the following patients would be tagged "red" using the START system? A) A 43-year-old who has a respiratory rate of 28 and a radial pulse, who is screaming to get her to the hospital B) A 36-year-old displaying no respirations with manual airway techniques, with a weak carotid pulse C) A 30-year-old with respirations of 24 and a radial pulse, who cannot follow commands D) A 16-year-old with a patent airway and a radial pulse, who is able to walk Answer: C Diff: 2 Page Ref: 307-308 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 9

29) You have been assigned the job of staging officer at a multiple-casualty incident. This means: A) you are responsible for staging all supplies and equipment needed by the treatment unit. B) you must work directly with incident command to ensure the financial needs of the operation are met. C) you must organize and prepare all waiting ambulances to transport patients. D) you are responsible for determining which patients go to which hospitals. Answer: C Diff: 2 Page Ref: 314-315 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 8 30) Which specialized unit, designed to support on-scene responders, may be established at large-scale incidents? A) Debriefing unit B) CISD unit C) Fatigue unit D) Rehab unit Answer: D Diff: 2 Page Ref: 315-316 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 12 31) Which of the following is the most important goal to achieve in the initial minutes of an MCI? A) Implementation of the NIMS B) Proper triage C) Designation of an IC D) Good assessment of resources needed Answer: A Diff: 1 Page Ref: 298-299 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 4 32) Which of the following is TRUE of MCI drills? A) You should never tell anyone they are going to a drill, because they won't take it seriously. B) They are not necessary for small, rural departments. C) They are effective only if you can provide real-life moulage and props. D) All agencies should drill, and never say, "It will never happen here." Answer: D Diff: 1 Page Ref: 318 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 11

33) You and your partner have just been relieved of duty at the scene of a school bus rollover. You feel fatigued and emotionally "blank." Which of the following actions would be most helpful to you? A) Detailed debriefing with a supervisor B) Replaying the incident in your mind C) Discussing the patients you cared for with your family D) Resting and ensuring that your basic needs are met Answer: D Diff: 1 Page Ref: 318 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 12 34) Disaster mental health services should be available: A) following any MCI. B) both immediately after the incident and in the following weeks. C) to all personnel involved in an incident. D) All of the above Answer: D Diff: 1 Page Ref: 318 Standard: EMS Operations (Multiple-Casualty Incidents) Objective: 12 Chapter 12 Rescue Awareness and Operations 1) The process of actually releasing the patient from the cause of entrapment is called: A) extraction. B) disentanglement. C) extrication. D) egress. Answer: B Diff: 1 Page Ref: 328 Standard: EMS Operations (Vehicle Extrication) Objective: 1 2) Which of the following BEST describes why paramedics should be trained to an awareness level regarding rescue operations? A) It is a requirement in order to take the NREMT exam. B) Most states require this training prior to licensure. C) Awareness training enables paramedics to recognize the need for more resources. D) Awareness training allows paramedics to begin rescue operations before other resources arrive. Answer: C Diff: 1 Page Ref: 324 Standard: EMS Operations (Vehicle Extrication) Objective: 2

3) Which of the following should be standard personal protective equipment on all ambulances for rescue operations? A) Ballistics vests B) United States Coast Guard-approved personal flotation devices C) Helmets meeting National Fire Protection Association standards D) SCBA Answer: C Diff: 2 Page Ref: 325 Standard: EMS Operations (Vehicle Extrication) Objective: 3 4) Which of the following types of gloves is the best suited for rescue operations? A) Vinyl B) Latex C) Leather D) Gauntlet style Answer: C Diff: 2 Page Ref: 325-326 Standard: EMS Operations (Vehicle Extrication) Objective: 3 5) Which of the following are desirable characteristics of footwear worn by EMS personnel? A) Slip-on, steel-toe boots or shoes B) Lightweight, low-top shoes C) Steel-toe, lace-up boots D) Smooth-sole, steel-shank shoes Answer: C Diff: 1 Page Ref: 326 Standard: EMS Operations (Vehicle Extrication) Objective: 3 6) Which of the following is NOT required for the patient being rescued? A) Foot protection B) Hearing protection C) Protective blankets D) Eye protection Answer: A Diff: 1 Page Ref: 327 Standard: EMS Operations (Vehicle Extrication) Objective: 4

7) Rescuers are preparing to break the windshield of a vehicle. You are inside the vehicle providing care. Which of the following is the BEST way to protect you and your patient during this operation? A) Have rescuers break the rear windshield instead. B) Place a helmet, goggles, and leather gloves on the patient. C) Cover yourself and the patient with a blanket or tarp. D) Remove yourself from the vehicle prior to the start of the extrication. Answer: C Diff: 1 Page Ref: 346 Standard: EMS Operations (Vehicle Extrication) Objective: 4 8) What is the most effective measure that can be taken to ensure safe and effective rescue operations? A) Developing standard safety procedures and protocols B) Providing all crews with helmets and equipment C) Dispatching a supervisor to each rescue scene D) Remaining clear of the scene until the rescue and extrication is complete Answer: B Diff: 1 Page Ref: 325 Standard: EMS Operations (Vehicle Extrication) Objective: 3 9) Upon arrival at the scene of a bridge collapse, you determine that at least three patients are now trapped at the bottom of a steep ravine. You inform dispatch of the situation and request that multiple resources respond, including crews trained in long line rescue. You have just completed which phase of rescue operations? A) Hazard mitigation B) Arrival and size-up C) Resource allocation D) Access and assessment Answer: B Diff: 1 Page Ref: 328 Standard: EMS Operations (Vehicle Extrication) Objective: 5 10) You are vacationing at a mountain resort when you hear cries for help. A teenaged girl is in the middle of a pond. She is in distress and cannot remove herself from the water. Which of the following should you attempt to do first? A) Reach out to her with a boat oar or similar object. B) Wade out to her. C) Throw her a flotation device. D) Find a rowboat or raft and go out to the victim. Answer: A Diff: 2 Page Ref: 334 Standard: EMS Operations (Vehicle Extrication) Objective: 6 98 Copyright © 2017 Pearson Education, Inc.

11) The cold protective response may be activated when a person's face is submerged in water that is less than ________ degrees Fahrenheit. A) 98.6 B) 75 C) 32 D) 68 Answer: D Diff: 2 Page Ref: 337 Standard: EMS Operations (Vehicle Extrication) Objective: 6 12) Which of the following is the sequence of actions in water rescue? A) Throw, wade, swim, row B) Throw, row, tow, go C) Reach, wade, float, dive D) Reach, throw, row, go Answer: D Diff: 2 Page Ref: 334 Standard: EMS Operations (Vehicle Extrication) Objective: 6 13) Which of the following factors may lead to injury or death of EMS personnel attempting water rescue? A) Hypothermia B) Failing to use a PFD C) Underestimating the current D) All of the above Answer: D Diff: 1 Page Ref: 333 Standard: EMS Operations (Vehicle Extrication) Objective: 6 14) Which of the following measures will NOT help prevent hypothermia in the water? A) Huddling with others in the water B) Keeping as much of your body out of the water as possible C) Treading water to produce heat from exertion D) Wearing appropriate protective gear Answer: C Diff: 2 Page Ref: 334 Standard: EMS Operations (Vehicle Extrication) Objective: 6

15) You have been caught in a flash flood and have underestimated the depth of the water and the strength of the current. As you float downstream, you notice a partially submerged tree in the water. Which of the following approaches should you take? A) Avoid becoming entangled in the tree. B) Try to swim over to the tree. C) See if you can touch your feet on the ground to steady yourself. D) Push off the tree to reach the shore or stable ground. Answer: B Diff: 2 Page Ref: 337 Standard: EMS Operations (Vehicle Extrication) Objective: 6 16) Which of the following is one of the greatest threats to rescuers entering a confined space? A) Engulfment by the contents of the space, such as grain or coal B) Toxic chemical exposure C) Oxygen-deficient atmosphere D) Electrocution Answer: C Diff: 2 Page Ref: 340-341 Standard: EMS Operations (Vehicle Extrication) Objective: 7 17) Which of the following is a toxic gas that results from incomplete combustion and may be found in confined spaces? A) Hydrogen sulfide B) Nitrous oxide C) Carbon dioxide D) Carbon monoxide Answer: D Diff: 2 Page Ref: 341 Standard: EMS Operations (Vehicle Extrication) Objective: 7 18) The term low-angle rescue refers to ascending or rappelling an incline of less than ________ degrees. A) 90 B) 40 C) 65 D) 15 Answer: B Diff: 2 Page Ref: 348 Standard: EMS Operations (Vehicle Extrication) Objective: 9

19) Hybrid electric vehicles pose a particular risk to rescue personnel because: A) they contain a high-voltage component in addition to an internal combustion motor. B) they are most commonly powered by diesel fuel. C) the air bags and seat belt pretensioners are more susceptible to damage during a crash. D) HEVs do not pose any additional risk to rescuers. Answer: A Diff: 2 Page Ref: 343 Standard: EMS Operations (Vehicle Extrication) Objective: 8 20) Which of the following hazards may be encountered by EMS personnel at the scene of a motor-vehicle collision? A) Unstable vehicles B) Energy-absorbing bumpers C) Supplemental restraint systems D) All of the above Answer: D Diff: 1 Page Ref: 343-344 Standard: EMS Operations (Vehicle Extrication) Objective: 8 21) On approaching a vehicle that has crashed into a retaining wall and in which the driver appears to be entrapped, you should do which of the following? A) Break the windshield glass, saw through the A posts, and roll the roof back. B) Use a spring-loaded punch to break the glass of the rear window. C) Stabilize the vehicle. D) Attempt to open each of the doors. Answer: C Diff: 2 Page Ref: 344 Standard: EMS Operations (Vehicle Extrication) Objective: 8 22) On the scene of a high-angle rescue operation, you note that one of the ropes to be used by the rescue team appears to be frayed. Which of the following actions should you take? A) Avoid interfering with the efforts of trained rescuers. B) Replace it with a rope from the ambulance. C) Wrap several layers of 2-inch tape around the frayed area. D) Inform the safety officer. Answer: D Diff: 2 Page Ref: 349 Standard: EMS Operations (Vehicle Extrication) Objective: 9

23) You are on the scene of a trench collapse. Which of the following should be your first concern? A) The possibility of secondary collapse B) The patient's risk of cervical spine injury C) The patient's airway D) Setting up incident command Answer: A Diff: 1 Page Ref: 342 Standard: EMS Operations (Vehicle Extrication) Objective: 9 24) For which of the following patients being carried over rough terrain would the administration of analgesia be appropriate? A) An unresponsive 25-year-old man who was impaled in the chest with a small tree branch when he fell from a deer stand B) A 16-year-old girl who was ejected from an all-terrain vehicle who is asking repetitive questions and has facial injuries C) A 24-year-old woman who was thrown from a horse and complains of 3/10 wrist pain D) A 35-year-old man who stepped in a hole while hiking and has an open fracture of the tibia and fibula Answer: D Diff: 1 Page Ref: 350 Standard: EMS Operations (Vehicle Extrication) Objective: 9 25) Which of the following is the preferred piece of equipment for carrying a patient over rough terrain? A) Scoop stretcher B) Stokes basket C) Wheeled stretcher D) Rigid backboard Answer: B Diff: 1 Page Ref: 348 Standard: EMS Operations (Vehicle Extrication) Objective: 9 26) You are caring for a patient injured in a back-country fall. You have accessed the patient and packaged him for transport and are awaiting the arrival of a helicopter. Knowing that the patient is 30 to 40 minutes from the nearest hospital by air, which of the following should you consider? A) Stopping fluid administration to keep the patient from needing to urinate during transport B) Removing splinting material to prevent compartment syndrome C) Administering pain medication and wrapping the patient in blankets D) Administering a sedative due to the long transport time Answer: C Diff: 1 Page Ref: 350-351 Standard: EMS Operations (Vehicle Extrication) Objective: 9 102 Copyright © 2017 Pearson Education, Inc.

27) Which of the following figures most prominently in boating fatalities? A) Lack of PFDs B) Alcohol use C) Excessive speed D) Underage operators Answer: A Diff: 1 Page Ref: 337 Standard: EMS Operations (Vehicle Extrication) Objective: 6 28) Which of the following personal characteristics causes the cold-protective response to be more pronounced? A) Geriatric age group B) Pediatric age group C) Female gender D) Male gender Answer: B Diff: 1 Page Ref: 338 Standard: EMS Operations (Vehicle Extrication) Objective: 6 29) Which of the following is NOT a phase of rescue operations? A) Hazard control B) Reconnaissance C) Disentanglement D) Medical treatment Answer: B Diff: 1 Page Ref: 328 Standard: EMS Operations (Vehicle Extrication) Objective: 5 30) Which of the following BEST describes the HELP position? A) A body position used when submerged to prevent heat loss and delay hypothermia B) The universal sign for "I need assistance" C) A means of deploying rescuers at a long-line rescue operation D) The positioning of flags at a rescue scene to aid in helicopter landing Answer: A Diff: 1 Page Ref: 334 Standard: EMS Operations (Vehicle Extrication) Objective: 1

Chapter 13 Hazardous Materials 1) What is CHEMTREC? A) A guidebook for identifying hazardous materials B) An organization with a 24-hour information hotline regarding hazardous materials C) The set of laws governing the transport of hazardous materials D) The acronym for the levels of training for hazmat providers Answer: B Diff: 1 Page Ref: 362 Standard: EMS Operations (Hazardous Materials) Objective: 1 2) An incident involving which of the following types of vehicles may result in a hazardous materials incident? A) Cars powered by alternative fuels B) Tractor-trailers C) Tanker trucks D) All of the above Answer: D Diff: 2 Page Ref: 358 Standard: EMS Operations (Hazardous Materials) Objective: 7 3) Each year in the United States, an estimated ________ of hazardous materials are shipped via road, rail, and pipelines. A) 8 million tons B) one hundred thousand pounds C) 4 billion tons D) 2 billion pounds Answer: C Diff: 2 Page Ref: 356 Standard: EMS Operations (Hazardous Materials) Objective: 7 4) You have responded to a ranch where three adult male patients are complaining of abdominal cramping, vomiting, and diarrhea. They state they were applying chemicals to a field when they became ill. Based on this, which of the following should you suspect? A) They have heatstroke. B) They became contaminated with organophosphates. C) They have been exposed to anhydrous ammonia. D) They have been exposed to anthrax. Answer: B Diff: 2 Page Ref: 368 Standard: EMS Operations (Hazardous Materials) Objective: 7

5) A substance that may be an acid or an alkali and that can damage the skin and other tissues best describes a(n): A) solvent. B) corrosive. C) irritant. D) desiccant. Answer: B Diff: 1 Page Ref: 368 Standard: EMS Operations (Hazardous Materials) Objective: 1 6) Unless specially trained, EMS personnel operate in which of the following zones of a hazardous materials incident? A) Green B) Orange C) Yellow D) Red Answer: A Diff: 2 Page Ref: 364 Standard: EMS Operations (Hazardous Materials) Objective: 4 7) On the scene of a hazardous materials emergency, which of the following individuals is best suited to serve as incident commander? A) Fire service rescue technician B) Paramedic C) Hazardous materials technician D) Hazmat specialist Answer: D Diff: 2 Page Ref: 357-358 Standard: EMS Operations (Hazardous Materials) Objective: 4 8) You have just completed hazmat EMS level 2 training. This means that you are now trained to: A) contain hazardous material spills. B) evacuate patients from the hot zone. C) provide patient care in the warm zone. D) clean up hazardous materials safely. Answer: C Diff: 1 Page Ref: 357 Standard: EMS Operations (Hazardous Materials) Objective: 2

9) Which one of the following statements shows that the paramedic has a proper understanding of basic operations at the scene of a hazardous materials emergency? A) "Life or health should never be risked if the threat is only to the environment." B) "The most important thing is to identify the exact material involved in the incident." C) "Olfactory clues are the most reliable way to identify a hazardous material incident." D) "Identification of the material is not important, as the approach is the same for all materials." Answer: A Diff: 2 Page Ref: 357 Standard: EMS Operations (Hazardous Materials) Objective: 4 10) As you approach the scene of a motor vehicle collision, you realize that there is a tanker truck involved and that it has tipped over. Which of the following actions is appropriate? A) Stop a safe distance away, use binoculars to locate any placards on the tanker, and reference the Emergency Response Guide. B) Stop a safe distance from the scene, use binoculars to locate any placards on the tanker, and reference the safety data sheet. C) When you reach the scene, look for the NFPA 704 label and reference the safety data sheet. D) When you reach the scene, look for any placards on the tanker and reference the Emergency Response Guide. Answer: A Diff: 2 Page Ref: 358 Standard: EMS Operations (Hazardous Materials) Objective: 5 11) During transport of a patient exposed to a hazardous material, which of the following types of glove provides the paramedic with the best protection during patient care? A) Leather B) Reinforced mesh cloth C) Latex D) Nitrile Answer: D Diff: 1 Page Ref: 373 Standard: EMS Operations (Hazardous Materials) Objective: 7 12) When providing medical monitoring of hazardous materials personnel, for which of the following should you keep a high index of suspicion? A) Heat stress B) Atrial fibrillation C) Myocardial ischemia D) Hypoglycemia Answer: A Diff: 2 Page Ref: 374 Standard: EMS Operations (Hazardous Materials) Objective: 5 106 Copyright © 2017 Pearson Education, Inc.

13) Which of the following would raise the most suspicion of a hazardous materials incident? A) A pair of landfill workers with symptoms of sore throat and fever B) Multiple patients at a factory with respiratory complaints C) Rising incidence of suicide in a rural county D) Multiple patients at an outdoor event complaining of "heatstroke" Answer: B Diff: 2 Page Ref: 357-358 Standard: EMS Operations (Hazardous Materials) Objective: 4 14) The most accurate information about a transported substance can be found in which of the following? A) NFPA 704 system B) Safety data sheet C) Shipping papers D) Emergency Response Guide Answer: C Diff: 1 Page Ref: 362 Standard: EMS Operations (Hazardous Materials) Objective: 5 15) Which of the following regarding hazardous materials is provided by the Emergency Response Guide? A) A different UN for every material listed B) Special information regarding long-term health and environmental hazards for each material C) Specific decontamination and treatment information for each material listed D) Evacuation distances for the most hazardous materials Answer: D Diff: 1 Page Ref: 361 Standard: EMS Operations (Hazardous Materials) Objective: 5 16) Which of the following is used to identify hazardous materials in fixed facilities? A) DOT placards B) SDS C) CAMEO tags D) NFPA 704 system Answer: D Diff: 1 Page Ref: 360-361 Standard: EMS Operations (Hazardous Materials) Objective: 5

17) You have entered a manufacturing setting on a call and note a large storage container with a diamond-shaped label. The left side of the label is blue and contains the number 4. The top portion of the label is red and contains the number 1. What does this mean? A) The substance is highly hazardous to health, but does not pose a significant fire risk. B) The substance is highly flammable, but does not pose a significant health risk. C) The substance is highly hazardous to health, but does not pose a significant risk of reactivity. D) The substance is highly reactive, but does not pose a significant health risk. Answer: A Diff: 3 Page Ref: 361 Standard: EMS Operations (Hazardous Materials) Objective: 5 18) You have arrived on the scene of a chemical leak at laboratory. The placard has a "1" in the blue diamond and a "4" in the red diamond, which means the material is: A) flammable, but represents a low health hazard. B) explosive with a high associated health hazard. C) a solid that is very flammable. D) a flammable liquid with radioactive properties. Answer: A Diff: 2 Page Ref: 361 Standard: EMS Operations (Hazardous Materials) Objective: 5 19) On the National Fire Protection Association hazardous materials classification placard, the blue diamond represents: A) reactivity. B) health hazard. C) specific hazard. D) fire hazard. Answer: B Diff: 1 Page Ref: 361 Standard: EMS Operations (Hazardous Materials) Objective: 5 20) You are working the scene of a collision involving a tractor-trailer that is hauling an unknown chemical. Because no material is leaking from the truck and the scene is safe, the incident commander asks you to get the truck's shipping papers. Where would these most likely be located? A) Shipping vault on the trailer B) Cab of the truck C) Rear compartment on the tanker D) Electrical box between the tractor and trailer Answer: B Diff: 2 Page Ref: 362 Standard: EMS Operations (Hazardous Materials) Objective: 5 108 Copyright © 2017 Pearson Education, Inc.

21) It has been determined that the concentration of a substance is at IDLH. This means that patients exposed to the area: A) are at risk for adverse effects or death as soon as they are exposed. B) will suffer no adverse effects if they have been exposed for less than 15 minutes. C) have a 50 percent likelihood of dying. D) require transport and inpatient hospitalization. Answer: A Diff: 2 Page Ref: 365 Standard: EMS Operations (Hazardous Materials) Objective: 5 22) In a hazardous materials incident, decontamination begins in the ________ zone. A) central B) cold C) warm D) hot Answer: D Diff: 1 Page Ref: 364 Standard: EMS Operations (Hazardous Materials) Objective: 6 23) At the scene of a hazardous materials emergency, you have been assigned to the cold zone. In this zone, which one of the following would you perform? A) Initial decontamination B) Initial triage C) Removal of contaminated rescue gear D) Obtaining vital signs Answer: D Diff: 2 Page Ref: 364 Standard: EMS Operations (Hazardous Materials) Objective: 6 24) When working in the warm zone, the paramedic should remember that: A) the area is actively contaminated. B) there is no danger of contamination. C) protective gear must be worn. D) patient care is not performed. Answer: C Diff: 2 Page Ref: 364 Standard: EMS Operations (Hazardous Materials) Objective: 6

25) Which of the following is the most common route of exposure to hazardous materials? A) Injection B) Ingestion C) Inhalation D) Absorption Answer: C Diff: 1 Page Ref: 367 Standard: EMS Operations (Hazardous Materials) Objective: 7 26) The highest level of respiratory and splash protection from hazardous materials exposure is provided by level ________ protective equipment. A) A B) B C) C D) D Answer: A Diff: 3 Page Ref: 372 Standard: EMS Operations (Hazardous Materials) Objective: 8 27) Firefighter "turnout" gear is considered what level of protective equipment? A) A B) B C) C D) D Answer: D Diff: 3 Page Ref: 373 Standard: EMS Operations (Hazardous Materials) Objective: 8 28) Which of the following is the universal decontamination agent for hazardous materials exposure? A) A low-sudsing detergent B) Water C) Activated charcoal D) Tincture of green soap Answer: B Diff: 1 Page Ref: 369 Standard: EMS Operations (Hazardous Materials) Objective: 8

29) Which of the following is NOT recommended in managing patients exposed to carbamate pesticides? A) Using tincture of green soap in the decontamination process B) Administering pralidoxime C) Decontaminating with water D) Administering atropine Answer: B Diff: 2 Page Ref: 368 Standard: EMS Operations (Hazardous Materials) Objective: 8 30) The driver of a truck carrying a caustic substance in powder form has accidentally come into contact with the material. You are first on the scene, and a quick observation indicates that he has powder on his arms. Your immediate action would be to: A) brush off the powder, then rinse the area with water. B) place the patient in the ambulance, but avoid touching his arms. C) instruct the patient to remain still and wait for the incident safety officer. D) wrap the arms in dry, sterile dressings. Answer: A Diff: 2 Page Ref: 368 Standard: EMS Operations (Hazardous Materials) Objective: 9 31) You have been cleared by the incident commander at a hazmat incident to prepare to go off duty. After completing decontamination, which of the following should be your FIRST action? A) Return to the ambulance and drive to your station. B) Inform dispatch that you are off duty and leave the scene. C) Report directly to EMS for post-entry monitoring. D) Remove and bag your uniform. Answer: C Diff: 2 Page Ref: 373 Standard: EMS Operations (Hazardous Materials) Objective: 10 32) Which of these is required for those who may perform patient care in the cold zone on patients who do not present a significant risk of secondary contamination? A) EMS Level 1 training B) EMS Level 2 training C) Awareness Level D) Multiple Casualty training Answer: A Diff: 2 Page Ref: 357 Standard: EMS Operations (Hazardous Materials) Objective: 3

Chapter 14 Crime Scene Awareness 1) You are on the scene of an assault. While you quickly assess the patient, your partner is observing the scene for danger. This is called the ________ approach. A) decoy B) contact and cover C) defensive D) covert evaluation Answer: B Diff: 1 Page Ref: 385 Standard: Assessment (Scene Size-Up) Objective: 1 2) Particulate evidence is best described as: A) small hairs, fibers, and other items that cannot readily be seen with the naked eye. B) evidence that is found at a secondary crime scene. C) residue from blood that has been washed away but can be seen with Luminol. D) microscopic blood splatter. Answer: A Diff: 1 Page Ref: 390 Standard: Assessment (Scene Size-Up) Objective: 1 3) According to the Division of Violence Prevention, arrest rates for violent crimes are highest among which age group? A) 35-40 B) 13-20 C) 15-34 D) 20-40 Answer: C Diff: 2 Page Ref: 378 Standard: Assessment (Scene Size-Up) Objective: 2 4) On average, how many youth homicides occur each day in the United States? A) 11 B) 16 C) 26 D) 36 Answer: B Diff: 2 Page Ref: 378 Standard: Assessment (Scene Size-Up) Objective: 2

5) You are dispatched to a residence for an unknown medical problem. The location is in an area of town known for gang activity and violent crimes. As you approach the scene, you see a residence that is poorly lit, with no lights on and no one visible nearby. Which of the following describes the safest approach to this situation? A) Drive past the residence and stage around the corner until the police arrive. B) Park just past the residence and approach the front door at an angle. C) Park in front of the residence, illuminating the front door with floodlights. D) Park and exit the ambulance, knock on the front door while shouting, "Paramedics!" Answer: A Diff: 1 Page Ref: 385 Standard: Assessment (Scene Size-Up) Objective: 3 6) You have responded to a call of patient at a rural location with difficulty breathing. As memory serves you, the farmhouse you are responding to has been abandoned for years. As you approach on the main road, you see several vehicles parked around the house, although it is apparent that the house is not in livable condition. For which of the following should you maintain a high index of suspicion? A) The house may be structurally unsound. B) The house is not the house you think it is, and is not abandoned. C) The house may be serving as a clandestine drug lab. D) The house has been occupied by a family who may be using a source of heat that releases carbon monoxide. Answer: C Diff: 2 Page Ref: 383-384 Standard: Assessment (Scene Size-Up) Objective: 3 7) You have responded to the parking lot of a high school for an assault. On arrival, there is a crowd of 20 to 25 emotional juveniles standing around the scene. Which of the following is the best way to protect yourself? A) Monitor the activity of the crowd and retreat if the situation escalates. B) Ignore the crowd and do what is necessary to assess and treat the patient. C) Confront the crowd and tell them they need to break up and leave the area. D) Notify the school principal that these students need to return to class. Answer: A Diff: 2 Page Ref: 382 Standard: Assessment (Scene Size-Up) Objective: 3

8) You have just approached a residence for a report of an injured person. Which of the following safety measures should you take? A) Contact dispatch and ask if there have ever been any violent crimes at this location. B) Stay at least 3 feet away from anyone on scene. C) Ensure that you have a clear path of egress at all times. D) Tell your partner that it is his/her responsibility to protect you. Answer: C Diff: 2 Page Ref: 385-386 Standard: Assessment (Scene Size-Up) Objective: 5 9) You have responded to a report of an unresponsive person in a vehicle on a dark city street. On arrival, you note the vehicle described by dispatch, but there is no one around it. Which of the following applies in this situation? A) Park with the ambulance facing the front of the vehicle so you can illuminate the interior and easily survey for potential danger. B) Park behind the vehicle and approach from the rear on the passenger's side while your partner remains behind the wheel of the ambulance. C) Have your partner illuminate you with the spotlight so the vehicle occupant(s) can identify you as an EMS provider. D) Park behind the vehicle and approach from the rear on the passenger's side while your partner approaches from the rear on the driver's side. Answer: B Diff: 3 Page Ref: 381 Standard: Assessment (Scene Size-Up) Objective: 4 10) Which of the following describes the BEST guideline for paramedics to follow to protect themselves from physical violence? A) Obtain a permit and carry a firearm. B) Wear body armor when dispatched on suspicious calls. C) Retreat from the scene if threatened, even if it means leaving the patient behind. D) Learn techniques of self-defense. Answer: C Diff: 1 Page Ref: 385 Standard: Assessment (Scene Size-Up) Objective: 5

11) You are on the scene of a call for an injured woman. Your scene size-up did not reveal any indications of danger. On assessing the patient, she tells you that she was beaten with a telephone receiver by her estranged husband. Before you can request law enforcement assistance, the husband returns with a baseball bat and threatens to kill you if you don't leave the house and states, "She's staying here," in reference to the patient. The assailant is standing with the bat held above his shoulder, ready to swing. Which of the following is the best course of action? A) Try to reason with the husband, using the techniques you learned for dealing with behavioral emergencies, while your partner goes outside to request law enforcement. B) Retreat from the residence, leaving the patient behind; move your vehicle away from the address; and request law enforcement. C) Carry out the "take-down" approach you and your partner have practiced for such a situation. D) Inform the assailant that you will leave but that you have to take the patient with you. Answer: B Diff: 3 Page Ref: 384 Standard: Assessment (Scene Size-Up) Objective: 4 12) A woman has called 911 due to difficulty breathing. As you arrive at the scene, you observe a dilapidated home with all windows covered and several improvised vents in the roof. The woman comes outside as you approach and says "Don't go inside, let's just go to the hospital." As you are loading her into the ambulance you smell a strong chemical smell and see fumes leaving the rooftop vents. How should you proceed? A) Load the patient into the ambulance and proceed to the hospital after notifying the Drug Enforcement Administration of the address. B) Ask the patient directly about the chemical smell and ventilating fumes. C) Enter the house to look for evidence of a drug lab after turning the patient over to your partner. D) Load the patient into the ambulance and notify dispatch that there is a suspected drug lab at the location and law enforcement is needed. Answer: D Diff: 2 Page Ref: 383-384 Standard: Assessment (Scene Size-Up) Objective: 8 13) When using a flashlight to approach a scene at night, which of the following is the best way to position the flashlight for safety? A) Switch the flashlight from hand to hand as you approach the scene. B) Hold the flashlight off to one side of your body. C) Hold the flashlight in front of you, sweeping the beam from side to side. D) Hold the light with your arm extended above your head. Answer: B Diff: 2 Page Ref: 380 Standard: Assessment (Scene Size-Up) Objective: 5

14) While caring for a victim of domestic violence, the patient's partner returns and charges into the house with a handgun. You should: A) flee immediately, seeking cover and overturning objects as you leave the home. B) signal your partner to initiate your practiced "take-down" maneuvers. C) put your hand up and say calmly, "We are here to help you." D) grab the patient and seek cover. Answer: A Diff: 2 Page Ref: 384 Standard: Assessment (Scene Size-Up) Objective: 5 15) Which of the following is a common critique of body armor and its use by EMS providers? A) It is too expensive and not worth it for EMS providers. B) It requires too much training to use properly. C) It provides a false sense of security. D) It protects only against low-powered ammunition. Answer: C Diff: 2 Page Ref: 387 Standard: Assessment (Scene Size-Up) Objective: 6 16) Tactical EMS requires special training and authorization. All of the following items are ways that TEMS differs from routine EMS EXCEPT: A) they treat more medical patients than trauma patients. B) treatment must be coordinated with an incident commander. C) the main priority is removing the patient from the hot zone. D) chemical agents are used as defensive weapons. Answer: A Diff: 1 Page Ref: 388 Standard: Assessment (Scene Size-Up) Objective: 7 17) You are transporting a patient to the hospital with a gunshot wound and are being accompanied in the patient compartment by a police officer. Just before going into cardiac arrest, the patient says, "It was Joey. Joey did this to me." The patient cannot be resuscitated and is pronounced dead in the emergency department. Which of the following is TRUE regarding the patient's dying declaration? A) You should write a narrative account of the incident, including the patient's statement, and keep it for your personal records. B) You should record the patient's statement verbatim in your prehospital care report. C) It is not necessary for you to document it, because the patient technically did not die in the back of the ambulance. D) It is not necessary for you to document it, because it was witnessed by law enforcement. Answer: B Diff: 3 Page Ref: 390 Standard: Assessment (Scene Size-Up) Objective: 8 116 Copyright © 2017 Pearson Education, Inc.

18) You have started an IV at the scene of a crime and left some blood on the floor. Which of the following best describes the reason that you should notify police? A) They need to protect themselves against bloodborne pathogens during their investigation. B) It is not necessary to inform the police of this unless there is more than one victim. C) There may be trace evidence underneath the blood. D) The blood may complicate the investigation of blood-splatter evidence. Answer: D Diff: 2 Page Ref: 390 Standard: Assessment (Scene Size-Up) Objective: 8 19) You are on the scene of a patient with a gunshot wound to the chest. Which of the following describes the best action for dealing with the victim's shirt? A) Cut around any bullet holes, put the shirt in a plastic bag with the patient's other personal items, and transport it to the emergency department with the patient. B) If you must leave the scene with the patient before police arrive, leave the shirt with a family member or bystander, and tell that person to give it to the police. C) It is not necessary to preserve the bullet holes. Simply discard the shirt in a biohazard bag. D) Cut around any bullet holes and give the shirt to police at the scene. Answer: D Diff: 2 Page Ref: 390 Standard: Assessment (Scene Size-Up) Objective: 8 20) You arrive at a residence for a call for an unknown problem. Outwardly, the scene appears safe. When you knock on the door, a distraught school-age child opens the door and says his father is holding his teenage sister and his mother hostage in a bedroom. Which of the following is the best course of action? A) See if the child can get his father to agree to allow you to assess the hostages so you can inform law enforcement whether or not they have been harmed. B) Retreat with the child, request law enforcement, and stage around the corner from the residence until law enforcement notifies you that the scene is secure. C) Shout up the stairs that you are there to help in any way you can and see if you can talk the father down. D) Find out from the child what kind of weapon is being used so you can decide if it is reasonable to overpower and restrain the father until law enforcement arrives. Answer: B Diff: 2 Page Ref: 381, 384 Standard: Assessment (Scene Size-Up) Objective: 8

21) You are caring for one of three people involved in a stabbing incident at a local bar. You move your patient into the back of the ambulance and begin care. Prior to leaving the scene, you find a knife in the patient's pocket. How should you proceed? A) Bag the knife and take it to the hospital. B) Place the knife in a belongings bag along with the patient's other personal effects. C) Ask you partner to get a law enforcement officer and have the officer retrieve the knife. D) Ask the patient if the knife was used during the incident. Answer: C Diff: 2 Page Ref: 388-389 Standard: Assessment (Scene Size-Up) Objective: 8 22) You are caring for a woman who was the victim of a drive-by shooting while in her apartment. There is a lot of clutter on the apartment floor, along with pools of blood. Which of the following is the BEST approach to this scene? A) Carefully enter the scene while avoiding stepping in blood. B) Ask law enforcement officers to bring the patient out to you. C) Enter the scene quickly, without regard for the patient’s blood. D) Wipe away blood near the patient so you don't step in it. Answer: A Diff: 2 Page Ref: 390 Standard: Assessment (Scene Size-Up) Objective: 8 Chapter 15 Rural EMS 1) Which of the following procedures is used to prevent farm machinery from being accidentally restarted? A) Auger-off B) Cribbing C) Lock-out/tag-out D) PTO Answer: C Diff: 1 Page Ref: 400 Standard: Assessment (Scene Size-Up); EMS Operations (Air Medical) Objective: 1

2) Although hospitals are widely scattered in rural areas, you might expect to find ________, which are capable of providing limited, nonemergent medical care to meet some of the urgent health care needs of the community. A) mobile health screening vans B) prompt care facilities C) private practice physician offices D) extended care facilities Answer: B Diff: 1 Page Ref: 398 Standard: Assessment (Scene Size-Up); EMS Operations (Air Medical) Objective: 1 3) Approximately ________ Americans live in rural areas. A) 50 million B) 10 million C) 25 million D) 75 million Answer: A Diff: 1 Page Ref: 395 Standard: Assessment (Scene Size-Up); EMS Operations (Air Medical) Objective: 2 4) Which of the following may provide a solution to communications issues in rural EMS systems? A) Seeking grant funding for radio equipment upgrades B) Using landlines instead of radios C) Using EMS access numbers other than 911 D) Using text-message-based dispatch systems Answer: A Diff: 1 Page Ref: 397 Standard: Assessment (Scene Size-Up); EMS Operations (Air Medical) Objective: 4 5) The population in rural areas consists of a disproportionately high number of people in which age group? A) Middle-aged adults B) Children aged 5 and under C) Elderly adults D) Young adults Answer: C Diff: 1 Page Ref: 395 Standard: Assessment (Scene Size-Up); EMS Operations (Air Medical) Objective: 2

6) Which of the following factors can account for a delay in the time it takes a patient in a rural setting to reach definitive care? A) Delays in family or bystanders discovering the ill or injured patient B) The time it takes providers to reach the squad building C) Lengthy transport times D) All of the above Answer: D Diff: 1 Page Ref: 395-396 Standard: Assessment (Scene Size-Up); EMS Operations (Air Medical) Objective: 3 7) Which of the following best describes the EMS staffing situation in rural areas? A) Volunteers may lack experience, even after several years of volunteering. B) Because of low operating costs, volunteer agencies are frequently able to send volunteers for specialized training and continuing education. C) Volunteer turnover is low because of family support for volunteer efforts. D) Volunteer turnover is low because the volunteers tend to have families in the area and close community ties. Answer: A Diff: 2 Page Ref: 396 Standard: Assessment (Scene Size-Up); EMS Operations (Air Medical) Objective: 3 8) Which of the following is NOT a factor that adversely affects the delivery of EMS in rural areas? A) Inadequate medical direction B) Reliance on volunteers C) Lack of opportunity for providers to use their skills D) Low-income patient population Answer: D Diff: 1 Page Ref: 395-397 Standard: Assessment (Scene Size-Up); EMS Operations (Air Medical) Objective: 3

9) You are active in your local rural rescue squad as a paramedic. Your small town of 500 people does not have a hospital. There is a small community hospital 25 miles away and a large urban hospital 70 miles away. Recently, you have had two chest pain patients go into cardiac arrest and die after reaching the local community hospital, which does not have a cardiac catheterization lab or fibrinolytic therapy available. Given your rural setting, which of the following should you suggest to the medical director and rescue squad council as a solution? A) Allow paramedics with the rescue squad to perform 12-lead ECGs and carry bedside cardiac marker assays, heparin, and fibrinolytics. B) Suggest fund-raising activities to build a cardiac catheterization lab at the community hospital. C) Develop a general protocol that states that all patients with chest pain of suspected cardiac origin should be transported directly from the scene to the urban hospital 70 miles away. D) Develop a general protocol that states that all patients with chest pain of suspected cardiac origin should be transported to the community hospital for evaluation by the nurse practitioner before transporting to the urban hospital. Answer: C Diff: 3 Page Ref: 397-398 Standard: Assessment (Scene Size-Up); EMS Operations (Air Medical) Objective: 4 10) You are on the scene of a single-vehicle rollover collision in which the two teenage occupants were ejected. Both patients are conscious but seriously injured. Yours is the only transporting vehicle on the scene and you are the only paramedic, but there are two volunteer EMTs and two first responders on the scene. Helicopter transport is not available. There is a small community hospital 23 miles away but a larger level II regional trauma center 40 miles away. The closest BLS transporting unit is 18 miles away. Which of the following is the best transport decision? A) Transport both patients in one unit to the community hospital. B) Transport the first patient to the community hospital while one EMT and one first responder remain with the patient, then immediately return to the scene for the second patient. C) Transport both patients in one unit to the regional trauma center. D) Transport the first patient to the community hospital while one EMT and one first responder wait on the scene for the BLS transport unit. Answer: C Diff: 3 Page Ref: 399-400 Standard: Assessment (Scene Size-Up); EMS Operations (Air Medical) Objective: 5

11) You are caring for a man who had his arm mangled by a piece of farm equipment. Bleeding has been controlled with a tourniquet; however, the patient is hypotensive and tachycardic. He has an extensive cardiac history and takes Pradaxa. There is a community hospital 18 minutes away by ground, a level III trauma center 40 minutes away by ground, and a level I trauma center 30 minutes away by air. You should: A) transport to the community ER so he can receive a blood transfusion. B) transport by ground to the level III facility, as they have the resources to stabilize the patient. C) call for air transport to the higher-level trauma center. D) call for air transport, but tell them to fly to the level III trauma center, as it is closer. Answer: C Diff: 2 Page Ref: 404 Standard: Assessment (Scene Size-Up); EMS Operations (Air Medical) Objective: 5 12) A 77-year-old man presents as hypertensive with crackles in all lung fields. The patient is tachypneic and has a history of MI, CAD, and CHF. His SpO2 is 78% on room air and he takes an extensive list of medications. He is 60 minutes away by ground from the closest hospital. Which of the following is TRUE regarding this patient? A) Air transport should be requested, as this is a critical patient. B) This patient should be transported by ground, as ALS level care will likely improve all of his symptoms. C) This patient should be treated on scene with nitroglycerine and CPAP, and released once his symptoms have resolved. D) Medical direction is required in this situation, as the patient is likely to present with multiple complications during treatment. Answer: B Diff: 3 Page Ref: 398-399 Standard: Assessment (Scene Size-Up); EMS Operations (Air Medical) Objective: 5 13) Which of the following statements concerning the use of helicopters in rural EMS is TRUE? A) Helicopters should be used only when a short extrication time is anticipated. B) In some instances, it may be more efficient to transport patients by ground. C) Helicopter transport is contraindicated for the patient suffering from altitude sickness. D) The best use of helicopter transport is for the patient in traumatic cardiac arrest. Answer: B Diff: 2 Page Ref: 405 Standard: Assessment (Scene Size-Up); EMS Operations (Air Medical) Objective: 5

14) You have been dispatched to a family farm operation for a report of a tractor rollover with an injured person. Which of the following types of injuries should you anticipate? A) Wrap B) Crush C) Shearing D) Rapid deceleration Answer: B Diff: 2 Page Ref: 404 Standard: Assessment (Scene Size-Up); EMS Operations (Air Medical) Objective: 1, 6 15) Which of the following is a characteristic of the rural setting? A) People living in rural areas are less likely to have chronic health conditions. B) People living in rural areas have a much lower risk of serious injuries. C) There are fewer doctors per capita than in urban settings. D) All of the above are characteristics. Answer: C Diff: 1 Page Ref: 396 Standard: Assessment (Scene Size-Up); EMS Operations (Air Medical) Objective: 2 16) You have been dispatched to a hunting camp for a report of a four-wheel ATV rollover with an injured person. Which of the following types of injuries should you anticipate? A) Degloving B) Crush C) Shearing D) Rapid deceleration Answer: B Diff: 2 Page Ref: 404 Standard: Assessment (Scene Size-Up); EMS Operations (Air Medical) Objective: 7 17) Which of these terms refers to the condition in which, after circulation to a portion of the body is cut off, toxins develop in the blood, and the patient goes into shock when circulation is restored? A) cribbing B) shear trauma C) orthopedic trauma D) compartment syndrome Answer: D Diff: 2 Page Ref: 401 Standard: Assessment (Scene Size-Up); EMS Operations (Air Medical) Objective: 6

Chapter 16 Responding to Terrorist Acts 1) While caring for victims exposed to radiation, which of the following devices do rescuers wear to monitor the doses of radiation the victims are receiving? A) Dosimeter B) Mark I kit C) CS canister D) Geiger counter Answer: A Diff: 1 Page Ref: 413 Standard: EMS Operations (Terrorism and Disaster) Objective: 1 2) Which of the following BEST describes incendiary agents? A) Chemical weapons designed to paralyze the central nervous system B) Terrorist operatives implanted in civilian society who intend to carry out acts of terror C) A special subset of explosives with less explosive power and greater heat and burn potential D) Any substance or material that is highly flammable Answer: C Diff: 1 Page Ref: 411 Standard: EMS Operations (Terrorism and Disaster) Objective: 1 3) The main objective of terrorist acts is to: A) incite fear in the public. B) cause a mass casualty incident. C) draw attention to a group's political agenda. D) demonstrate a group's power and abilities. Answer: A Diff: 1 Page Ref: 411 Standard: EMS Operations (Terrorism and Disaster) Objective: 2 4) Terrorist attacks are most likely to be targeted toward which of the following? A) Children B) Colleges C) Government buildings D) Individuals Answer: C Diff: 1 Page Ref: 411 Standard: EMS Operations (Terrorism and Disaster) Objective: 2

5) You respond to an airport for a report of several people with upper respiratory problems. As you enter the airport, you notice that there are multiple people coughing and vomiting throughout the ticketing area. This may indicate which of the following types of terrorist attack? A) Biological B) Chemical C) Dirty bomb D) Conventional Answer: B Diff: 1 Page Ref: 414 Standard: EMS Operations (Terrorism and Disaster) Objective: 2 6) Which of the following scenarios is most likely to be a potential terrorist incident? A) Multiple explosions in an urban subway system B) A derailed commuter train C) A fire in an office building D) Multiple people sick in a restaurant Answer: A Diff: 2 Page Ref: 410-411 Standard: EMS Operations (Terrorism and Disaster) Objective: 2 7) Which of the following is the weapon of choice for terrorists worldwide? A) Conventional explosives B) Chemical weapons C) Biological weapons D) Nuclear weapons Answer: A Diff: 1 Page Ref: 410 Standard: EMS Operations (Terrorism and Disaster) Objective: 2 8) Which of the following is an example of an incendiary agent or device? A) White phosphorus B) Sarin gas C) A mixture of diesel fuel and nitrogen-based fertilizer D) Tularemia Answer: A Diff: 1 Page Ref: 411 Standard: EMS Operations (Terrorism and Disaster) Objective: 2

9) Which of the following is the most common mechanism of action in nerve agents? A) Inhibit degradation of acetylcholine B) Central nervous system depression C) Inhibition of acetylcholinesterase D) Unopposed adrenergic stimulation Answer: A Diff: 1 Page Ref: 414 Standard: EMS Operations (Terrorism and Disaster) Objective: 2 10) Which of the following is the cardinal sign of a toxic chemical release? A) A low-hanging vapor cloud B) An odor similar to rotten eggs C) Puddles of an evaporating liquid D) Similar signs and symptoms occurring rapidly in a group of individuals Answer: D Diff: 1 Page Ref: 414 Standard: EMS Operations (Terrorism and Disaster) Objective: 2 11) You and your partner are responding to an explosion at a large office building that appears to be a terrorist incident. When searching the area for victims, you should be aware of: A) the probability that nerve agents will be deployed. B) any sensitive documents that may be lying around. C) the likelihood of secondary explosions. D) terrorists hiding in the building. Answer: C Diff: 1 Page Ref: 420 Standard: EMS Operations (Terrorism and Disaster) Objective: 3 12) Which of the following injuries would be the result of a pressure wave associated with the detonation of an explosive device? A) Splenic hemorrhage B) Ruptured eardrums C) Burns D) Penetrating trauma Answer: B Diff: 1 Page Ref: 411 Standard: EMS Operations (Terrorism and Disaster) Objective: 2

13) You are involved in the initial response to a nuclear detonation. Which of the following will likely be an early priority in managing this incident? A) Determining who is responsible for the attack B) Moving survivors into structures to protect them from fallout C) Administering medications designed to mitigate the effects of radiation D) Keeping responders away from the area to prevent radiation poisoning Answer: B Diff: 2 Page Ref: 413 Standard: EMS Operations (Terrorism and Disaster) Objective: 4 14) Which of the following is NOT a typical indication of exposure to a chemical nerve agent? A) Blurry vision B) Hot, dry skin C) Rhinorrhea D) Fasciculations Answer: B Diff: 1 Page Ref: 414 Standard: EMS Operations (Terrorism and Disaster) Objective: 2 15) The contents of a Mark I kit are most effective when they are: A) inhaled. B) injected subcutaneously or intramuscularly. C) ingested. D) administered intravenously. Answer: D Diff: 1 Page Ref: 414-415 Standard: EMS Operations (Terrorism and Disaster) Objective: 4 16) A group of railway passengers presents with vomiting, diarrhea, watery eyes, and salivation. Which of the following is the likely cause of their symptoms? A) Chemical agent B) Biologic agent C) Radiation agent D) Synthetic agent Answer: A Diff: 1 Page Ref: 414 Standard: EMS Operations (Terrorism and Disaster) Objective: 2

17) Which of the following is the most effective way for EMS personnel to protect themselves against exposure to biological agents of terrorism? A) Disinfect the ambulance. B) Use a HEPA mask. C) Get immunized. D) Wear gloves. Answer: B Diff: 1 Page Ref: 417 Standard: EMS Operations (Terrorism and Disaster) Objective: 3 18) Which of the following is NOT a chemical nerve agent? A) Tabun B) Lewisite C) VX D) GB Answer: B Diff: 1 Page Ref: 414 Standard: EMS Operations (Terrorism and Disaster) Objective: 2 19) You are caring for a patient who has been exposed to a nerve agent. Appropriate treatment of this patient would include: A) epinephrine. B) adenosine. C) pralidoxime chloride. D) albuterol. Answer: C Diff: 1 Page Ref: 414 Standard: EMS Operations (Terrorism and Disaster) Objective: 4 20) Which of the following statements regarding biological weapons is TRUE? A) Biological weapons are easily recognized. B) Biological weapons are difficult to detect right away. C) Only governments have access to biological weapons. D) Biological weapons are a commonly used terrorist tactic. Answer: B Diff: 1 Page Ref: 417 Standard: EMS Operations (Terrorism and Disaster) Objective: 2