TEST BANK for Prehospital Emergency Pharmacology 8th Edition by BLEDSOE, Bryan, Dwayne Clayden

Prehospital Emergency Pharmacology 8th Edition Bledsoe Test Bank Prehospital Emergency Pharmacology, 8e (Bledsoe/Clayden) Chapter 1 General Information 1) The study of natural drug sources that has been expanded to include chemicals developed and used in laboratory research most correctly describes: A) Pharmacology.

B) Pharmacodynamics.

C) Pharmacognosy.

D) Pharmacokinetics.

Answer: C Explanation: A) Pharmacology is the study of drugs and their actions on the body.

B) Pharmacodynamics refers to the mechanisms by which medications produce biochemical or physiological changes in the body.

C) Study of natural drug sources that has been expanded to include chemicals developed and used in lab research.

D) The study of how medications enter the body, reach their site of action and eventually become eliminated.

Page Ref: 2 2) Atropine is a powerful organic alkaloid that reacts with acid to form a salt that is readily soluble in body fluids. From which of the following sources is atropine derived?

A) Plant B) Animal C) Mineral D) Synthetic Answer: A Explanation: A) Atropine is developed from the plant Atropa belladonna.

B) Animal sources are extracted from the body fluids of animals.

C) Mineral sources provide inorganic material not available from plants or animals.

D) Synthetic sources are created in the lab using processes such as recombinant DNA. They may be used in combination with natural sources.

Page Ref: 3 3) Examples of synthetically produced medications include: A) Diazepam, fentanyl, and adenosine.

B) Pepsin, pancreatin, and oxytocin.

C) Atropine, morphine, and digitalis.

D) Magnesium, sodium bicarbonate, and calcium chloride.

Answer: A Explanation: A) Diazepam, fentanyl, and adenosine are all produced synthetically.

B) Pepsin, pancreatin, and oxytocin are derived from animal sources.

C) Atropine, morphine, and digitalis are identified as plant sources.

D) Magnesium, sodium bicarbonate, and calcium chloride are identified as mineral sources of drugs.

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4) In order to obtain the MOST current information related to a medication, it is suggested that the prehospital provider: A) Use only local protocol as your source.

B) Use multiple sources and compare information in conjunction with medical direction.

C) Rely on an EMS guide as the sole source of information.

D) Utilize the internet as a resource because it is most correct.

Answer: B Explanation: A) Local protocols may not encompass the many medications currently available.

B) Using multiple sources as well as comparing information will provide the provider with the most current information. Medical direction is also imperative.

C) While EMS guides may provide some information, they may not include all relevant information.

D) Internet sources are sometimes difficult to determine validity of information present and should be verified.

Page Ref: 4, 5 5) A tool that may be readily available and carried by the prehospital provider for field use when seeking information regarding an unknown medication is: A) United States Pharmacopeia.

B) Physicians' Desk Reference.

C) Drug information/hospital formulary.

D) Smart phone.

Answer: D Explanation: A) The United States Pharmacopeia contains all current drugs, but is not readily available.

B) The Physicians' Desk Reference, while useful, is not typically readily available or practical at the scene of an emergency.

C) The drug information/hospital formulary is generally not used in the prehospital setting.

D) Specific applications are available for most smart phones that contain readily available information related to both prescribed and non-prescription medications.

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6) The phase of drug testing that includes determining toxicity, pharmacokinetics, and determining a drug's "therapeutic index" occurs during: A) Postmarketing surveillance.

B) New drug application.

C) Clinical research and development.

D) Preclinical testing, research, and development.

Answer: D Explanation: A) Postmarketing surveillance occurs during phase four of testing. A new drug's therapeutic index must already be determined.

B) An investigational new drug may be applied for once the therapeutic index has been determined prior to the phase 1 of human drug testing.

C) Clinical research and development begins after the therapeutic index has been determined.

D) Preclinical testing, research, and development occurs prior to human testing and is concerned with the pharmacokinetics and pharmacodynamics of a new drug in order to discover its therapeutic index.

Page Ref: 6 7) The term "therapeutic index" refers to: A) Ratio of a drug's lethal dose to its effective dose.

B) Amount of drug required to cause a side effect.

C) Pharmacokinetics of a drug.

D) Efficacy of a drug.

Answer: A Explanation: A) The ratio of a drug's lethal dose to its effective dose determines the therapeutic index.

B) Side effects are the undesired effects of a medication.

C) Pharmacokinetics refers to the drug's movement from introduction into the system until system elimination.

D) Efficacy refers to how well the drug works in terms of treatment effect.

Page Ref: 6 8) Which of the following statements regarding the use of abbreviations in pharmacology is TRUE? A) Abbreviations vary depending upon the drug manufacture.

B) The abbreviation "mg" always will refer to the mineral, magnesium.

C) The USP in the only recognized source for determining abbreviations.

D) Abbreviations in pharmacology should be used carefully to avoid confusion and should be agreed upon in local systems.

Answer: D Explanation: A) Abbreviations should be used with caution as they can lead to confusion. A standardized system is in place that makes charting and documentation more clear and concise.

B) Most sources recognize the abbreviation "mg" to indicate the unit of measure "milligram."

Magnesium is an element with the designation of Mg. C) The USP contains the formulary used in the United States.

D) Medical abbreviations should be used carefully to avoid confusion and should be agreed upon in local systems.

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9) Following the designation of a new drug as an "investigational new drug," there are phases of testing on humans.

A) one B) two C) three D) four Answer: D Explanation: A) There are three other phases of drug testing.

B) There are two other phases of drug testing.

C) There is another phase of drug testing.

D) There are four phases of drug testing that occur following the designation of a drug as an "investigational new drug."

Page Ref: 9 10) The phase of drug testing that determines the pharmacokinetics, toxicity, and safe dose in humans is: A) Phase one.

B) Phase two.

C) Phase three.

D) Phase four.

Answer: A Explanation: A) The primary purpose of phase one testing is to determine the pharmacokinetics, toxicity, and safe dose in humans.

B) The primary purpose of phase two testing is to find the therapeutic medication level and watch carefully for toxic and side effects.

C) The primary purpose of phase three testing is to refine the usual therapeutic dose and to collect relevant data on side effects.

D) The primary purpose of phase four testing involves postmarketing analysis during conditional approval.

Page Ref: 9 11) An example of a drug that may receive expedited medical approval would be: A) A drug used to treat a rare disease that affects less than 200,000 people.

B) A placebo that is administered to provide psychological control of responses.

C) A drug that may help prevent a public health threat such as HIV. D) A drug that is being evaluated in order to determine the therapeutic index.

Answer: C Explanation: A) This Answer describes the definition of an orphan drug.

B) A placebo is used in testing and does not require expedited medical approval.

C) Expedited approval may be granted when a drug may be of use in treating a public health threat such as HIV. D) The therapeutic index is obtained during preclinical phase of drug testing and does not require expedited approval.

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12) A drug in which potential tax credits or grants may provide incentives to assist in the research and development for a condition that affects a very small portion of the general population is known as a/an .

A) Orphan drug B) Expedited drug C) Investigational new drug D) Phase 1 drug Answer: A Explanation: A) A company may receive incentives to encourage research and development of a drug that is meant for a small percentage of the general population.

B) An expedited drug is a drug that moves quickly through the normal phases of human testing when that drug may help in the prevention of a public health crisis.

C) A drug gains the status of investigational new drug when it has completed its preclinical testing phase and is ready for human testing.

D) Phase one refers to a drug testing and approval phase.

Page Ref: 10 13) The FDA may require the manufacture of a drug to post a prominent "black box" warning when: A) The drug receives IND status (Investigational new drug).

B) Following phase one human testing.

C) Unlabeled uses of the drug occur.

D) A problem may arise that may lead to death or severe injury if the medication is used.

Answer: D Explanation: A) A drug gains the status of investigational new drug when it has completed its preclinical testing phase and is ready for human testing.

B) The primary purpose of phase one testing is to determine the pharmacokinetics, toxicity, and safe dose in humans.

C) Unlabeled uses of a drug may occur when a physician or group of peers determines that a drug that has indications for one disorder inadvertently is beneficial for another disorder that it was not given an indication for during the human testing phases.

D) The FDA requires a prominent "black box" warning when the use of a prescribed drug may lead to death or injury as a result of its use.

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14) A physician has prescribed a drug normally used for hypertension to treat recurrent episodes of angina based on recommendations of colleagues and the most recent medical journals. Which of the following describes his actions?

A) The physician may do so legally based on the unlabeled use of medications.

B) The physician may do so legally if the uses are posted in the PDR. C) The physician may do so legally if the uses are approved by the manufacturer of the drug.

D) It is illegal for the physician to prescribe a drug for anything other than the manufacturers intended, stated use as registered with the USP. Answer: A Explanation: A) A physician may utilize a medication for something other than its intended use if colleagues, or current medical journals, agree.

B) The PDR will only contain the manufactures approved indications.

C) The manufacture can only recommend a drug for its specific indications that are determined during human drug testing.

D) A physician may utilize a medication for something other than its intended use if colleagues, or current medical journals, agree.

Page Ref: 11 15) The use of standing orders and treatment protocols are BEST described as: A) The emergency care provider following the orders and advise of an on-scene physician.

B) The administration of morphine following on-line medical consultation.

C) The independent authority granted to prehospital care providers a consequence of the Controlled Substance Act. D) Treatments that are rendered to treat specific presenting signs and symptoms prior to contacting medical direction.

Answer: D Explanation: A) This describes face-to-face transfer of orders from physician to paramedic.

B) This describes the function of on-line medical direction.

C) No such authority exists. The CSA regulated and controlled narcotics and other dangerous drugs by classifying them.

D) Treatments of specific presenting signs and symptoms may be treated when standing orders and protocols are in place and under the direction of off-line medical direction.

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16) The included the truth in labeling clause which would require manufacturers to post a statement accurately describing a package's content.

A) Controlled Substance Act B) Federal Food, Drug, and Cosmetic Act of 1938 C) Pure Food and Drug Act of 1906 D) Kefauver-Harris Amendment Answer: B Explanation: A) The Controlled Substance Act helped regulate and control narcotics and other dangerous substances by providing classifications related to the medications use.

B) The Federal Food, Drug, and Cosmetic Act required a statement that accurately described a package's content.

C) Established the FDA and prohibited the sale of medicinal preparations that had little or no use and restricted the sale of drugs with a potential of abuse. It was not as all-encompassing as its originators envisioned.

D) The Kefauer-Harris Amendment was an amendment to the Federal Food, Drug, and Cosmetic Act that required pharmaceutical manufacturers to provide proof of the safety and effectiveness of their drugs.

Page Ref: 13 17) Which of the following is TRUE of the Comprehensive Drug Abuse Prevention and Control Act of 1970?

A) It required labeling of all medications.

B) It required that manufactures provide proof of safety and effectiveness prior to production.

C) Controlled import, manufacture, and sale of the opium plant and derivatives.

D) Provided classifications of drugs into five different categories or "schedules."

Answer: D Explanation: A) Labeling of medications was required by the Federal Food, Drug, and Cosmetic Act. B) The Kefauer-Harris Amendment was an addition to the Federal Food, Drug, and Cosmetic Act. C) The Harrison Narcotic Act of 1914 regulated the importation, manufacture, and sale of the opium and its derivatives.

D) The Controlled Substances Act of 1970, or the Comprehensive Drug Abuse Prevention and Control Act of 1970 classifies drugs used in medicine into five different categories, or schedules.

Page Ref: 14 18) Which of the following would be listed as a Schedule I drug?

A) Heroin B) Hydromorphone C) Codeine D) Tramadol Answer: A Explanation: A) Heroin has no medical use and is scheduled as a Schedule I drug.

B) Hydromorphone is a Schedule II drug.

C) Codeine is a Schedule III drug.

D) Tramadol is a Schedule IV drug.

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19) Careful management of narcotic medications carried on emergency service vehicles includes: A) Eliminating standing orders and protocols when using narcotics.

B) Only using Schedule IV narcotics if necessary.

C) Ensuring that the medications are stored in a substantial safe or cabinet or have a tamperproof seal.

D) Allowing Schedule I drug if an unlabeled medication use exists according to current literature.

Answer: C Explanation: A) Standing orders may be necessary in circumstances where on-line medical direction is not available.

B) Schedule IV narcotics generally do not have application to prehospital care.

C) All narcotics should be stored in a substantial safe or cabinet or have a tamperproof seal if necessary to remove from unit.

D) Schedule I narcotics have no acceptable use in prehospital care and often are illegal.

Page Ref: 15 20) A term that refers to the amount of drug that is absorbed and reaches the general circulation is: A) Purity.

B) Potency.

C) Efficacy.

D) Bioavailability.

Answer: D Explanation: A) Purity refers to the uncontaminated amount of the drug containing only one active component.

B) Potency refers to a drugs strength or power to produce the desired effect.

C) Efficacy refers to how well the drug works in terms of treatment effect.

D) Bioavailability is the degree to which a drug becomes absorbed and reaches general circulation.

Page Ref: 17 21) While checking the medications in your unit's drug box, you identify the medication, "meperidine hydrochloride, USP." You recognize this as the drug's: A) Chemical name.

B) Official name.

C) Trade name.

D) Generic name.

Answer: B Explanation: A) Chemical name precisely describes the medications atomic and molecular structure.

B) The official name of a drug is followed by the letters USP indicating that it is in the official formulary of the United States.

C) A trade name of a drug is the name a manufacturer gives a drug and is registered.

D) The generic name, while similar to the official name does not have USP following it.

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22) Liquid medications administered into the body through intramuscular, subcutaneous, or intravenous are known as: A) Parenteral medications.

B) Prefilled syringes.

C) Tinctures.

D) Suspensions.

Answer: A Explanation: A) Parenteral medications are liquids administered by IM, SQ, or IV routes.

B) Prefilled syringes are ways in which a medication is supplied.

C) A tincture is a medication extracted with alcohol.

D) A suspension contains insoluble medications.

Page Ref: 20 23) After determining that your patient has overdosed on a narcotic medication causing a decreased respiratory drive, you administer the medication, naloxone that opposes the effects of the narcotic increasing the respiratory drive. This is an example of a/an: A) Side effect.

B) Contraindication.

C) Adverse reaction.

D) Antagonism.

Answer: D Explanation: A) A side effect is an unavoidable, undesired effect seen with therapeutic medicine doses.

B) A contraindication is a situation in which it would be harmful to administer a medication.

C) An adverse reaction is the same as a side effect.

D) An antagonism signifies the opposition between two or more medications such as morphine and naloxone.

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Prehospital Emergency Pharmacology, 8e (Bledsoe/Clayden) Chapter 2 Pharmacokinetics and Pharmacodynamics 1) Two major divisions of pharmacology are: A) Pharmacokinetics and pharmacodynamics.

B) Pharmacognosy and biotransformation.

C) Active transport and diffusion.

D) Biotransformation and elimination.

Answer: A Explanation: A) Pharmacokinetics and pharmacodynamics are the two major divisions of pharmacology.

B) Pharmacognosy refers to the broad study of natural and synthetic drugs and biotransformation is a function of pharmacokinetics.

C) Active transport and diffusion explain how a medication moves.

D) Biotransformation and elimination is a function of pharmacokinetics.

Page Ref: 26 2) Which of the following factors is NOT a component of pharmacokinetics?

A) Absorption B) Distribution C) Biotransformation D) Binding Answer: D Explanation: A) Absorption explains the movement of a medication into the system.

B) Distribution is how the medication travels to target tissues or organs.

C) Biotransformation is how a medication is broken down in the system.

D) Binding is a component of pharmacodynamics.

Page Ref: 26 3) Drug A requires the use of adenosine triphosphate (ATP) in order to move into the cellular membrane. This type of diffusion is known as: A) Elimination.

B) Active transport.

C) Facilitated.

D) Osmosis.

Answer: B Explanation: A) Elimination is the removal of a drug from the body.

B) Active transport involves the use of energy, such as ATP to move a substance through a membrane that otherwise would not be able to penetrate.

C) Facilitated diffusion requires the use of a helper protein (such as insulin with glucose) to cause a change in the cellular membrane allowing entry of the substance.

D) Osmosis is a passive process involving the movement of water.

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4) Glucose in the bloodstream is a large molecule that cannot readily enter a cell unless it binds with insulin. This BEST describes: A) Osmosis.

B) Diffusion.

C) Carrier-mediated diffusion.

D) Absorption.

Answer: C Explanation: A) Osmosis involves the movement of solvent, normally water.

B) Diffusion is a general term related to the movement of substances and involves both active and passive forms, of which carrier-mediated diffusion is included.

C) Carrier-mediated diffusion most correctly explains the process described.

D) Absorption encompasses a medications progress from its pharmaceutical dosage form to a biologically available substance that can then pass through or across tissues.

Page Ref: 26 5) The term describes the movement of molecules across a membrane down a pressure gradient from an area of higher pressure to and area of lower pressure normally resulting from hydrostatic forces.

A) Filtration B) Carrier-mediated diffusion C) Active transport D) Osmosis Answer: A Explanation: A) Filtration is correct.

B) Carrier-mediated diffusion occurs when a protein is involved in binding and causing change in membrane shape to allow diffusion.

C) Active transport involves the use of energy to cause diffusion.

D) Osmosis is the movement of water from an area of low solute concentration to an area of high solute concentration.

Page Ref: 27 6) describes the movement of a medication from the site of application into the body and into the extracellular compartment.

A) Diffusion B) Osmosis C) Absorption D) Elimination Answer: C Explanation: A) Diffusion is the movement of a substance across a membrane from an area of high concentration to lower concentration.

B) Osmosis is the movement of water from an area of low solute concentration to an area of high solute concentration.

C) Absorption encompasses a medications progress from its pharmaceutical dosage form to a biologically available substance that can then pass through or across tissues.

D) Elimination refers to removal of a substance from the body.

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7) Which of the following is NOT a factor in the absorption of a medication?

A) Surface area B) Concentration of the medication C) pH of the medication D) Medication potency Answer: D Explanation: A) Medications are absorbed quite rapidly from large surface areas.

B) Medications administered in high concentrations are absorbed much more rapidly than medications administered in low concentrations.

C) Acidic medications tend to be more rapidly absorbed when placed into an acidic environment while alkaline medications are more rapidly absorbed in alkaline environments.

D) Medication potency refers to the relative amount of a medication required to produce the desired response.

Page Ref: 37 8) Which of the following forms of absorption is generally the slowest due to the decreased vascular supply?

A) Subcutaneous B) Intramuscular C) Intravenous D) Sublingual Answer: A Explanation: A) The subcutaneous layer of the skin is composed of dense fatty tissue that has poor vascular supply and slow absorption of medications.

B) Muscles generally have very good blood supply promoting absorption.

C) Intravenous injection provides the most rapid (and common) route of absorption.

D) The sublingual area is highly vascular resulting in rapid absorption.

Page Ref: 28 9) BEST describes the process in which a medication is transported from the site of absorption to the site of action.

A) Active transport B) Diffusion C) Distribution D) Elimination Answer: C Explanation: A) Active transport involves the movement of a substance across the cellular membrane utilizing an energy source.

B) Diffusion describes movement across the cellular membrane and can be an active or passive process.

C) Distribution is the process whereby a medication is transported from the site of absorption to the site of action.

D) Elimination is removal of a substance from the body.

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10) You are treating a patient who suffers from renal disease and decreased perfusion of the kidneys. What effect will this have on the distribution of a drug that normally acts on kidneys, such as the diuretic medication Lasix?

A) The drug will be present in increased concentrations at the kidneys resulting in toxicity.

B) The drug will be poorly delivered to the kidneys due to a decreased perfusion and will not produce the desired results.

C) As the kidneys are a primary organ of elimination, the effects of the drug will be unchanged.

D) The drug will most likely be metabolized by the liver resulting in the same effects systemically.

Answer: B Explanation: A) Decreased renal blood flow results in poor delivery of the medication to the kidney.

B) Correct.

C) The decreased blood flow to the kidney will prevent the drug from producing the desired results.

D) If a drug is meant for a specific organ of tissue, it must reach the site in order to be effective.

Page Ref: 31 11) While researching the drug amiodarone, you read that the drug is considered to be highly protein bound upon entering the body. Knowing this, you can deduce that: A) The drug is largely ineffective when administered by intravenous route.

B) The drugs half-life will be relatively short due to the rapid elimination of the free, or unbound, percentage.

C) Much of the drug remains active in the bloodstream and only a small percentage is bound in tissues.

D) The drug remains bound to proteins but will slowly release the active component when necessary resulting in a long half-life.

Answer: D Explanation: A) When administered in therapeutic dosages, intravenous routes provide the most rapid, effective dose.

B) The drug will have a long half-life as the bound component will slowly release as the free or unbound active component is metabolized.

C) When the drug is highly protein bound, much of the drug will be stored in protein reservoirs.

Only a small amount remains in the bloodstream as an active metabolite.

D) Correct.

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12) The blood-brain barrier is a preventive barrier that prevents MOST medications from reaching the brain.

A) Lipid-soluble B) Water-soluble C) Non-ionized, unbound D) Barbiturate Answer: B Explanation: A) Lipid-soluble medications readily pass the blood-brain barrier.

B) Water-soluble medications cannot permeate the blood-brain barrier.

C) A non-ionized, unbound medication can pass the blood-brain barrier.

D) A barbiturate is an example of a non-ionized, unbound drug.

Page Ref: 31 13) The process by which a medication passing through the liver may partially or completely inactivate many medications is known as: A) First-pass effect.

B) Prodrug effect.

C) Protein reservoir binding.

D) Plasma binding effect.

Answer: A Explanation: A) Correct.

B) A prodrug is an inactive precursor of a drug prior to conversion to an active metabolite.

C) Protein reservoir binding occurs when a portion of a drug is bound to proteins but may be released for use at a later time.

D) Plasma binding occurs with proteins when a portion of a drug is bound to proteins but may be released for use at a later time.

Page Ref: 32 14) A medication's half-life refers to the: A) Concentration of a drug.

B) Dose required to be therapeutic.

C) Time required for the total dose of a medication to be decreased by one-half.

D) Removal of a medication from the body.

Answer: C Explanation: A) Concentration refers to the amount of drug available.

B) The therapeutic index is the difference between minimal therapeutic dose and toxic level of dose.

C) Correct.

D) This defines the process of elimination.

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15) is the length of time that a medication concentration is sufficient in the blood to produce a therapeutic response.

A) Half-life B) Duration of action C) Efficacy D) Affinity Answer: B Explanation: A) Half-life is the time required for one-half of the dose of a medication to be removed from the body.

B) Correct.

C) Efficacy is the ability of a drug to produce the expected response.

D) Affinity is the force of attraction between a drug and its receptor site.

Page Ref: 34 16) Which of the following is the MOST common way that medications exert their actions?

A) Receptor site binding.

B) Changing the physical properties of a cell.

C) Chemically combining with another chemical.

D) Altering the normal metabolic pathway.

Answer: A Explanation: A) Correct.

B) While all answers listed are ways in which a drug may exert its actions, receptor site binding is the most common.

C) While all answers listed are ways in which a drug may exert its actions, receptor site binding is the most common.

D) While all answers listed are ways in which a drug may exert its actions, receptor site binding is the most common.

Page Ref: 35 17) A medication such as nalbuphine binds with a specific receptor site causing an expected effect, but blocks another medication from triggering the receptor. This is known as a/an: A) Agonist.

B) Antagonist.

C) Agonist-antagonist.

D) Beta blocker.

Answer: C Explanation: A) An agonist binds to a specific receptor causing a desired response.

B) An antagonist blocks a receptor site, but does not produce the expected result.

C) Correct.

D) A beta blocker is an example of an antagonistic effect.

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18) is the relative amount of a medication required to produce a desired response.

A) Antagonism B) Efficacy C) Therapeutic threshold D) Potency Answer: D Explanation: A) An antagonism produces a blocking effect at a receptor site.

B) Efficacy is the power of a medication to produce a therapeutic effect.

C) Therapeutic threshold is the minimum concentration of a medication required to cause a desired response.

D) Correct.

Page Ref: 37 19) If a drug exceeds its therapeutic index, the drug will: A) Cause the desired response.

B) Be toxic to the patient.

C) Not have any effect on the patient.

D) Be present in the minimal level and may not cause the desired response.

Answer: B Explanation: A) For a drug to cause a desired response, it must remain within the therapeutic index.

B) The difference between the minimum effective concentration and the toxic level is the therapeutic index.

C) If a drug exceeds the therapeutic index, it will be toxic to the patient.

D) The minimal dose required is known as the minimum effective concentration.

Page Ref: 39 20) Which of the following statements is TRUE regarding medication administration to the children and elderly?

A) Liver and kidney functions in both populations are altered leaving both susceptible to altered medication responses.

B) Doses need to be significantly higher in both populations to produce the desired effect due to decreased liver functions.

C) Both populations should be treated the same as all patients as the therapeutic index does not change.

D) Pediatric patients have well developed livers, while elderly patients suffer from decreased liver function.

Answer: A Explanation: A) Correct.

B) Doses need to be altered accordingly to the appropriate population being treated.

C) While the therapeutic index may the change, the patient's ability to metabolize or excrete the medication will affect how much drug may be available.

D) The infant population does not have well developed renal and hepatic function.

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Prehospital Emergency Pharmacology, 8e (Bledsoe/Clayden) Chapter 3 Administration of Medications 1) The selection and administration of a particular medication to a specific patient depends on: A) Bioavailability.

B) A complete patient assessment.

C) The drug's half-life.

D) Pharmacodynamics.

Answer: B Explanation: A) Bioavailability refers to the amount of drug delivered to a specific tissue or organ.

B) Correct.

C) Half-life refers to the time required for a level of a medication in the blood to be reduced by 50 percent of its beginning level.

D) Pharmacodynamics refers to how a specific drug acts on the system.

Page Ref: 47 2) You have just received a verbal order from medical direction to administer 2 mg of morphine sulfate to a patient. You should immediately: A) Inquire about allergies.

B) Confirm the narcotic log is correct.

C) Gather the appropriate syringe and needle applicable to the situation.

D) Repeat the medication order to base physician.

Answer: D Explanation: A) While inquiring about patient allergies is relevant; the order should be repeated immediately.

B) Narcotic logs should be kept up-to-date and checked at shift beginning and end or when removing from storage.

C) Gathering equipment should occur following confirmation of order.

D) Correct.

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3) Medical direction has ordered that you administer a medication to a patient that you believe will cause harm to the patient if administered. After reading back the order to medical direction, the physician insists that you give the medication. Which of the following BEST describes your next actions?

A) State your objections, but give the medication per medical controls advice.

B) State your objectives, withhold the medication, and document carefully.

C) Give the medication and carefully observe your patient.

D) Refuse to acknowledge medical direction on the radio and document radio interference on your report.

Answer: B Explanation: A) If you believe that a medication or procedure may unnecessarily harm your patient, you should act in the patient's best interest and avoid the medication or procedure.

B) Correct.

C) Knowingly administering a medication or procedure that causes unnecessary harm violates the code of conduct expected of a paramedic and may place you in legal jeopardy.

D) Answer implies unethical behavior.

Page Ref: 48 4) Managing multiple patients, such as at a mass-casualty situation places the paramedic at risk when considering medication administration because of potential communication issues with medical direction. Which of the following will help ensure patient status?

A) Use only the patient's last name when communicating.

B) Only one paramedic should administer medication during a multi-patient incident.

C) Use of an incident command system to ensure proper identification of patients.

D) Avoid the use of medications in the field during operations deferring emergency care to the hospital staff.

Answer: C Explanation: A) Multiple patients may share same name.

B) It is not practical to have only one paramedic administer medications at a mass-casualty situation.

C) Correct.

D) Patients may be in need of urgent care at the scene.

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5) When selecting a medication, a prehospital provider should check the label at least times.

A) One B) Two C) Three D) Four Answer: C Explanation: A) When ordered to administer a medication, the provider should check label at least three times. First, when selecting a medication; second when you draw the medication; and third, prior to administration.

B) When ordered to administer a medication, the provider should check label at least three times.

First, when selecting a medication; second when you draw the medication; and third, prior to administration.

C) When ordered to administer a medication, the provider should check label at least three times.

First, when selecting a medication; second when you draw the medication; and third, prior to administration.

D) When ordered to administer a medication, the provider should check label at least three times.

First, when selecting a medication; second when you draw the medication; and third, prior to administration.

Page Ref: 49 6) administration involves the administration of medications by any route other than the alimentary canal.

A) Parenteral B) Gastrointestinal C) Rectal D) Oral Answer: A Explanation: A) Correct.

B) GI administration involves the alimentary tract.

C) Rectal administration involves the alimentary tract.

D) Oral administration involves the alimentary tract.

Page Ref: 52 7) Which of the following is NOT an advantage of parenteral drug administration?

A) Rapid onset of action B) Can be given to unconscious and nauseated patients C) Absorbed dosage and action is more predictable D) Low potential for infection Answer: D Explanation: A) Rapid onset of action is an advantage of parenteral administration.

B) Both are an advantage of parenteral administration.

C) This is an advantage of parenteral administration.

D) Low potential for infection is an advantage of enteral medications.

Page Ref: 52

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8) Which of the following routes is NOT a type of enteral administration?

A) Sublingual B) Topical C) Buccal D) Rectal Answer: B Explanation: A) Sublingual route is enteral.

B) Topical route is parenteral.

C) Buccal route is enteral.

D) Rectal route is enteral.

Page Ref: 51 9) Correct cleansing of the patient's skin prior to injection of a medication includes: A) Debridement of any open wound sites.

B) Only using soap sponges.

C) Ensuring only one quick wipe with an alcohol prep.

D) Utilizing a disinfectant, wipe in a spiral form from the center of the site outward.

Answer: D Explanation: A) Debridement of wounds is not required and wound sites should be avoided.

B) Cleansing the skin should be followed by an alcohol swab or chloraprep.

C) While an alcohol may be used, a single swipe in not likely to kill all microorganisms.

D) Correct.

Page Ref: 54 10) describes a medical environment free of pathogens.

A) Aseptic B) Septic C) Septicemic D) Parenteral Answer: A Explanation: A) Correct.

B) Sepsis implies the presence of pathogens.

C) Septicemia is a condition of pathogens in the bloodstream.

D) Parenteral is a route of administration.

Page Ref: 54

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11) Which of the following is toxic to living tissues and should only be used for nonliving surfaces?

A) Antiseptics B) Antigens C) Disinfectants D) Aseptic agents Answer: C Explanation: A) Antiseptic agents are not toxic to living tissues and are used to cleanse skin.

B) Antigens are proteins found on living tissues.

C) Correct.

D) Asepsis refers to an environment free of pathogens.

Page Ref: 55 12) Once an injection has been given to a patient, which of the following should NOT be done?

A) Observe and document all findings on a patient.

B) Immediately dispose of used sharps in proper containers.

C) Treat all bodily fluids as potentially infection.

D) Recap the needle to avoid accidentally being stuck.

Answer: D Explanation: A) Observations and findings should be documented on all patients.

B) All sharps should be immediately disposed of.

C) All bodily fluids should be considered to be infectious.

D) You should never recap a needle as it presents an increasing risk of accidental needle stick.

Page Ref: 55 13) medications are absorbed through the mucous membranes beneath the tongue.

A) Sublingual B) Buccal C) Oral D) Transdermal Answer: A Explanation: A) Correct.

B) Buccal administration involves placing the medication between the cheek and gums.

C) Oral administration involves swallowing a medication via the GI tract.

D) Transdermal medications are absorbed through the skin.

Page Ref: 56

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14) When injecting a patient with a subcutaneous medication, the provider should NOT exceed mL of volume.

A) 10 B) 5 C) 2 D) 1 Answer: D Explanation: A) Total volume when administering subcutaneous medication should not exceed 1 mL. B) Total volume when administering subcutaneous medication should not exceed 1 mL. C) Total volume when administering subcutaneous medication should not exceed 1 mL. D) Total volume when administering subcutaneous medication should not exceed 1 mL. Page Ref: 57 15) You are at the scene of a cardiac arrest patient where the crew is experiencing difficulty establishing an intravenous line. The patient, however, is intubated. Standing orders exist that authorize the administration of epinephrine 1 mg. Which of the following BEST describes your actions?

A) Do not administer the epinephrine until an IV is established.

B) Administer the medication subcutaneously, but double the dosage.

C) Give 1 mg epinephrine down the endotracheal tube.

D) Give 2.0 mg epinephrine down the endotracheal tube.

Answer: D Explanation: A) Epinephrine can be administered endotracheally.

B) Epinephrine can be administered endotracheally.

C) You should give 2-2.5 times the normal dose of epinephrine if utilizing the endotracheal route.

D) Correct.

Page Ref: 52 16) Which of the following statements regarding intraosseous medication administration is FALSE? A) The only medications that can be given by intraosseous route are epinephrine, lidocaine, naloxone, and atropine.

B) Sites include the humeral head and the anterior proximal tibia.

C) The onset of action of medications administered by intraosseous route is similar to that of intravenous injection.

D) Entry into the bone marrow cavity is evident by a number of factors including the IO needle standing upright without support.

Answer: A Explanation: A) Although these medications may be administered intraosseous, they are not the only ones. Virtually all medications may be administered by intraosseous route.

B) True.

C) True.

D) True.

Page Ref: 58 6

17) The MOST commonly used method of administering an inhaled medication in the emergency setting is: A) Metered-dose inhaler.

B) Dry powder inhalers.

C) Small volume, or updraft or hand-held inhaler.

D) Endotracheal administration.

Answer: C Explanation: A) These are most commonly administered by the patient at home.

B) These medications are typically used for maintenance therapy and not for acute care.

C) Correct.

D) Endotracheal administration is reserved for cardiac arrest situations.

Page Ref: 59 18) You are at the scene of a six-month-old who is having seizures. They have been repetitive and because of the duration, the child is exhibiting cyanosis and decreased oxygen saturation.

Which of the following actions should you consider?

A) Administering diazepam via the rectal route B) Waiting for the seizures to stop and attempting IV access C) Administering diazepam deeply into the deltoid utilizing a two-inch needle for injection D) Placing ice packs under the axilla and groin in case the seizure is febrile in nature Answer: A Explanation: A) Correct.

B) Because of the serious respiratory compromise, this seizure should be treated as soon as possible.

C) While IM injection may be somewhat beneficial, it is a slow route of absorption. Also, the needle length in the pediatric patient should not exceed one inch.

D) Recommended guidelines for febrile seizures include gentle cooling. Rectal diazepam is a better choice.

Page Ref: 60

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Prehospital Emergency Pharmacology, 8e (Bledsoe/Clayden) Chapter 4 Medication Dosage Calculations 1) The unit of measure used for calculating mass in the metric system is: A) Pound.

B) Liter.

C) Gram.

D) Ounce.

Answer: C Explanation: A) The pound is not a unit of measure in the metric system.

B) The liter is used to measure volume in the metric system.

C) Correct.

D) The ounce is not a unit of measure in the metric system.

Page Ref: 63 2) Which of the following conversions is INCORRECT? A) 1 kilogram = 100 gram B) 1000 milligram = 1 kilogram C) 1 gram = 1000 milligram D) 1 milligram = 1000 kilogram Answer: C Explanation: A) 1 kg = 1000 grams B) 1000 mg = 1 gram C) Correct.

D) 1 mg = 0.001 gram Page Ref: 64 3) You are preparing to administer a medication to a patient weighing approximately 220 pounds. Because the medication is dosed according to weight, you must convert the patient's weight to kilograms which equals .

A) 220 kilograms B) 1000 kilograms C) 2200 kilograms D) 100 kilograms Answer: D Explanation: A) To convert a patient's weight from pounds to kilograms, you must divide the weight in pounds by 2.2 kg/lb.

B) To convert a patient's weight from pounds to kilograms, you must divide the weight in pounds by 2.2 kg/lb.

C) To convert a patient's weight from pounds to kilograms, you must divide the weight in pounds by 2.2 kg/lb.

D) To convert a patient's weight from pounds to kilograms, you must divide the weight in pounds by 2.2 kg/lb.

Page Ref: 65

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4) The unit of measure used for calculating volume in the metric system is the A) Gram B) Milligram C) Ounce D) Liter Answer: D Explanation: A) The gram is the metric unit of mass.

B) The milligram is a measure of mass.

C) Although the ounce measures volume, this is not a metric unit.

D) Correct.

Page Ref: 63

.

5) You have selected a bag of 0.9% saline solution containing 1 liter of the solution. In order to utilize the solution more effectively, you are going to need to convert the solution to milliliters.

You know that 1 liter = _ milliliters.

A) 100 B) 1000 C) 10,000 D) 1 Answer: B Explanation: A) In order to convert liters to milliliters, you must multiply the volume in liters × 1000 ml/liter.

B) In order to convert liters to milliliters, you must multiply the volume in liters × 1000 ml/liter.

C) In order to convert liters to milliliters, you must multiply the volume in liters × 1000 ml/liter.

D) In order to convert liters to milliliters, you must multiply the volume in liters × 1000 ml/liter.

Page Ref: 64 6) In general, when abbreviating units of measure in the metric system, the provider should: A) Use lower case letters unless it starts a sentence.

B) Always capitalize the first letter when writing metric abbreviations.

C) Capitalize both letters only when using abbreviations.

D) As a rule, you should never abbreviate in order to avoid confusion in a medication order or conversion.

Answer: A Explanation: A) Correct.

B) Generally, the metric symbols or the abbreviations are written in lowercase letters.

C) Generally, the metric symbols or the abbreviations are written in lowercase letters.

D) Common, accepted abbreviations are used when documenting medical information.

Page Ref: 65

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7) When expressing metric dosages where the number is less than one (a decimal fraction), the health care provider should: A) Convert the decimal to the next greater value to avoid having a number smaller than one.

B) Ensure that the decimal point is at the start of the equation and no numbers precede it to avoid confusion.

C) Ensure that a 0 precedes the decimal to draw attention to the decimal.

D) Change the equation to a common fraction avoiding the use of a decimal.

Answer: C Explanation: A) "When the number is less than one (a decimal fraction), a "0" is written before the decimal point. This leading "0" is especially important in medication calculations because it draws attention to the decimal point and prevents medication dosage errors."

B) "When the number is less than one (a decimal fraction), a "0" is written before the decimal point. This leading "0" is especially important in medication calculations because it draws attention to the decimal point and prevents medication dosage errors."

C) "When the number is less than one (a decimal fraction), a "0" is written before the decimal point. This leading "0" is especially important in medication calculations because it draws attention to the decimal point and prevents medication dosage errors."

D) "When the number is less than one (a decimal fraction), a "0" is written before the decimal point. This leading "0" is especially important in medication calculations because it draws attention to the decimal point and prevents medication dosage errors."

Page Ref: 66 8) Which of the following components are necessary to calculate the ordered dose of a medication?

A) The doctor's order, the concentration of medication on hand, and units to administer B) The amount of medication and the route of administration C) The concentration or "what's on hand" D) The unit of measurement that needs to be administered Answer: A Explanation: A) Correct.

B) These are components of the doctor's order. The doctor's order is only one component necessary to calculate the ordered dose.

C) The concentration is a component necessary to calculate the ordered dose, but it is also necessary to know the doctor's order, and the unit of measurement.

D) The unit of measurement is a component of the ordered dose, but it is also necessary to know the doctor's order and the concentration available.

Page Ref: 67

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9) During the morning drug inventory of your unit, you notice that you have a solution of 10% calcium chloride available. Based on the commonly used weight/volume percentage, you know that this solution contains: A) 10 milligrams/100 cc.

B) 100 grams/cc.

C) 10 grams/cc.

D) 10 grams/100 cc.

Answer: D Explanation: A) When expressed a percentage solution, the solution will contain the number of grams expressed in 100 cc. Although the paramedic may not have 100 cc on hand, a simple calculation of the standard concentration will reveal the amount on hand.

B) When expressed a percentage solution, the solution will contain the number of grams expressed in 100 cc. Although the paramedic may not have 100 cc on hand, a simple calculation of the standard concentration will reveal the amount on hand.

C) When expressed a percentage solution, the solution will contain the number of grams expressed in 100 cc. Although the paramedic may not have 100 cc on hand, a simple calculation of the standard concentration will reveal the amount on hand.

D) When expressed a percentage solution, the solution will contain the number of grams expressed in 100 cc. Although the paramedic may not have 100 cc on hand, a simple calculation of the standard concentration will reveal the amount on hand.

Page Ref: 71 10) When referring to a concentration of a premixed solution, such as a vial, a prehospital provider is generally referring to: A) The percentage of a concentration.

B) The total amount of mass in the solution.

C) The amount of milligrams or micrograms in one milliliter.

D) The total amount of volume on hand.

Answer: C Explanation: A) When referring to a percentage, you are referring to the number of grams present in 100 mL. B) The total amount of mass is a component of concentration but needs to be divided by the amount of solvent in order to simplify dosage calculations.

C) Correct.

D) The total amount of volume on hand is a component of concentration but must be divided into the total solute to simplify dosage calculations.

Page Ref: 73

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11) When receiving an order to administer a certain number of units of a medication per minute to a patient, the paramedic knows that this will be a/an: A) Infusion.

B) Bolus.

C) Subcutaneous injection.

D) Injection.

Answer: A Explanation: A) Correct.

B) A bolus is a one-time, single dose of medication.

C) A subcutaneous injection is a bolus given into the subcutaneous layer of tissue.

D) An injection is given as a bolus.

Page Ref: 74 12) When calculating an infusion dose, it is necessary for the paramedic to determine the .

A) Patient's weight B) Drops per minute C) Total amount of medication that will be given D) Estimated size of the syringe Answer: B Explanation: A) While the patients weight may be a consideration with infusions, this is not always the case.

B) Correct.

C) The total amount of medication given may not always be necessary. The patient may continue on the medication after delivery to the receiving facility.

D) Not necessary in calculating an infusion delivery.

Page Ref: 77

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13) You have received an order for 25 grams of dextrose to be administered to a hypoglycemic patient. The solution for administration is supplied as a 50% solution. How much volume should you administer to the patient for the CORRECT dose to be given?

A) 25 mL B) 250 mL C) 100 mL D) 50 mL Answer: D Explanation: A) When expressed as a percentage concentration, a medication will contain the number of grams expressed in 100 mL. In this case, there are 50 grams in 100 mL. In order to give the desired dose of 25 grams, the paramedic will administer 50 mL. B) When expressed as a percentage concentration, a medication will contain the number of grams expressed in 100 mL. In this case, there are 50 grams in 100 mL. In order to give the desired dose of 25 grams, the paramedic will administer 50 mL. C) When expressed as a percentage concentration, a medication will contain the number of grams expressed in 100 mL. In this case, there are 50 grams in 100 mL. In order to give the desired dose of 25 grams, the paramedic will administer 50 mL. D) When expressed as a percentage concentration, a medication will contain the number of grams expressed in 100 mL. In this case, there are 50 grams in 100 mL. In order to give the desired dose of 25 grams, the paramedic will administer 50 mL. Page Ref: 71 14) You are ordered to give 2.0 mg of epinephrine 1:10,000 by the endotracheal route during cardiac arrest as the intravenous line has not yet been established. Epinephrine is supplied as 0.1 mg/mL. How many milliliters will you give?

A) 1 mL B) 10 mL C) 20 mL D) 0.20 mL Answer: C Explanation: A) The student may utilize information contained in Section 2 of this Chapter in the text. There are different methods to utilize when calculating medication dosages.

B) The student may utilize information contained in Section 2 of this Chapter in the text. There are different methods to utilize when calculating medication dosages.

C) The student may utilize information contained in Section 2 of this Chapter in the text. There are different methods to utilize when calculating medication dosages.

D) The student may utilize information contained in Section 2 of this Chapter in the text. There are different methods to utilize when calculating medication dosages.

Page Ref: 67-69

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15) Following the administration of 6 mg of adenosine to treat supraventricular tachycardia, your patient continues to have the arrhythmia. Medical direction orders that you give the patient another dose, but asks that you double the initial dosage. Adenosine is supplied as 3 mg/mL. How many milliliters will you administer?

A) 0.6 mL B) 6 mL C) 40 mL D) 4 mL Answer: D Explanation: A) The student may utilize information contained in Section 2 of this Chapter in the text. There are different methods to utilize when calculating medication dosages.

B) The student may utilize information contained in Section 2 of this Chapter in the text. There are different methods to utilize when calculating medication dosages.

C) The student may utilize information contained in Section 2 of this Chapter in the text. There are different methods to utilize when calculating medication dosages.

D) The student may utilize information contained in Section 2 of this Chapter in the text. There are different methods to utilize when calculating medication dosages.

Page Ref: 67-69 16) You are treating a pediatric patient for bradycardia. The patient weighs approximately 10 kilograms. Protocol indicates that 0.01 mg/kg IV/IO should be given. What is the dose of epinephrine for this patient?

A) 1 mg B) 0.1 mg C) 10 ml D) 1 mg/mL Answer: B Explanation: A) The student may utilize information contained in Section 3 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

B) The student may utilize information contained in Section 3 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

C) The student may utilize information contained in Section 3 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

D) The student may utilize information contained in Section 3 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

Page Ref: 69-70

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17) You are preparing a mixture of dopamine for a patient suffering from heart failure. You place 400 mg in 500 mL of dextrose 5% and water. What is the concentration of the solution?

A) 800 micrograms/mL B) 800 milligrams/mL C) 80 micrograms/mL D) 8 milligrams/mL Answer: A Explanation: A) The student may utilize information contained in Section 4 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

B) The student may utilize information contained in Section 4 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

C) The student may utilize information contained in Section 4 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

D) The student may utilize information contained in Section 4 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

Page Ref: 71-74 18) You are ordered to administer 2 mg/min of lidocaine to a patient who has received a bolus of lidocaine during cardiac arrest. You have prepared the lidocaine by placing 1 gram in 250 cc of D5W. You are utilizing a microdrip (60 gtts/mL) administration set. What is the correct drip rate?

A) 10 gtts/min B) 20 gtts/min C) 30 gtts/min D) 40 gtts/min Answer: C Explanation: A) The student may utilize information contained in Section 5 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

B) The student may utilize information contained in Section 5 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

C) The student may utilize information contained in Section 5 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

D) The student may utilize information contained in Section 5 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

Page Ref: 75-77

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19) You are treating a 220-pound male patient in cardiogenic shock. The physician has ordered that you administer 5 mcg/kg/min to this patient. You prepare the infusion by placing 200 mg of dopamine into 250 mL of D5W. Using a microdrip (60 gtts/mL) administration set, what will you set the rate of infusion at (gtts/min)?

A) 3 gtts/min B) 38 gtts/min C) 300 gtts/min D) 0.300 gtts/min Answer: B Explanation: A) The student may utilize information contained in Section 6 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

B) The student may utilize information contained in Section 6 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

C) The student may utilize information contained in Section 6 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

D) The student may utilize information contained in Section 6 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

Page Ref: 77-78 20) You are ordered to give 250 ml of 0.9% normal saline to a patient over 20 minutes. You are using a macroinfusion set (10 gtts/ml). What will you set your drip rate at?

A) 50 gtts/min B) 100 gtts/min C) 125 gtts/min D) 150 gtts/min Answer: C Explanation: A) The student may utilize information contained in Section 7 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

B) The student may utilize information contained in Section 7 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

C) The student may utilize information contained in Section 7 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

D) The student may utilize information contained in Section 7 of this Chapter in the text. There are different methods to utilize when calculating medication dosages and the student should use the one that works best for them.

Page Ref: 78-79

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Prehospital Emergency Pharmacology, 8e (Bledsoe/Clayden) Chapter 5 Fluids, Electrolytes, and Intravenous Therapy 1) Fluids that are contained in our system are separated into various compartments. Which of the following accounts for the majority of our total body weight?

A) Extracellular fluid B) Intravascular fluid C) Intracellular fluid D) Interstitial fluid Answer: C Explanation: A) Extracellular fluid accounts for about 15 percent of total body weight.

B) Intravascular fluid accounts for about 4.5 percent of total body weight.

C) Correct. Intracellular fluid accounts for about 45 percent of total body weight.

D) Interstitial fluid accounts for about 10.5 percent of total body weight.

Page Ref: 86 2) The process by which the body attempts to maintain a stable, internal environment in order to maintain physiological activities and proper balance is known as .

A) Homeostasis B) Hemostasis C) Hemodynamics D) Hemolysis Answer: A Explanation: A) Correct.

B) Hemostasis is the body's attempt to correct bleeding and is a function of homeostasis.

C) Hemodynamics is the regulation of fluid movement through the blood vessels and is a component of homeostasis.

D) Hemolysis is the destruction of blood cells.

Page Ref: 86 3) Some chemicals that when placed in water take on an electrical charge are known as .

A) Minerals B) Emulsions C) Solutes D) Electrolytes Answer: D Explanation: A) Not all minerals will take on an electrical charge.

B) An emulsion is a preparation of a medication.

C) Solute is a term use to explain mass that will dissolve in water. Not all solutes take on an electrical charge.

D) Correct.

Page Ref: 86

1

4) The primary extracellular cations in the body are: A) Calcium and chloride.

B) Sodium and calcium.

C) Magnesium and potassium.

D) Iron and sodium bicarbonate.

Answer: B Explanation: A) Although calcium is a primary cation in extracellular fluid, chloride is an anion.

B) Correct.

C) Magnesium and potassium are found in the intracellular space.

D) Iron and sodium bicarbonate are not primary cations in extracellular space.

Page Ref: 86 5) is primarily responsible for maintaining the balance of water in the body. and is regulated by the kidney.

A) Calcium B) Phosphorus C) Sodium D) Potassium Answer: C Explanation: A) Calcium is found mainly in bone tissue and is responsible for structure of bone and teeth as well as other functions.

B) Phosphorus is an anion and does not regulate water.

C) Correct.

D) Potassium is necessary for the transmission and conduction of nerve impulses, maintenance of normal cardiac rhythms, and skeletal muscle contraction.

Page Ref: 86 6) Which of the following is NOT a means by which substances such as oxygen, carbon dioxide, and nutrients exchange across a semipermeable membrane?

A) Diffusion B) Osmosis C) Facilitated diffusion D) Active transport Answer: B Explanation: A) Diffusion is the movement of a solute or gas across a semipermeable membrane from an area of higher concentration to an area of lower concentration.

B) Osmosis involves the movement of water, rather than substances.

C) facilitated diffusion is the movement of a solute across a semipermeable membrane with assistance of a "helper" such as a protein.

D) active transport is movement of a particle across a semipermeable membrane utilizing an energy source such as adenosine triphosphate.

Page Ref: 89

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7) When a fluid on one side of a cellular membrane contains a higher solute concentration than fluid on the other side, the fluid is said to be .

A) Hypertonic B) Isotonic C) Hypotonic D) Electrolytic Answer: A Explanation: A) Correct.

B) Isotonic implies that the fluids on either side are balanced.

C) Hypotonic implies that the fluid is less in solute concentration than fluid on the opposite side of the membrane.

D) Electrolytic does not pertain to body fluids.

Page Ref: 88 8) The two major components that make up the living tissue, blood, are: A) Erythrocytes and leukocytes.

B) Platelets and erythrocytes.

C) Plasma and electrolytes.

D) Plasma and formed elements.

Answer: D Explanation: A) These are formed elements.

B) These are formed elements.

C) Plasma is a component, but electrolytes are dissolved in plasma.

D) Correct.

Page Ref: 89 9) The function of blood includes the delivery of substances such as hormones and electrolytes.

A) Respiratory B) Excretory C) Regulatory D) Protective Answer: C Explanation: A) This function delivers oxygen in exchange for carbon dioxide.

B) This function removes cellular debris and waste products.

C) Correct.

D) This function provides defense against injury and invading microorganisms.

Page Ref: 90

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10) are present on the surface of cells that identify the cell as either "self" or "foreign" and allow the body to attack and destroy non-self-invaders.

A) Antigens B) Antibodies C) Platelets D) Erythrocytes Answer: A Explanation: A) Correct.

B) Antibodies are produced by beta cells as a defense against invading pathogens.

C) Platelets are involved in the blood clotting process known as hemostasis.

D) Erythrocytes carry oxygen from the lungs to body tissues.

Page Ref: 91 11) A protein-containing fluid that has high molecular weight and does NOT readily diffuse across a cellular membrane is known as a: A) Hypotonic solution.

B) Crystalloid solution.

C) Lactated solution.

D) Colloid.

Answer: D Explanation: A) Hypotonic solutions readily cross a cellular membrane and do not expand volume because of low molecular weight.

B) Crystalloid solutions do not contain proteins and do not remain in the vasculature long.

C) A lactate solution contains a buffer.

D) Correct.

Page Ref: 92 12) Which of the following statements regarding colloid statements is TRUE? A) Colloids readily diffuse into the extravascular space for fluid replacement.

B) Colloids exert osmotic pressures that draw fluids into the vascular space for volume replacement.

C) Colloids do not contain proteins or sugars; therefore, they do not make suitable solutions for volume replacement.

D) Colloids are inexpensive, have and long shelf-life, and are widely used among most EMS communities.

Answer: B Explanation: A) Due to the large molecular size and weight, colloids remain in the vascular space.

B) Correct.

C) Colloids are generally protein-containing solutions, or have large sugar molecules (such as Dextran) and are suitable volume expanders.

D) Colloids are expensive, have a short shelf-life, and are infrequently used in the EMS community.

Page Ref: 92

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13) When compared to plasma, a crystalloid solution that contains a similar solute concentration as plasma is referred to as a/an: A) Hypotonic solution.

B) Hypertonic solution.

C) Isotonic solution.

D) Colloid solution.

Answer: C Explanation: A) A hypotonic solution has less solute concentration than blood.

B) A hypertonic solution has greater solute concentration than blood.

C) Correct.

D) A colloid solution is not a crystalloid solution.

Page Ref: 93 14) You are assessing a patient whom you believe is bleeding internally and is in an early stage of shock. After placing the patient on oxygen and positioning the patient, which of the following solutions should you ask your partner to prepare for you as you attempt to initiate an intravenous line?

A) 0.45% normal saline B) 0.9% normal saline C) Dextrose 5% in water (D5W) D) Crystalloids are contraindicated in the treatment of shock. Only whole blood or blood components are used in these situations.

Answer: B Explanation: A) Hypotonic solutions enter the cells rapidly leaving the intravascular space making them not suitable for volume replacement.

B) Correct.

C) Hypotonic solutions enter the cells rapidly leaving the intravascular space making them not suitable for volume replacement.

D) While whole blood is most preferable, in the prehospital realm, they are rarely used and crystalloids provide temporary volume expansion until the patient can be delivered to the hospital.

Page Ref: 93 15) Lactated Ringer's solution (Hartmann's solution) is indicated in which of the following conditions?

A) Hypovolemic shock B) Cardiogenic shock C) Renal failure D) Pulmonary edema Answer: A Explanation: A) Correct.

B) A patient suffering from cardiogenic shock should not be given a fluid that will expand volume.

C) Lactated Ringer's solution is contraindicated in renal failure.

D) Volume expansion is contraindicated in situations involving pulmonary edema such as cardiogenic shock or congestive heart failure.

Page Ref: 95 5

16) You are treating a patient who is hypertensive and has crackles in the bases of her lungs. She prefers to remain sitting and is short of breath. After providing high-flow oxygen you determine the need to initiate an intravenous line in case you will need to administer medication, such as a diuretic. Which of the following fluid choices is MOST correct?

A) 0.9% NaCl at 100 cc/hour B) Dextran C) Lactated Ringer's solution at a wide-open rate D) Dextrose 5% in water at a TKO rate Answer: D Explanation: A) An isotonic solution will expand the intravascular volume resulting in worsening of an overload condition.

B) Dextran is a volume expander and not a good choice for this patient.

C) An isotonic solution will expand the intravascular volume resulting in worsening of an overload condition.

D) Correct.

Page Ref: 101 17) Which of the following catheters should be used when initiating an intravenous line on an adult patient who may need large amounts of fluid?

A) 22-gauge B) 24-gauge C) 16-gauge D) A butterfly-type catheter Answer: C Explanation: A) A 22-gauge catheter is not suitable for volume expansion due to the small amount of fluid that can be given.

B) A 24-gauge is not suitable for volume expansion due to the small amount of fluid that can be given.

C) Correct.

D) A butterfly-type catheter is not suitable for volume expansion due to the small amount of fluid that can be given.

Page Ref: 108 18) An administration set suitable for administering large amounts of fluid to patients suffering from fluid loss would be a: A) Piggy-back medication infusion set.

B) Buretrol or volutrol set.

C) Microdrip infusion set.

D) Macrodrip infusion set.

Answer: D Explanation: A) Piggy-back sets are used to administer IV drip medications.

B) A buretrol or volutrol set is used to give set amounts of fluid or medications.

C) A microdrip set is used when volume control is essential or when administering medications

by IV infusion.

D) A macrodrip provides the most volume when necessary.

Page Ref: 109 6

19) In cardiac arrest or traumatic arrest, the MOST suitable vein is for intravenous access is: A) Dorsal hand.

B) Leg veins.

C) Antecubital vein.

D) External jugular.

Answer: C Explanation: A) The dorsal hand is a distal peripheral vein and is not preferred in states of decreased perfusion.

B) Leg veins are distal peripheral vein and are not preferred in states of decreased perfusion.

C) Correct.

D) Although the external jugular vein is a peripheral vein, it is preferred to utilize the antecubital vein unless it is not accessible.

Page Ref: 109 20) You are administering blood to a patient during transport from one facility to another. The patient suddenly complains of chest pain, back pain, tachycardia, hypotension, dizziness, and fever. The patient is MOST likely experiencing _ .

A) Hypovolemia B) Transfusion reaction C) Side effects of the transfusion D) A myocardial infarction Answer: B Explanation: A) The blood products would be a suitable replacement for hypovolemia and the patient is suffering from other symptoms.

B) Correct.

C) A side effect is an expected, although not desired, effect of the medication and may be tolerated by the patient if the benefit of administration is greater than the discomfort.

D) Although chest pain is a symptom of myocardial infarction, given the other symptoms, a transfusion reaction is most likely the cause.

Page Ref: 112

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Prehospital Emergency Pharmacology, 8e (Bledsoe/Clayden) Chapter 6 The Autonomic Nervous System 1) The nervous system is divided into two major components known as the: A) Endocrine and autonomic.

B) Central nervous system and peripheral nervous system.

C) Sympathetic and parasympathetic.

D) Somatic and autonomic.

Answer: B Explanation: A) The endocrine, although closely related with the nervous system is not a major component of the nervous system. The autonomic system is a branch of the peripheral nervous system.

B) Correct.

C) The sympathetic and parasympathetic nervous system is a branch of the autonomic nervous system.

D) The somatic and autonomic are branches of the peripheral nervous system.

Page Ref: 115 2) The branch of the autonomic nervous system that controls vegetative functions such as digestion of food, is the: A) Sympathetic.

B) Somatic.

C) Central.

D) Parasympathetic.

Answer: D Explanation: A) The sympathetic branch is the opposite of the parasympathetic and is responsible for stress response.

B) The somatic branch controls voluntary muscular activity.

C) The central nervous system consists of the brain and spinal cord.

D) Correct.

Page Ref: 116 3) Autonomic nerves exit the central nervous system into specialized areas known as the: A) Peripheral nervous system.

B) Endocrine system.

C) Autonomic ganglia.

D) Somatic nervous system.

Answer: C Explanation: A) The peripheral nervous system refers more correctly to all nervous tissue outside of the CNS. B) The endocrine system, although closely related with the nervous system is not a component of the nervous system.

C) Correct.

D) The somatic nervous system is not part of the autonomic nervous system.

Page Ref: 116

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4) Nervous tissue that exits the autonomic ganglia and terminates in various target tissues are referred to as: A) Preganglionic nerves.

B) Postganglionic nerves.

C) Autonomic nerves.

D) Central nervous tissue.

Answer: B Explanation: A) Preganglionic nervous tissue terminates in the autonomic ganglia from the CNS. B) Correct.

C) Autonomic nervous tissue includes both pre and postganglionic nervous tissue.

D) The CNS consists of the brain and spinal cord.

Page Ref: 116 5) The space that exists between nerve cells is known as the .

A) Synapse B) Postganglionic region C) Preganglionic region D) Neuroeffector junction Answer: A Explanation: A) Correct.

B) Postganglionic nervous tissue exists outside the autonomic ganglia.

C) Preganglionic nervous tissue exists at the autonomic ganglia.

D) A neuroeffector junction exists between a nerve and its target organ.

Page Ref: 117 6) Sympathetic nerves arising from the collateral ganglia located in the abdominal cavity, when stimulated, cause all of the following EXCEPT: A) Reduction of blood flow to abdominal organs.

B) Bronchodilation.

C) Relaxing of smooth muscle in the wall of the urinary bladder.

D) Release of glucose stores from the liver.

Answer: B Explanation: A) Stimulation of the collateral ganglia causes reduction of blood flow to abdominal organs.

B) Correct. Bronchodilation is a function of the stimulation of the sympathetic chain ganglia, not the collateral ganglia.

C) Relaxing of the smooth muscle in the urinary bladder is a function of the collateral ganglia.

D) Stimulation of the collateral ganglia results in the release of glucose stores in the liver.

Page Ref: 119

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7) results in direct stimulation of the adrenal medulla resulting in the release of epinephrine (adrenalin) and norepinephrine (noradrenalin).

A) Collateral stimulation B) Parasympathetic stimulation C) Endocrine stimulation D) Sympathetic stimulation Answer: D Explanation: A) Collateral stimulation results in innervations of abdominal organs.

B) Parasympathetic stimulation results in vegetative functions.

C) Endocrine activity is triggered by nervous system stimulation.

D) Correct.

Page Ref: 120 8) Receptors located on organs located throughout the body that are stimulated by the release of norepinephrine and epinephrine are known as: A) Hormonal receptors.

B) Adrenergic receptors.

C) Cholinergic receptors.

D) Preganglionic receptors.

Answer: B Explanation: A) While hormones do seek receptor sites, this is vague as there are many hormones.

B) Correct.

C) Cholinergic receptors are stimulated by acetylcholine.

D) Pre-ganglionic receptors are first order neurons.

Page Ref: 120 9) Stimulation of receptors results in peripheral vasoconstriction, mild bronchoconstriction, and stimulation of metabolism.

A) Alpha1 B) Alpha2 C) Beta1 D) Beta2 Answer: A Explanation: A) Correct.

B) Alpha2 stimulation inhibits the release of preganglionic norepinephrine.

C) Beta1 causes an increase in heart rate, cardiac contractile force, automaticity, and conduction.

D) Beta2 stimulation causes vasodilatation and bronchodilation.

Page Ref: 120

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10) Stimulation of result in an increase in heart rate, cardiac contractile force, increased automaticity, and increased conduction.

A) Alpha1 B) Beta1 C) Beta2 D) Dopaminergic Answer: B Explanation: A) Results in peripheral vasoconstriction, mild bronchoconstriction, and stimulation of metabolism.

B) Correct.

C) Beta2 stimulation causes vasodilation and bronchodilation.

D) Thought to cause dilation of the renal, coronary, and cerebral arteries.

Page Ref: 121 11) A medication that mimics the actions of the sympathetic nervous system such as epinephrine, is known as a/an: A) Parasympathomimetic.

B) Parasympatholytic.

C) Sympathomimetic.

D) Sympatholytic.

Answer: C Explanation: A) Mimics the parasympathetic nervous system response.

B) Opposes the actions of the parasympathetic nervous system.

C) Correct.

D) Opposes the actions of the sympathetic nervous system.

Page Ref: 121 12) Stimulation of the results in pupillary constriction, digestive gland secretion, bronchoconstriction, and reduction in heart rate and contractile force.

A) Sympathetic ganglia B) Adrenal gland C) Somatic nervous system D) Parasympathetic nervous system Answer: D Explanation: A) Results in opposite effects of those listed.

B) The adrenal gland is stimulated by the sympathetic nervous system and results in opposite effects of those listed.

C) Somatic stimulation controls voluntary muscular activity.

D) Correct.

Page Ref: 121

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13) All preganglionic and postganglionic parasympathetic nerve fibers are stimulated by the neurotransmitter .

A) Epinephrine B) Norepinephrine C) Acetylcholine D) Dopamine Answer: C Explanation: A) Epinephrine is a hormone released by the adrenal medulla.

B) Norepinephrine is a neurotransmitter of postganglionic sympathetic nervous tissue.

C) Correct.

D) Dopamine is thought to cause dilation of the renal, coronary, and cerebral arteries.

Page Ref: 122 14) The neurotransmitter responsible for transmitting impulses through somatic nerves is: A) Norepinephrine.

B) Acetylcholine.

C) Dopamine.

D) Acetylcholinesterase.

Answer: B Explanation: A) Norepinephrine is a neurotransmitter of postganglionic sympathetic nervous tissue.

B) Correct.

C) Dopamine is thought to cause dilation of the renal, coronary, and cerebral arteries.

D) Acetylcholinesterase is an enzyme responsible for the breakdown of acetylcholine in the synapse.

Page Ref: 122

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Prehospital Emergency Pharmacology, 8e (Bledsoe/Clayden) Chapter 7 Medications Used in the Treatment of Cardiovascular Emergencies 1) Metabolism that occurs without the presence of oxygen is inefficient and is defined as: A) Aerobic.

B) Anaerobic.

C) Oxygen free radicals.

D) Lipolysis.

Answer: B Explanation: A) This is normal and indicates the presence of oxygen.

B) Correct.

C) Excessive amounts of oxygen that destroys body tissues.

D) Lipolysis is the breakdown of fat.

Page Ref: 130 2) Oxygen should be administered: A) To all patients.

B) Only in low concentrations.

C) In high concentration to all patients as it will not cause harm.

D) To patients who have signs of hypoxia.

Answer: D Explanation: A) Not all patients need oxygen. It should be administered to those patients experiencing hypoxia.

B) There are some patients who require high concentrations of oxygen such as the severely hypoxic patient.

C) Excessive amounts of oxygen can cause the formation of toxic chemicals and bring about oxidative stress.

D) Correct.

Page Ref: 131 3) Chemically similar drugs such as dopamine, epinephrine, norepinephrine, isoproterenol, and dobutamine are referred to as .

A) Catecholamines B) Sympatholytics C) Parasympathomimetics D) Hormones Answer: A Explanation: A) Correct.

B) Sympatholytics are medications that oppose the sympathetic nervous system.

C) Mimic the action of the parasympathetic nervous system.

D) Hormones are naturally produced and part of the endocrine system.

Page Ref: 132

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4) The primary use of a sympathomimetic in emergency medicine is: A) Oppose the effects of the parasympathetic nervous system.

B) Decrease blood pressure and heart rate.

C) Increase motility of the digestive tract.

D) Increase blood pressure in cardiogenic and septic shock.

Answer: D Explanation: A) A sympathomimetic stimulates the effects of the sympathetic nervous system.

However, in opposition to the sympathetic nervous system, a parasympatholytic would be more desirable.

B) Sympathomimetics increase blood pressure and heart rate.

C) A parasympathomimetic would increase motility of the digestive tract.

D) Correct.

Page Ref: 132 5) The beneficial effects of epinephrine in cardiac arrest are thought to be due to its: A) Alpha adrenergic effects.

B) Beta adrenergic effects.

C) Dopaminergic effects.

D) Parasympathetic effects.

Answer: A Explanation: A) Correct.

B) While epinephrine has beta adrenergic effects, it is thought that the alpha1 effects of vasoconstriction have more of a role in increasing blood flow through coronary vessels.

C) Epinephrine does not have dopaminergic effects.

D) Epinephrine does not have parasympathetic effects.

Page Ref: 135 6) When administering epinephrine 1:10,000 using the IV or IO route in cardiac arrest, the standard initial dose is: A) 1 mg.

B) 10 mg.

C) 0.1 mg.

D) 100 mg.

Answer: A Explanation: A) Current guidelines recommend that 1 mg of epinephrine be administered during cardiac arrest every 3-5 minutes.

B) Current guidelines recommend that 1 mg of epinephrine be administered during cardiac arrest every 3-5 minutes.

C) Current guidelines recommend that 1 mg of epinephrine be administered during cardiac arrest every 3-5 minutes.

D) Current guidelines recommend that 1 mg of epinephrine be administered during cardiac arrest every 3-5 minutes.

Page Ref: 136

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7) Indications for the use of dopamine include A) Hypovolemia B) Cardiogenic shock C) Pheochromocytoma D) Tachycardia Answer: B Explanation: A) Contraindication.

B) Correct.

C) Contraindication.

D) Precaution, as it may worsen tachycardia.

Page Ref: 141

.

8) When administering dopamine, the initial dosage is: A) 200 mcg/kg.

B) 20 mcg/min.

C) 2-10 mcg/kg/min.

D) 20-100 mcg/kg/min.

Answer: C Explanation: A) Current guidelines suggest the administration of 2-10 mcg/kg/min. Dosage should be adjusted to patient response.

B) Current guidelines suggest the administration of 2-10 mcg/kg/min. Dosage should be adjusted to patient response.

C) Current guidelines suggest the administration of 2-10 mcg/kg/min. Dosage should be adjusted to patient response.

D) Current guidelines suggest the administration of 2-10 mcg/kg/min. Dosage should be adjusted to patient response.

Page Ref: 142 9) Dobutamine is useful in congestive heart failure because: A) It causes less increase in heart rate than other sympathomimetics.

B) It is less expensive than dopamine.

C) It may be given as a single-dose bolus.

D) Other medications are ineffective at increasing cardiac contractility.

Answer: A Explanation: A) Correct.

B) It would be unethical to administer or withhold a medication based on cost.

C) Dobutamine is administered by intravenous infusion.

D) There are other medications that are effective; however, dobutamine causes less increase of heart rate and oxygen demand.

Page Ref: 143

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10) Although seldom used, isoproterenol indications include: A) To increase the blood pressure in cardiogenic shock.

B) Utilized along with transcutaneous pacing to increase the heart rate.

C) To treat shock resulting from tachyarrhythmias.

D) Beta-blocker overdoses.

Answer: D Explanation: A) Isuprel is contraindicated in cardiogenic shock.

B) It is used only when transcutaneous pacing is unavailable.

C) Isuprel should only be used in shock resulting from bradycardias.

D) A possible indication for isoproterenol is a patient suffering from a beta-blocker overdose.

Page Ref: 140 11) It is important to understand that the concomitant use of a non-selective beta-antagonist along with a slow calcium channel blocker may result in .

A) Hypertension B) Tachycardia C) Bronchodilation D) Asystole Answer: D Explanation: A) Hypotension would result.

B) Bradycardia would result.

C) Bronchoconstriction would result as a result of the Beta two blockade.

D) The concomitant use of a beta blocking agent such as propranolol and a slow calcium channel blocker such as verapamil may result in irreversible asystole.

Page Ref: 148 12) Metoprolol is indicated in all of the following EXCEPT: A) Symptomatic bradycardia.

B) Supraventricular tachycardia.

C) Atrial fibrillation with a rapid ventricular response.

D) Acute myocardial infarction with hypertension.

Answer: A Explanation: A) Blocking beta adrenergic activity would further reduce myocardial function.

B) Indicated C) Indicated D) Indicated Page Ref: 151

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13) Because of its selective alpha1 antagonistic properties, labetalol is indicated in .

A) Tachycardia B) Ventricular fibrillation C) Cardiogenic shock D) Acute hypertensive emergency Answer: D Explanation: A) Although labetalol may be used in supraventricular tachycardia, its alpha1 antagonism results in vasodilation and makes it more suitable for hypertensive emergencies.

B) No indication exists.

C) Contraindicated.

D) Correct.

Page Ref: 153 14) Lidocaine is contraindicated in which of the following?

A) High-grade heart blocks B) Ventricular fibrillation C) Pulseless ventricular tachycardia D) Cardiac arrest refractory to amiodarone Answer: A Explanation: A) Lidocaine is contraindicated in high-grade heart blocks such as 2nd degree-type II and 3rd degree.

B) Indicated C) Indicated D) Indicated Page Ref: 160 15) Following the administration of adenosine, the paramedic should be aware that: A) The patient may be hypotensive and hypovolemic.

B) The patient will require a drip infusion.

C) The patient may experience arrhythmias including transient asystole.

D) Sympathomimetics may be necessary to counteract the long-term effects of adenosine.

Answer: C Explanation: A) Hypotension may be transient, but will not result in hypovolemia.

B) In the acute setting, there is not an indication for a drip infusion of adenosine.

C) Correct.

D) The half-life of adenosine precludes long term effects.

Page Ref: 164

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16) The initial dose of adenosine is: A) 0.6 mg.

B) 6 mg.

C) 12 mg.

D) 60 mg.

Answer: B Explanation: A) The recommended initial dose of adenosine in PSVT is 6 mg IV pushed rapidly. Two additional doses may be administered if ineffective at 12 mg each.

B) The recommended initial dose of adenosine in PSVT is 6 mg IV pushed rapidly. Two additional doses may be administered if ineffective at 12 mg each.

C) The recommended initial dose of adenosine in PSVT is 6 mg IV pushed rapidly. Two additional doses may be administered if ineffective at 12 mg each.

D) The recommended initial dose of adenosine in PSVT is 6 mg IV pushed rapidly. Two additional doses may be administered if ineffective at 12 mg each.

Page Ref: 165 17) According to the Vaughn-Williamson classification, diltiazem (Cardizem) is a Class antiarrhythmic.

A) I B) II C) III D) IV Answer: D Explanation: A) Class I antiarrhythmics are sodium channel blockers.

B) Class II antiarrhythmics are beta blocking agents.

C) Class III antiarrhythmics are potassium blocking agents.

D) Correct.

Page Ref: 156

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18) Amiodarone is indicated in which of the following life-threatening arrhythmias?

A) Third-degree AV block B) Sinus bradycardia C) 2nd degree AV block D) Stable ventricular tachycardia Answer: D Explanation: A) Amiodarone is indicated in the following conditions: pulseless ventricular tachycardia, ventricular fibrillation, stable regular and irregular narrow-complex tachycardia, and control of ventricular rate in accessory pathways.

B) Amiodarone is indicated in the following conditions: pulseless ventricular tachycardia, ventricular fibrillation, stable regular and irregular narrow-complex tachycardia, and control of ventricular rate in accessory pathways.

C) Amiodarone is indicated in the following conditions: pulseless ventricular tachycardia, ventricular fibrillation, stable regular and irregular narrow-complex tachycardia, and control of ventricular rate in accessory pathways.

D) Amiodarone is indicated in the following conditions: pulseless ventricular tachycardia, ventricular fibrillation, stable regular and irregular narrow-complex tachycardia, and control of ventricular rate in accessory pathways.

Page Ref: 168 19) You are treating a patient who has been identified as having stable ventricular tachycardia.

Medical direction has ordered amiodarone as the antiarrhythmic of choice. The correct dosage in this situation is: A) 300 mg IV bolus.

B) 150 mg IV bolus infusion over 10 minutes.

C) 6 mg IV bolus rapidly.

D) 2 mg/min IV infusion.

Answer: B Explanation: A) This is a dosage of amiodarone reserved for pulseless rhythms.

B) Correct.

C) This is a dosage for adenosine.

D) This dosage does not apply to amiodarone.

Page Ref: 169 20) The antiarrhythmic of choice for a patient experiencing a polymorphic ventricular tachycardia know as torsades des pointes is .

A) Magnesium sulfate B) Lidocaine C) Amiodarone D) Calcium chloride Answer: A Explanation: A) Correct.

B) Lidocaine can be harmful and is contraindicated.

C) Amiodarone can be harmful and is contraindicated.

D) Calcium chloride is not an antiarrhythmic.

Page Ref: 172 7

21) Excessive stimulation of the vagus nerve may result in .

A) Hypertension B) Bradycardia C) Tachycardia D) Ventricular tachycardia Answer: B Explanation: A) Excessive vagal stimulation would result in hypotension.

B) Correct. Stimulation of the vagus nerve results in the release of acetylcholine, the primary neurotransmitter of the parasympathetic nervous system. This results in opposition of the sympathetic nervous system and causes a decrease in the cardiac rate, or bradycardia.

C) Stimulation of the vagus nerve would result in bradycardia.

D) Stimulation of the vagus nerve results in asystole, not ventricular tachycardia.

Page Ref: 173 22) For hemodynamically significant bradycardia in which pacing is delayed or unavailable, the recommended dose of atropine sulfate is: A) 0.01 mg.

B) 5 mg.

C) 10 mg.

D) 0.5 mg.

Answer: D Explanation: A) The recommended dosage for atropine sulfate for hemodynamically significant bradycardia is 0.5 mg every 3-5 minutes up to 3 mg.

B) The recommended dosage for atropine sulfate for hemodynamically significant bradycardia is 0.5 mg every 3-5 minutes up to 3 mg.

C) The recommended dosage for atropine sulfate for hemodynamically significant bradycardia is 0.5 mg every 3-5 minutes up to 3 mg.

D) The recommended dosage for atropine sulfate for hemodynamically significant bradycardia is 0.5 mg every 3-5 minutes up to 3 mg.

Page Ref: 174 23) Which of the following statements is TRUE regarding the medication digoxin?

A) Digoxin has negative chronotropic (slows AV conduction) and increased inotropic (force of cardiac contraction) effects.

B) Digoxin is relatively safe in the emergency setting because of a very wide therapeutic dose range.

C) Digoxin may be used safely with bradycardia as it strengthens the force of cardiac contractions.

D) Because it is an antiarrhythmic, digoxin may be used in cardiac arrest.

Answer: A Explanation: A) Correct.

B) Digoxin has a very narrow therapeutic index and patients must be closely monitored for signs and symptoms of toxicity during administration.

C) Digoxin is not indicated in bradycardia.

D) Digoxin is not indicated in cardiac arrest.

Page Ref: 176 8

24) In acute coronary syndrome, aspirin is given because: A) It reduces the pain caused by infarcted tissue.

B) Aspirin is a natural anticoagulant released by MAST cells.

C) Aspirin inhibits the aggregation of platelets preventing occlusion of coronary arteries.

D) Aspirin causes vasodilation resulting in increased coronary blood flow.

Answer: C Explanation: A) Aspirin does not relieve pain associated with infarction.

B) This describes the effects of heparin which is released by MAST cells.

C) Correct.

D) This best describes the effects of nitroglycerine.

Page Ref: 177 25) Contraindications that apply to both aspirin and clopidogrel include: A) Bleeding disorders.

B) Chest pain unrelieved by nitroglycerine.

C) Recent myocardial infarction.

D) The patient who is taking nonsteroidal anti-inflammatory medication.

Answer: A Explanation: A) Correct.

B) Chest pain is an indication.

C) MI is not a contraindication.

D) Although the effects of NSAIDs may be potentiated, it is not contraindicated.

Page Ref: 179 26) When available, is the preferred method for clearing an arterial occlusion.

A) Aspirin B) Heparin C) Fibrinolytics D) Percutaneous coronary interventions Answer: D Explanation: A) Aspirin, while helpful in the prevention of arterial occlusion will not clear an already blocked artery.

B) Heparin, while helpful in the prevention of arterial occlusion (or blood clotting) will not clear an already blocked artery.

C) Fibrinolytics have been shown to be effective and may be the only choice if PCI is not available.

D) Correct.

Page Ref: 186

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27) When utilizing sodium bicarbonate, it is important to understand that: A) It may result in long term acidosis.

B) Sodium bicarbonate will inactivate catecholamines administered through the same intravenous line unless the line is flushed thoroughly.

C) It is indicated for overdoses of alkaline solutions.

D) If used, sodium bicarbonate should be administered early, preferably following the first dose of epinephrine and prior to intubation to reverse the immediate effects of acidosis.

Answer: B Explanation: A) The use of sodium bicarbonate may result in transient acidosis which is correctable by adequate ventilation.

B) Correct.

C) Sodium bicarbonate is an alkaline solution and would worsen this condition.

D) Sodium bicarbonate is not indicated in cardiac arrest, and if used should be used late after the patient has been intubated and ventilated.

Page Ref: 196 28) A contraindication for the use of morphine sulfate is: A) Hypovolemia.

B) Chest pain.

C) Pulmonary edema.

D) Kidney stones.

Answer: A Explanation: A) Hypovolemia should be treated with fluid replacement. The hemodynamic effects of morphine would worsen this condition.

B) Indicated for chest pain.

C) Although other vasoactive medications are preferred, morphine is not contraindicated with pulmonary edema.

D) Indicated for pain related to kidney stones.

Page Ref: 197 29) Furosemide works by: A) Increasing cardiac contractility.

B) Reducing arterial blood pressure through alpha1 blockade.

C) Stimulating beta receptors and increasing cardiac conduction velocity.

D) Inhibiting the reuptake of sodium and chloride resulting in diuresis.

Answer: D Explanation: A) Furosemide does not have an effect on contractility, but does reduce preload.

B) Furosemide relaxes the venous system, but not arterial.

C) Furosemide has no effect on beta receptors.

D) Correct.

Page Ref: 201

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30) The preferred route of administration for nitroglycerine in the prehospital setting is .

A) IV B) Subcutaneous C) Sublingual D) Transdermal Answer: C Explanation: A) Intravenous nitroglycerine is best reserved for emergency department or hospital administration.

B) Nitroglycerine is not administered subcutaneously.

C) Correct.

D) Although administered by transdermal route, the sublingual route is preferred for its rapid onset of action. Transdermal nitroglycerine is used for long term control of angina.

Page Ref: 208 31) The system that plays an important role in maintenance of blood pressure through endocrine regulation is: A) Thyroid.

B) Hepatic.

C) Renin-angiotensin-aldosterone (RAAS).

D) Pancreatic.

Answer: C Explanation: A) The thyroid gland regulates metabolism.

B) The hepatic system is involved in metabolism.

C) Correct.

D) The pancreas plays an important role in glucose metabolism.

Page Ref: 216 32) When preparing sodium nitroprusside for use in hypertensive emergencies, it is important to remember that: A) Once mixed, keep wrapped in an opaque wrapper to prevent deactivation.

B) Lactated Ringer's solution is the preferred solution for mixing.

C) Sodium nitroprusside is not indicated for hypertensive emergencies.

D) Give as a bolus over 20 minutes and then utilize other antihypertensive agents to achieve desired results.

Answer: A Explanation: A) Correct. It is easily deactivated by light once prepared.

B) Only normal saline or D5W should be used when preparing.

C) The primary indication for sodium nitroprusside is hypertensive crisis.

D) Sodium nitroprusside is given by IV infusion and may be potentiated by other agents.

Page Ref: 220

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Prehospital Emergency Pharmacology, 8e (Bledsoe/Clayden) Chapter 8 Medications Used in the Treatment of Respiratory Emergencies 1) The MOST common medications used in the treatment of respiratory emergencies are the: A) Xanthines.

B) Parasympathomimetics.

C) Cholinergics.

D) Sympathomimetics.

Answer: D Explanation: A) Xanthines are utilized infrequently in the treatment of respiratory disorders.

B) Parasympathomimetics are not used in the treatment of respiratory disorders.

C) Cholinergics are parasympathomimetics and are not used in the treatment of respiratory disorders.

D) Correct.

Page Ref: 226 2) In treating respiratory disorders, it is MOST desirable for a medication to stimulate which receptor sites?

A) Alpha1 B) Beta1 C) Beta2 D) Both beta1 and beta2 Answer: C Explanation: A) Alpha1 stimulation is not desirable in respiratory disorders.

B) Beta1 stimulation causes increase in heart rate, force, and automaticity.

C) Correct.

D) While many medications used in the treatment of respiratory disorders stimulate both b1 and b2 receptor sites, it is more preferable to utilize a medication that stimulates only b2 sites.

Page Ref: 226 3) When utilizing corticosteroids in the treatment of respiratory disorders, it is important to know that: A) Time of onset is usually about 1-4 hours and effects will not be noticed by the paramedic in the acute setting.

B) Corticosteroids are desirable for short-term control of bronchoconstriction.

C) Administering the steroids as the first medication will allow the medication to work quickly in reversing bronchospasm.

D) Steroids should always be given to a patient suffering from asthma.

Answer: A Explanation: A) Correct.

B) Because of the delayed action, steroids are generally not used in the field setting.

C) Bronchodilators are first line medications in respiratory disorders.

D) The use of steroids in treating asthma is controversial.

Page Ref: 226

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4) Use of neuromuscular blockade in respiratory distress is: A) Indicated to maintain the patient's protective reflexes.

B) Commonly indicated to gain control of a patient's airway.

C) Contraindicated.

D) Only indicated when an experienced provider is available to gain control of the airway.

Answer: D Explanation: A) Neuromuscular blockades remove the patient's protective reflexes and cause apnea.

B) The use of neuromuscular blockade is not common practice.

C) While caution should be used, it is not contraindicated.

D) Correct.

Page Ref: 226 5) Oxygen delivery using a nasal cannula at 1-6 liters per minute provides oxygen concentrations between: A) 80-100 percent.

B) 20-21 percent.

C) 24-44 percent.

D) 60-80 percent.

Answer: C Explanation: A) Nasal cannula can provide concentrations between 24-44 percent when oxygen flow rates are between 1-6 liter per minute.

B) Nasal cannula can provide concentrations between 24-44 percent when oxygen flow rates are between 1-6 liter per minute.

C) Nasal cannula can provide concentrations between 24-44 percent when oxygen flow rates are between 1-6 liter per minute.

D) Nasal cannula can provide concentrations between 24-44 percent when oxygen flow rates are between 1-6 liter per minute.

Page Ref: 227 6) An advantage to using a device that provides continuous positive airway pressure for respiratory disorders is that: A) Oxygen concentrations can be closely controlled in patients with COPD. B) It can replace intubation in a patient who has lost the ability to maintain his airway.

C) Lower liter flows of oxygen are required when using these devices.

D) These devices keep the alveoli inflated resulting in improved lung efficiency.

Answer: D Explanation: A) This answer best describes a venture mask.

B) Intubation is the best choice when a patient can not protect or maintain their airway.

C) Incorrect.

D) Correct.

Page Ref: 228

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7) Which statement regarding the use of pulse oximetry is FALSE? A) Pulse oximetry has been referred to as the fifth vital sign.

B) False readings occur frequently with oximetry and it should be used with caution.

C) Pulse oximetry may detect problems prior to changes in pulse, blood pressure, or respirations.

D) Oximetry provides continuous and immediate evaluation of delivery of oxygen to tissues.

Answer: B Explanation: A) The incidence of false readings with pulse oximetry is small.

B) The incidence of false readings with pulse oximetry is small.

C) The incidence of false readings with pulse oximetry is small.

D) The incidence of false readings with pulse oximetry is small.

Page Ref: 228 8) You have intubated a patient and are obtaining a capnogram that indicates that there is no carbon dioxide present. With this information, you know that: A) The endotracheal tube is correctly placed due to the lack of exhaled carbon dioxide.

B) You are hyperventilating the patient and should reduce the amount of ventilations per minute until the carbon dioxide levels come up.

C) The endotracheal tube is incorrectly placed in the esophagus and the patient should be extubated immediately.

D) The endotracheal tube is placed in the right mainstem bronchus and should be carefully withdrawn.

Answer: C Explanation: A) When properly placed, patient's exhalation through an endotracheal tube will produce levels of carbon dioxide.

B) Hyperventilation will reduce levels of CO2.

C) Correct.

D) This would still produce levels of exhaled CO2.

Page Ref: 229 9) The major characteristic of asthma is: A) Destruction of alveoli leading to a decreased gas exchange in the pulmonary vasculature.

B) Increasing diameter in the bronchioles during exhalation resulting in air trapping in the alveoli.

C) Accumulation of edema in the alveolar sacs resulting in decreased exchange of oxygen and carbon dioxide.

D) Reversible lower airway obstruction.

Answer: D Explanation: A) This best describes COPD. B) The bronchioles decrease in diameter during exhalation.

C) This best describes pulmonary edema.

D) Correct.

Page Ref: 230

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10) When treating asthma, the initial treatment should be directed towards which of the following?

A) Reversing bronchial spasm B) Reducing inflammation C) Eliminating pulmonary edema D) Preventing cardiac arrhythmias Answer: A Explanation: A) Correct.

B) While reducing inflammation is useful in treating asthma; it is a secondary consideration to reversing bronchial spasm.

C) This is a goal of treating CHF. D) While cardiac arrhythmia is undesirable, they may occur when treating bronchospasm.

Page Ref: 231 11) Following the initial treatment of asthma, the paramedic should consider the administration of , especially if transport time is long.

A) Aminophylline B) Epinephrine C) Corticosteroids D) Atropine Answer: C Explanation: A) Aminophylline is indicated when a patient has not responded to attempts at bronchodilation through the use of sympathomimetics.

B) Epinephrine may be utilized in the initial treatment of asthma.

C) Correct.

D) Atropine is rarely used in the treatment of asthma.

Page Ref: 232 12) The initial dose of epinephrine in anaphylaxis is: A) 0.3 mg-0.5 mg 1:1000 IM. B) 3.0-5.0 mg IM. C) 1 mg 1:10,000 IV. D) 3.0-5.0 mg 1:10,000 IV. Answer: A Explanation: A) Current guidelines recommend 0.3-0.5 mg of 1:1000 solution administered intramuscularly or subcutaneously when given in the prehospital setting.

B) Current guidelines recommend 0.3-0.5 mg of 1:1000 solution administered intramuscularly or subcutaneously when given in the prehospital setting.

C) Current guidelines recommend 0.3-0.5 mg of 1:1000 solution administered intramuscularly or subcutaneously when given in the prehospital setting.

D) Current guidelines recommend 0.3-0.5 mg of 1:1000 solution administered intramuscularly or subcutaneously when given in the prehospital setting.

Page Ref: 233

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13) Side effects of albuterol include: A) Bradycardia, increased bronchial secretions, increased gut motility.

B) Hypotension, bradycardia, and dry mouth.

C) Increased air trapping, decreased peak-flow spirometry, and increasing capnography.

D) Anxiety, hypertension, tremors, and headache.

Answer: D Explanation: A) Side effects of albuterol include: palpitations, anxiety, dizziness, headache, nervousness, tremor, hypertension, arrhythmias, chest pain, nausea, and vomiting.

B) Side effects of albuterol include: palpitations, anxiety, dizziness, headache, nervousness, tremor, hypertension, arrhythmias, chest pain, nausea, and vomiting.

C) Side effects of albuterol include: palpitations, anxiety, dizziness, headache, nervousness, tremor, hypertension, arrhythmias, chest pain, nausea, and vomiting.

D) Side effects of albuterol include: palpitations, anxiety, dizziness, headache, nervousness, tremor, hypertension, arrhythmias, chest pain, nausea, and vomiting.

Page Ref: 234 14) A contraindication to the use of racemic epinephrine is .

A) Asthma B) COPD C) Epiglottitis D) Croup Answer: C Explanation: A) Racemic epinephrine is contraindicated in epiglottitis.

B) Racemic epinephrine is contraindicated in epiglottitis.

C) Racemic epinephrine is contraindicated in epiglottitis.

D) Racemic epinephrine is contraindicated in epiglottitis.

Page Ref: 236 15) A contraindication to the use of metaproterenol is: A) Significant tachycardia.

B) COPD. C) Wheezing.

D) Low peak-flow measurement.

Answer: A Explanation: A) Contraindications to the use of metaproterenol include significant cardiac arrhythmias and tachycardia.

B) Contraindications to the use of metaproterenol include significant cardiac arrhythmias and tachycardia.

C) Contraindications to the use of metaproterenol include significant cardiac arrhythmias and tachycardia.

D) Contraindications to the use of metaproterenol include significant cardiac arrhythmias and tachycardia.

Page Ref: 239

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16) Which of the following is the CORRECT dosage of Aminophylline for asthma refractory to sympathomimetic agents?

A) 5 mg slowly over 20 minutes B) 1 gram diluted in 250 cc of NaCl administered in 10 minutes C) 2-5 mg/kg diluted in 80 mL of D5W administered over 20 minutes D) Aminophylline is contraindicated in asthma.

Answer: C Explanation: A) Incorrect dosage.

B) Incorrect dosage.

C) Correct.

D) Aminophylline is indicated in asthma refractory to sympathomimetics.

Page Ref: 241 17) Anticholinergics are used in treating asthma because they: A) Inhibit the production of secretions by blocking the effects of the parasympathetic nervous system.

B) Stimulate bronchodilation through beta2 effects.

C) Cause sympathetic activity by binding at cholinergic receptor sites.

D) Relax bronchial muscle due to an effect similar to the xanthine bronchodilators.

Answer: A Explanation: A) Correct.

B) Sympathomimetics stimulate bronchodilation by stimulating beta2 receptors.

C) Anticholinergics block the effects of acetylcholine inhibiting the bronchial secretions.

D) Not true.

Page Ref: 242 18) Which of the following statements regarding the medication ipratropium is TRUE? A) Ipratropium is primarily a beta-agonist responsible for dilation of the bronchioles.

B) Ipratropium is given to relieve the long term inflammatory effects of asthma.

C) Ipratropium may be administered by intravenous route if it is given slowly over 20 minutes.

D) Ipratropium is most frequently administered with a beta-agonist to provide bronchodilation and drying of bronchial secretions.

Answer: D Explanation: A) It is a parasympatholytic, not a sympathomimetic.

B) Corticosteroids are used in the long term inflammatory effects of asthma.

C) Ipratropium is administered by nebulizer.

D) Correct.

Page Ref: 244

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19) A contraindication to the use of methylprednisolone in the prehospital realm is: A) Severe anaphylaxis.

B) COPD. C) Urticaria.

D) There are no contraindications to the use of methylprednisolone acute management of anaphylaxis.

Answer: D Explanation: A) Indication.

B) Indication.

C) Indication.

D) Correct.

Page Ref: 246

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Prehospital Emergency Pharmacology, 8e (Bledsoe/Clayden) Chapter 9 Medications Used in the Treatment of Allergic Reactions and Anaphylaxis 1) An exaggerated response by the immune system to a foreign substance is BEST described by the term .

A) Synergism B) Potentiation C) Allergic reaction D) Anaphylaxis Answer: C Explanation: A) A synergism is the combination of two or more medications creating an effect greater than the total sum of the medications individually.

B) Potentiation is enhancement of one drug by another.

C) Correct.

D) Although a type of allergic reaction, anaphylaxis is the most severe type of allergic reaction.

Page Ref: 251 2) The MOST common trigger of severe allergic reactions, other than injected penicillin, in the United States is: A) Hymenoptera stings.

B) Snake bites.

C) Food poisoning.

D) Jellyfish sting.

Answer: A Explanation: A) Injected penicillin and bee and wasp (Hymenoptera) stings are the two most common causes of fatal anaphylaxis.

B) Injected penicillin and bee and wasp (Hymenoptera) stings are the two most common causes of fatal anaphylaxis.

C) Injected penicillin and bee and wasp (Hymenoptera) stings are the two most common causes of fatal anaphylaxis.

D) Injected penicillin and bee and wasp (Hymenoptera) stings are the two most common causes of fatal anaphylaxis.

Page Ref: 252 3) Sensitization can BEST be defined as: A) An unexpected and exaggerated response to a particular antigen.

B) An initial exposure of an individual to an allergen.

C) Anaphylaxis.

D) The most severe allergic reaction.

Answer: B Explanation: A) Describes hypersensitivity.

B) Correct.

C) The most severe hypersensitive reaction, often life-threatening.

D) The most severe allergic reaction is best described by the term anaphylaxis.

Page Ref: 252

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4) The type of hypersensitivity reaction that MOST often results in skin rash and is often due to exposure to certain drugs or chemicals is called a/an: A) Delayed hypersensitivity.

B) Cytotoxic hypersensitivity.

C) Immediate hypersensitivity.

D) Anaphylaxis.

Answer: A Explanation: A) Correct.

B) Immunoglobulin B reaction such as thrombocytopenia.

C) Immunoglobulin E reaction such as asthma.

D) The most severe, life-threatening type of allergic reactions.

Page Ref: 252 5) Hay fever, drug allergies, food allergies, and eczema are all types of: A) Immediate hypersensitivity.

B) Delayed hypersensitivity.

C) Anaphylactic reactions.

D) Angioneurotic edema.

Answer: A Explanation: A) Correct.

B) Delayed hypersensitivity reactions are most often characterized by a skin rash and occur days after exposure.

C) Anaphylactic reactions are severe and life-threatening.

D) Edema that occurs in the face and skin and is usually very apparent.

Page Ref: 252 6) The principal mediator of an allergic reaction is .

A) Hymenoptera B) Injected penicillin C) Delayed hypersensitivity D) Histamine Answer: D Explanation: A) Hymenoptera is a classification of insects that includes wasps and bees.

B) Injected penicillin is the most common cause of anaphylactic reactions.

C) Delayed hypersensitivity is a type of allergic reaction that results in skin rash.

D) Correct.

Page Ref: 253

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7) When the IgE antibodies bind with the membranes of basophils and mast cells, these cells causing the release of histamine and other substances.

A) Degranulate B) Sensitize C) Mature D) Apoptosize Answer: A Explanation: A) Correct.

B) Sensitization refers to the initial exposure to an allergen.

C) Cells are already mature at this point.

D) Refers to cellular death.

Page Ref: 253 8) When released, histamine causes all of the following EXCEPT: A) Bronchodilation.

B) Vasodilation.

C) Increased vascular permeability.

D) Increased intestinal motility.

Answer: A Explanation: A) Histamine causes bronchoconstriction.

B) Histamine release results in localized vasodilation.

C) Histamine release results in increased vascular permeability.

D) Histamine release results in increased intestinal motility.

Page Ref: 253 9) A substance that is released by basophils and MAST cells that potentiates the effects of histamine causing spasm of the bronchioles is called: A) Hymenoptera.

B) Slow-reacting substance of anaphylaxis.

C) Delayed hypersensitivity.

D) Angioneurotic edema.

Answer: B Explanation: A) Hymenoptera is a classification of insects that includes wasps and bees.

B) Correct.

C) Delayed hypersensitivity is a type of allergic reaction most often resulting in skin rash.

D) Angioneurotic edema is marked edema of the skin, most often affecting the face, neck, and airways.

Page Ref: 254

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10) Initial treatment of mild to moderate allergic reactions in the field involves the administration of .

A) Parasympathomimetics B) Vasodilators C) Sympathomimetics D) Cholinergics Answer: C Explanation: A) Parasympathomimetics have no use in the initial treatment of allergic reactions.

B) Vasodilators would cause a further decrease in blood pressure and may result in shock.

C) Correct.

D) Cholinergics (parasympathomimetics) have no use in the initial treatment of allergic reactions.

Page Ref: 254 11) In cases of severe anaphylaxis involving hypotension and severe bronchoconstriction, the paramedic should consider the administration of _ as initial therapy.

A) Epinephrine 1:1000 intramuscularly B) Corticosteroids C) Epinephrine 1:10,000 intravenously D) Diphenhydramine intravenously Answer: C Explanation: A) While epinephrine 1:1000 intramuscularly may be useful in allergic reactions, it may not act fast enough in severe anaphylaxis.

B) Corticosteroids are utilized for the later effects of an allergic reaction.

C) Correct.

D) Diphenhydramine is useful, but epinephrine is more useful initially for life-threatening reactions.

Page Ref: 255 12) Following the administration of epinephrine during an allergic reaction, which of the following would you NOT expect to observe from your patient?

A) Hypotension B) Tachycardia C) Anxiety D) Palpitations Answer: A Explanation: A) Epinephrine causes vasoconstriction which will elevate blood pressure and the paramedic would most likely see hypertension.

B) Tachycardia would be experienced following epinephrine administration.

C) Anxiety is a side effect of epinephrine.

D) palpitations are expected following administration of epinephrine.

Page Ref: 256

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13) You are treating a patient suffering from severe anaphylaxis. Which of the following dosages of epinephrine would you be likely to administer?

A) Epinephrine 1:1000, 0.3-0.5 mg IM B) Epinephrine 1:1000, 0.3-0.5 mg IV C) Epinephrine 1:10,000, 0.3-0.5 mg IV D) Epinephrine 1:10,000, 0.05-0.1 mg IV Answer: D Explanation: A) In cases of severe anaphylaxis, the dosage of epinephrine 1:10,000 should be 0.05-0.1 mg intravenously. This is 5-10% of the normal dosage used in cardiac arrest. It may need to be administered every 3-5 minutes due to the half-life.

B) In cases of severe anaphylaxis, the dosage of epinephrine 1:10,000 should be 0.05-0.1 mg intravenously. This is 5-10% of the normal dosage used in cardiac arrest. It may need to be administered every 3-5 minutes due to the half-life.

C) In cases of severe anaphylaxis, the dosage of epinephrine 1:10,000 should be 0.05-0.1 mg intravenously. This is 5-10% of the normal dosage used in cardiac arrest. It may need to be administered every 3-5 minutes due to the half-life.

D) In cases of severe anaphylaxis, the dosage of epinephrine 1:10,000 should be 0.05-0.1 mg intravenously. This is 5-10% of the normal dosage used in cardiac arrest. It may need to be administered every 3-5 minutes due to the half-life.

Page Ref: 256 14) is the antihistamine MOST commonly used in the treatment of allergic reactions in the prehospital realm.

A) Diphenhydramine B) Hydroxyzine C) Promethazine D) Cimetidine Answer: A Explanation: A) Correct.

B) Hydroxyzine is a potent antihistamine that is only administered intramuscularly.

C) Promethazine has many undesirable effects when used in the prehospital realm.

D) Cimetidine is a selective H2 blocker and not commonly used.

Page Ref: 257 15) The dosage of Benadryl when used to treat allergic reactions is: A) 25-50 mg IV/IM. B) 0.5-1.0 mg IV. C) 2.5-5.0 mg IV/IM. D) 50-100 mcg IV/IM. Answer: A Explanation: A) The dose of Benadryl in allergic reactions is 25-50 mg IV/IM. B) The dose of Benadryl in allergic reactions is 25-50 mg IV/IM. C) The dose of Benadryl in allergic reactions is 25-50 mg IV/IM. D) The dose of Benadryl in allergic reactions is 25-50 mg IV/IM. Page Ref: 258

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16) Corticosteroids are used to treat: A) The initial response of an allergic reaction.

B) The effects of bronchoconstriction.

C) Vasodilation caused by histamine release.

D) The secondary inflammatory response of an allergic reaction.

Answer: D Explanation: A) Epinephrine is used during the initial response of an allergic reaction.

B) Sympathomimetics are used to combat the effects of bronchoconstriction.

C) Vasodilation is treated with sympathomimetics.

D) Correct.

Page Ref: 258 17) Which of the following medications should the paramedic consider if the effects of anaphylaxis are NOT being reversed after initial therapy with epinephrine?

A) Methylprednisolone B) Diphenhydramine C) Dopamine D) Promethazine Answer: C Explanation: A) Corticosteroids have little benefit in the acute phase of an anaphylactic reaction.

B) While antihistamines may be useful, in severe anaphylaxis, the use of vasopressors is indicated.

C) Correct.

D) While antihistamines may be useful, in severe anaphylaxis, the use of vasopressors is indicated.

Page Ref: 262 18) Which of the following medications may be useful in treating the effects of bronchoconstriction in a patient with an allergic reaction?

A) Hydrocortisone B) Proventil C) Intal D) Dopamine Answer: B Explanation: A) Steroids are most helpful in the secondary, inflammatory phase of an allergic reaction.

B) Correct.

C) Intal is a preventative medication and not indicated for the acute management of an allergic reaction.

D) Dopamine is a potent vasopressor reserved for anaphylaxis refractory to epinephrine.

Page Ref: 262

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Prehospital Emergency Pharmacology, 8e (Bledsoe/Clayden) Chapter 10 Medications Used in the Treatment of Metabolic–Endocrine Emergencies 1) cells of the pancreas secrete a hormone called glucagon.

A) Alpha B) Beta C) Charlie D) Delta Answer: A Explanation: A) Correct.

B) Beta cells secrete insulin.

C) There are no Charlie cells in the pancreas.

D) Delta cells of the pancreas secrete somatostatin.

Page Ref: 265 2) In response to increasing levels of blood sugar in the blood, is secreted by the pancreas in order to control blood sugar levels.

A) Glucagon B) Somatostatin C) Thyroxine D) Insulin Answer: D Explanation: A) Glucagon is secreted in response to decreasing levels of blood sugar.

B) Somatostatin is an inhibitory hormone secreted that inhibits the secretion of both insulin and glucagon.

C) Thyroxine is a not related to blood sugar.

D) Correct.

Page Ref: 265 3) Normal fasting blood sugar readings are between: A) 40-50 mg/dL. B) 50-80 mg/dL. C) 80-100 mg/dL. D) 100-120 mg/dL. Answer: C Explanation: A) Normal fasting blood sugars are typically between 80-100 mg/dL. B) Normal fasting blood sugars are typically between 80-100 mg/dL. C) Normal fasting blood sugars are typically between 80-100 mg/dL. D) Normal fasting blood sugars are typically between 80-100 mg/dL. Page Ref: 265

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4) A type of diabetes that typically develops later in life and is related to age, genetics, and obesity is known as: A) Type I diabetes.

B) Type II diabetes.

C) Hypoglycemia.

D) Hyperosmotic hyperglycemia.

Answer: B Explanation: A) Type I diabetes is typically referred to as "juvenile diabetes" and develops at or shortly after birth.

B) Correct.

C) Hypoglycemia is a diabetic emergency related to low blood sugar.

D) HHNK is a diabetic emergency that results from prolonged increased blood sugar levels.

Page Ref: 267 5) Constant thirst, excessive eating, excessive urination and weakness are symptoms MOST likely associated with: A) Hypoglycemia.

B) Hyperglycemia.

C) Type I diabetes.

D) Type II diabetes.

Answer: B Explanation: A) Hypoglycemia is referred to as "insulin shock" and associated with rapidly decreasing level of consciousness.

B) Correct.

C) Type I diabetes is a condition in which insulin is not produced or not produced in sufficient quantities to maintain blood glucose levels. Either hypo-or hyperglycemia may result.

D) Type II diabetes results later in life due to age, genetics, or obesity and may result in either hypo-or hyperglycemia.

Page Ref: 265 6) A diabetic condition resulting from a profound decrease in insulin activity as well as an increase in glucagon activity is called: A) Diabetic ketoacidosis.

B) Hypoglycemia.

C) Insulin shock.

D) Gluconeogenesis.

Answer: A Explanation: A) Correct.

B) Hypoglycemia results for an increase in insulin activity.

C) Insulin shock is hypoglycemia.

D) Gluconeogenesis is a term referring to the new production of glucose.

Page Ref: 268

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7) A respiratory pattern characterized by rapid, deep breathing in which the body attempts to expel large amounts of carbon dioxide to balance pH levels is/are known as: A) Central neurogenic hyperventilation.

B) Hypoventilation.

C) Biot's respirations.

D) Kussmaul's respirations.

Answer: D Explanation: A) Central neurogenic hyperventilation is a condition resulting from head injuries and increasing ICP. Although it closely resembles Kussmaul's, the underlying condition is different.

B) Hypoventilation is a decreased respiratory rate.

C) Biot's respirations are irregular, gasping respirations.

D) Correct.

Page Ref: 268 8) Treatment of hyperglycemia should focus on: A) Administration of dextrose 50%.

B) Administration of large amounts of insulin.

C) Fluid administration for dehydration.

D) Administration of glucagon to decrease blood sugar levels.

Answer: C Explanation: A) Dextrose would further elevate blood sugar levels.

B) Insulin is not administered in the field and must be carefully administered according to patient need.

C) Correct.

D) Glucagon would cause an increase in blood sugar levels.

Page Ref: 269 9) Which of the following statements regarding hyperosmolar hyperglycemic state is INCORRECT? A) Typically, blood sugar readings in excess of 600 mg/dL or more may be obtained.

B) A significant production of ketone bodies is produced.

C) Dehydration may become a dire emergency in these situations.

D) The onset is very slow.

Answer: B Explanation: A) True.

B) Because insulin production is present, significant ketone bodies do not develop.

C) True.

D) True.

Page Ref: 269

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10) You are treating a patient who is unconscious and unresponsive following administration of home insulin an hour before. The patient is cool, pale, and diaphoretic. The pulse is rapid and thready. Which of the following treatments is MOST likely to be beneficial to the patient?

A) Administration of insulin to stimulate circulating glucose to enter the cells B) Administration of large volumes of normal saline to combat the shock symptoms C) Administration of dextrose 50% D) Close monitoring of the patient while allowing the insulin the patient has already used to take effect Answer: C Explanation: A) Further administration of insulin would be detrimental to this patient.

B) While the patient is experiencing symptoms of "insulin shock," glucose is most correct to combat the symptoms.

C) Correct.

D) Allowing time to pass would further cause the glucose in the bloodstream to decrease which may result in brain death due to lack of glucose.

Page Ref: 270 11) If it is determined that insulin is to be used in the field following the administration of fluids for diabetic ketoacidosis, the standard dosage of regular insulin is: A) 5-10 units administered IV. B) An infusion of 5 units per minute.

C) 0.5-1.0 units subcutaneously.

D) Insulin should never be administered in the prehospital setting.

Answer: A Explanation: A) The standard dosage of insulin, if necessary, is 5-10 units of regular insulin administered IV, followed by an infusion of 0.1 unit/kg/hour.

B) The standard dosage of insulin, if necessary, is 5-10 units of regular insulin administered IV, followed by an infusion of 0.1 unit/kg/hour.

C) The standard dosage of insulin, if necessary, is 5-10 units of regular insulin administered IV, followed by an infusion of 0.1 unit/kg/hour.

D) The standard dosage of insulin, if necessary, is 5-10 units of regular insulin administered IV, followed by an infusion of 0.1 unit/kg/hour.

Page Ref: 274 12) You are at the scene of a patient who has attempted suicide by taking a large amount of metoprolol, a beta-blocking agent. After initial care of the airway, breathing, and circulation, you should consider the administration of: A) Lidocaine to suppress potential ventricular ectopy.

B) Insulin to decrease circulating glucose.

C) Epinephrine to antagonize the beta-blocking effects of metoprolol.

D) Glucagon as an antidote.

Answer: D Explanation: A) Glucagon is indicated in beta-blocker or calcium channel blocker overdose.

B) Glucagon is indicated in beta-blocker or calcium channel blocker overdose.

C) Glucagon is indicated in beta-blocker or calcium channel blocker overdose.

D) Glucagon is indicated in beta-blocker or calcium channel blocker overdose.

Page Ref: 275 4

13) Which of the following is a contraindication to the use of dextrose 50%?

A) Hyperglycemia B) Hypoglycemia C) Inability to obtain a blood glucose reading in an unconscious patient D) There are no contraindications to the use of dextrose 50% in suspected hypoglycemia.

Answer: D Explanation: A) The administration of dextrose to a patient who is hyperglycemic will not worsen the condition.

B) D50 is indicated in hypoglycemia.

C) If unsure of the blood sugar, dextrose 50% should be administered.

D) Correct. There are no contraindications when hypoglycemia is suspected.

Page Ref: 277 14) Caution should be used when administering dextrose to a patient due to: A) Causing a further increase in blood sugar.

B) Tissue necrosis at the IV site if infiltration occurs.

C) A paroxysmal decrease in the blood sugar if insulin deficiency exists.

D) Diabetic ketoacidosis.

Answer: B Explanation: A) An increase in blood sugar is the desired effect. However, if sugar levels are increased at time of administration, D50 will still not harm the patient.

B) Correct.

C) Not true.

D) Administration of dextrose will not harm the patient suffering from DKA. Page Ref: 277 15) A vitamin essential to the conversion of glucose is .

A) Thiamine B) Calcium C) Magnesium D) Vitamin C Answer: A Explanation: A) Thiamine is a vitamin essential to the conversion of glucose to energy.

B) Thiamine is a vitamin essential to the conversion of glucose to energy.

C) Thiamine is a vitamin essential to the conversion of glucose to energy.

D) Thiamine is a vitamin essential to the conversion of glucose to energy.

Page Ref: 277

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16) interferes with the absorption, intake, and use of thiamine.

A) Hypoglycemia B) Hyperglycemia C) Chronic alcoholism D) Beta-blocker overdose Answer: C Explanation: A) Chronic alcoholism interferes with the absorption, intake, and use of thiamine.

Prior to the administration of glucose, thiamine should be administered.

B) Chronic alcoholism interferes with the absorption, intake, and use of thiamine. Prior to the administration of glucose, thiamine should be administered.

C) Chronic alcoholism interferes with the absorption, intake, and use of thiamine. Prior to the administration of glucose, thiamine should be administered.

D) Chronic alcoholism interferes with the absorption, intake, and use of thiamine. Prior to the administration of glucose, thiamine should be administered.

Page Ref: 277

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Prehospital Emergency Pharmacology, 8e (Bledsoe/Clayden) Chapter 11 Medications Used in the Treatment of Neurological Emergencies 1) The primary initial treatment in the management of either blunt or penetrating trauma to the head is: A) High-dose steroid treatment.

B) Supportive care of the airway, breathing, and circulation.

C) Mannitol.

D) Furosemide.

Answer: B Explanation: A) High-dose steroid therapy, although once a treatment modality, is no longer recommended.

B) Correct.

C) Mannitol, an osmotic diuretic, may be useful, but supportive care is more important in the initial management.

D) Furosemide is not indicated in the treatment of blunt or penetrating trauma of the head.

Page Ref: 283 2) Mannitol, an osmotic diuretic, exerts its actions by: A) Stimulating the kidneys to remove sodium and water from the circulation reducing circulating volume.

B) Drawing fluid from the intracellular space to the extracellular space.

C) Decreasing circulating volume in the intravascular space.

D) Promoting hemostasis of broken blood vessels.

Answer: B Explanation: A) This affect describes the effects of furosemide, a loop diuretic.

B) Correct.

C) Mannitol causes a transient increase in circulating volume by drawing fluid into the vascular (extracellular) space.

D) Mannitol does not promote hemostasis.

Page Ref: 284 3) Status epilepticus can BEST be described as: A) A continuous seizure lasting for 30 minutes or more without an intervening period of consciousness.

B) A generalized tonic-clonic seizure.

C) A seizure characterized by prolonged postictal phases followed by a brief period of consciousness.

D) More than two seizures in one day.

Answer: A Explanation: A) Correct.

B) Generalized tonic-clonic seizure is a type of seizure with tonic, clonic, and postictal phases.

C) A defining characteristic of status epilepticus is that there is no intervening period of consciousness.

D) Status epilepticus more correctly refers to a continuous seizure.

Page Ref: 285 1

4) Which of the statements BEST describes a partial, or focal, seizure?

A) Simple partial seizures are localized and do not pose a significant threat to the neurological system.

B) Partial seizures involve a period of rigidity followed by convulsive activity and flaccidity until the patient gradually returns to consciousness.

C) Simple partial seizures are referred to as absence seizures.

D) Simple partial seizures are described in terms of alterations in consciousness or behavior.

Answer: D Explanation: A) Although not as dramatic as a general seizure, partial seizures left untreated pose a significant threat to the neurological system.

B) This answer best describes a, generalized grand-mal seizure.

C) An absence seizure is a generalized seizure.

D) Correct.

Page Ref: 285 5) You are at the scene of a patient with a decreased level of consciousness that is having repetitive twitching of the left arm. This type of activity is BEST described as a/an: A) Generalized tonic-clonic seizure.

B) Status epilepticus.

C) Complex, partial seizure.

D) Absence seizure.

Answer: C Explanation: A) This is a generalized seizure.

B) Status epilepticus is best described as two or more seizures, or a seizure lasting 30 minutes or more, without an intervening period of consciousness.

C) Correct.

D) An absence seizure is a generalized seizure.

Page Ref: 285 6) Which of the following medications inhibit the influx of sodium into the cells decreasing the ability of the cell to depolarize and propagate seizures?

A) Phenytoin (Dilantin) B) Diazepam (Valium) C) Lorazepam (Ativan) D) Gabapentin (Neurontin) Answer: A Explanation: A) Correct.

B) Diazepam is a benzodiazepine that interacts with GABA receptors producing an inhibitory response.

C) Lorazepam is a benzodiazepine that interacts with GABA receptors producing an inhibitory response.

D) Gabapentin interacts with GABA receptors.

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7) Which of the following statements regarding the use of benzodiazepines is INCORRECT? A) Benzodiazepines are primarily used for skeletal muscle relaxation, preprocedure sedation, and anticonvulsant activity.

B) Benzodiazepines have an onset of action of 1-5 minutes when given parenterally.

C) Benzodiazepines act on the CNS by interacting with GABA receptor sites.

D) Benzodiazepines are dangerous to the patient and should be used with extreme caution due to a narrow therapeutic index.

Answer: D Explanation: A) This choice is a correct statement.

B) This choice a correct statement.

C) This choice is a correct statement.

D) Correct. Benzodiazepines may be used safely in the prehospital setting because of their effectiveness and safety.

Page Ref: 286 8) is an antidote for benzodiazepine overdose and should be available when benzodiazepines are used.

A) Flumazenil (Romazicon) B) Naloxone (Narcan) C) Sodium bicarbonate D) Dextrose 50% (D50) Answer: A Explanation: A) Correct.

B) Naloxone is a narcotic antagonist.

C) Sodium bicarbonate is an alkalinizing agent and is useful in barbiturate overdose.

D) Dextrose 50% is used for hypoglycemia.

Page Ref: 287 9) You are treating a patient who is experiencing status epilepticus. After initial management of the airway, breathing, and circulation, which of the following treatment modalities is MOST correct?

A) Mannitol, 1.5-2.0 g/kg IV B) Diazepam 5-10 mg IV C) Romazicon 0.2 mg IV D) Naloxone 0.2-0.4 mg IV Answer: B Explanation: A) Mannitol is an osmotic diuretic used in head trauma.

B) Correct.

C) Romazicon is an antagonist used for benzodiazepine overdose.

D) Naloxone is a narcotic antagonist used for narcotic overdose.

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10) Prior to cardioversion, lorazepam may be given because: A) It produces an amnesia-like effect.

B) It is an effective pain medication.

C) It will prevent any seizure activity that may result from the procedure.

D) It is an effective antiarrhythmic.

Answer: A Explanation: A) Correct.

B) Benzodiazepines are not indicated for pain.

C) Although lorazepam may be indicated for seizures, its use as a preprocedure medication in cardioversion is for its amnesia effects.

D) Lorazepam does not have antiarrhythmic effects.

Page Ref: 288 11) You have administered two doses of diazepam for a patient who is experiencing generalized seizures but the medication is ineffective at stopping the seizure. You should consider the administration of which of the following?

A) Romazicon to reverse the effects of the benzodiazepines.

B) Reducing the dosage of diazepam for subsequent doses.

C) Consider the administration of phenytoin.

D) No further treatment is necessary.

Answer: C Explanation: A) Reversal is not indicated.

B) Reducing the dosage would not be beneficial.

C) Correct.

D) Allowing the seizure activity to continue would be harmful to the patient.

Page Ref: 291 12) In addition to its anticonvulsant activity, phenytoin is also indicated in the treatment of cardiac arrhythmias due to: A) Hypoxia.

B) Benzodiazepine overdose.

C) Narcotic overdose.

D) Digitalis toxicity.

Answer: D Explanation: A) Hypoxia should be treated with ventilation and oxygenation.

B) Benzodiazepine overdose should be treated with Romazicon.

C) Narcotic overdose should be managed with naloxone.

D) Correct.

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13) When administering Dilantin, you should give it: A) Rapidly, 50 mg over 15 seconds.

B) Diluted with dextrose 5% in water (D5W) over 10 minutes.

C) No faster than 50 mg/min, with a loading dose of 10-20 mg/kg.

D) 50 mg/min IM injection only.

Answer: C Explanation: A) Dilantin should be administered slowly.

B) Dilantin should be administered in saline only as precipitate will form if dextrose containing solutions are used.

C) Correct.

D) In the prehospital setting, Dilantin should be given intravenously.

Page Ref: 292 14) The half-life of phenobarbitol is: A) 1-2 hours.

B) 10-12 hours.

C) 24-48 hours.

D) 2-6 days.

Answer: D Explanation: A) Phenobarbitol is a long-acting anticonvulsant with a half-life of 2-6 days.

B) Phenobarbitol is a long-acting anticonvulsant with a half-life of 2-6 days.

C) Phenobarbitol is a long-acting anticonvulsant with a half-life of 2-6 days.

D) Phenobarbitol is a long-acting anticonvulsant with a half-life of 2-6 days.

Page Ref: 293 15) A common precaution to the use of anticonvulsant medications is: A) The effects of alcohol will potentiate the effects of the medication given, therefore the paramedic should use with caution if alcohol use is suspected.

B) Benzodiazepine medications have a very narrow therapeutic index and should be used sparingly in the prehospital setting to avoid overdosage.

C) The effects of anticonvulsant medications can be antagonized utilizing naloxone, therefore, they should only be used if naloxone is on hand.

D) Only a single dose of anticonvulsant medications should be used due to the long half-life of the medications.

Answer: A Explanation: A) Correct.

B) Benzodiazepines have a wide therapeutic index and may be used with a relative degree of safety.

C) Naloxone is a narcotic antagonist and will not have any effect on anticonvulsant medications.

D) It may be necessary to administer repeat doses of anticonvulsants. Not all anticonvulsants have a long half-life.

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Prehospital Emergency Pharmacology, 8e (Bledsoe/Clayden) Chapter 12 Medications Used in the Treatment of Obstetrical and Gynecological Emergencies 1) As a general rule, when treating any woman of childbearing age, you should: A) Reduce all dosages of medications to avoid complications.

B) Increase most medication doses due to an increase in body fat percentage.

C) Until proven otherwise, you should consider the patient to be pregnant.

D) Not administer any medications to a woman of childbearing age.

Answer: C Explanation: A) Medications are not dosed according to the patient's sex.

B) Dosages should be dosed according to body weight or therapeutic dose of a particular medication.

C) Correct.

D) Although the potential for a patient to be pregnant exists, the paramedic must weigh the risk versus benefit of administering a medication.

Page Ref: 299 2) According to FDA classification of medications for use in pregnant women, a medicine that will pose harm to the fetus and the risk of using such medication outweighs the possible benefit to the mother would receive a classification of .

A) A B) B C) C D) X Answer: D Explanation: A) Adequate studies demonstrate no risk to the fetus in the first or later trimesters.

B) Animal studies have not demonstrated a risk to the fetus, but there are not adequate studies in pregnant women.

C) Animal studies have demonstrated adverse effects; however, the benefits may outweigh the risk.

D) Correct.

Page Ref: 300 3) A/An medication may potentially deform, injure, or kill a developing fetus.

A) Teratogenic B) Gestational C) Eclamptic D) FDA Class A Answer: A Explanation: A) Correct.

B) Gestational refers to the time of fetal development in the womb.

C) Eclampsia is a toxic condition of pregnancy.

D) A class A medication has been shown to be safe to administer.

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4) has proven effective in the management of convulsions related to eclampsia (toxemia of pregnancy).

A) Diazepam B) Magnesium sulfate C) Phenobarbitol D) Phenytoin Answer: B Explanation: A) Diazepam is indicated for seizures, but not in the case of eclampsia.

B) Correct.

C) While phenobarbitol is indicated in seizures, magnesium sulfate is the drug of choice in eclampsia.

D) Phenytoin is not indicated in convulsions due to eclampsia.

Page Ref: 301 5) Which of the following is NOT a sign/symptom of hypertensive disorder of pregnancy?

A) Hypotension B) Seizures C) Protein in the urine D) Edema Answer: A Explanation: A) Correct. HYPERtension is a symptom.

B) Seizures may be present in hypertensive disorder of pregnancy.

C) Protein in the urine is consistent with hypertensive disorder of pregnancy.

D) Edema is consistent with hypertensive disorder of pregnancy.

Page Ref: 301 6) You are treating a patient who is in her third trimester of pregnancy who is having seizures.

Family members report that the patient had been complaining of headaches, visual disturbances, epigastric pain, and had become edematous over the past week. You think that the patient is MOST likely suffering from .

A) Epilepsy B) Cardiac arrest C) Placenta previa D) Eclampsia Answer: D Explanation: A) Although seizures are characteristic of pregnancy, this patient symptoms are most likely the result of eclampsia (toxemia) of pregnancy.

B) There is no indication that this patient is suffering from cardiac arrest.

C) Placenta previa is characterized by bright-red vaginal bleeding.

D) Correct. The presence of a seizure indicates the progression from pre-eclampsia to eclampsia.

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7) All of the following are risk factors for hypertensive disorders of pregnancy EXCEPT: A) More than one fetus.

B) First pregnancy.

C) Diabetes.

D) Previous history of hypertension.

Answer: A Explanation: A) Correct.

B) A first pregnancy is considered a risk factor.

C) Diabetes is considered a risk factor.

D) Hypertension is a risk factor.

Page Ref: 301 8) Magnesium sulfate is contraindicated in patients who have: A) Seizures due to eclampsia.

B) Multifocal ventricular tachycardia (torsades des points).

C) Heart blocks.

D) Preterm labor.

Answer: C Explanation: A) MS is indicated in seizures due to eclampsia.

B) MS is indicated in torsades des pointes.

C) Correct. MS is contraindicated in heart blocks.

D) MS is indicated in preterm labor due to its smooth muscle relaxation.

Page Ref: 302 9) The MOST common cause of vaginal bleeding in the third trimester of pregnancy is: A) Spontaneous abortion.

B) Placenta previa.

C) Ectopic pregnancy.

D) Pre-eclampsia.

Answer: B Explanation: A) Spontaneous abortion is most common in the first trimester of pregnancy.

B) Correct.

C) Ectopic pregnancy is a first trimester emergency.

D) Pre-eclampsia is not a common cause of vaginal bleeding.

Page Ref: 303 10) is a naturally occurring hormone released by the posterior pituitary gland.

A) Oxytocin B) Thyroxine C) Adrenalin D) Norepinephrine Answer: A Explanation: A) Correct.

B) Thyroxine is released by the thyroid.

C) Adrenalin is released by the adrenal gland.

D) Norepinephrine is a neurotransmitter released at neuronal synapses.

Page Ref: 303 3

11) Which of the following dosing regimens of Oxytocin is CORRECT? A) Administer 10 mg by intramuscular injection.

B) Administer 10 units in 500 cc of normal saline in order to promote delivery of the fetus.

C) Administer 10 units IV bolus following delivery of the fetus.

D) Administer 10 units in 500 cc of normal saline titrated according to severity of bleeding and uterine response.

Answer: D Explanation: A) Oxytocin can be administered intramuscularly in 3-10 unit increments following delivery of the placenta, or by preparing 10-20 units in 500 or 1000 mL of normal saline or lactated Ringer's titrated according to severity of bleeding and uterine response.

B) Oxytocin can be administered intramuscularly in 3-10 unit increments following delivery of the placenta, or by preparing 10-20 units in 500 or 1000 mL of normal saline or lactated Ringer's titrated according to severity of bleeding and uterine response.

C) Oxytocin can be administered intramuscularly in 3-10 unit increments following delivery of the placenta, or by preparing 10-20 units in 500 or 1000 mL of normal saline or lactated Ringer's titrated according to severity of bleeding and uterine response.

D) Oxytocin can be administered intramuscularly in 3-10 unit increments following delivery of the placenta, or by preparing 10-20 units in 500 or 1000 mL of normal saline or lactated Ringer's titrated according to severity of bleeding and uterine response.

Page Ref: 304 12) Stimulation of receptors in the uterus causes uterine relaxation and suppression of the preterm labor.

A) Alpha1 B) Alpha2 C) Beta1 D) Beta2 Answer: D Explanation: A) Alpha1 stimulation causes vasoconstriction.

B) Alpha2 causes vasodilation.

C) Beta1 receptors are found in the heart and increase force, rate, and contractility.

D) Correct.

Page Ref: 304 13) A medication that causes cessation of uterine contractions is said to be a/an .

A) Teratogenic B) Tocolytic C) Sympathetic D) Adrenergic Answer: B Explanation: A) Teratogenic medications may potentially deform, injure or kill the fetus.

B) Correct.

C) Sympathetic refers to a specific nervous system response.

D) Adrenergic drugs relate to the sympathetic nervous system.

Page Ref: 304 4

14) Beta2 Terbutaline causes: A) Bronchodilation and uterine contraction.

B) Bronchoconstriction and uterine contraction.

C) Bronchodilation and uterine relaxation.

D) Bronchoconstriction and uterine relaxation.

Answer: C Explanation: A) Beta2 stimulation causes bronchodilation and uterine relaxation while exerting minimal effects on the cardiovascular system.

B) Beta2 stimulation causes bronchodilation and uterine relaxation while exerting minimal effects on the cardiovascular system.

C) Beta2 stimulation causes bronchodilation and uterine relaxation while exerting minimal effects on the cardiovascular system.

D) Beta2 stimulation causes bronchodilation and uterine relaxation while exerting minimal effects on the cardiovascular system.

Page Ref: 305 15) When administering terbutaline in the prehospital setting, the paramedic should give it by: A) Subcutaneous injection.

B) Intravenous injection.

C) Intramuscular injection.

D) Rapid intravenous injection.

Answer: A Explanation: A) Correct.

B) Terbutaline can be given by infusion, but not as a bolus injection.

C) Terbutaline should not be given by IM injection.

D) Terbutaline can be given by infusion, but not as a bolus injection and if given by infusion, should be given slowly.

Page Ref: 306

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Prehospital Emergency Pharmacology, 8e (Bledsoe/Clayden) Chapter 13 Medications Used in Toxicological Emergencies 1) When evaluating the patient with suspected toxic exposure, the paramedic should consider: A) Contacting the EMS director for advice regarding potential antidotes.

B) Establishing contact with a regional poison center early for advice.

C) Administering the "coma cocktail" to cover the potential of another cause of overdose.

D) If unsure, waiting to administer any antidote until arrival at the medical facility that the patient desires.

Answer: B Explanation: A) The EMS director is not the best source for information. Possibly consider contacting the EMS Medical Director, but that may not always be feasible.

B) Correct.

C) The "coma cocktail" is no longer recommended.

D) Waiting to treat a patient may be detrimental; also, the patient should be transported to a facility capable of handling their problem, which sometimes may not be the patient's choice.

Page Ref: 309 2) Which of the following statements regarding the use of syrup of ipecac is TRUE? A) Syrup of ipecac is indicated in any overdose where the oral ingestion has occurred.

B) Gastric lavage should be performed when ipecac has been administered to remove any residual effects of the ipecac.

C) Routine use of ipecac is no longer recommended due to the potential for aspiration of stomach contents.

D) If using ipecac, activated charcoal should be avoided until the patient has emptied their stomach contents.

Answer: C Explanation: A) SOI is no longer indicated. Also, vomiting of some ingested poisons is contraindicated.

B) Gastric lavage is no longer routinely indicated.

C) Correct.

D) Ipecac is no longer indicated.

Page Ref: 311 3) If gastric lavage is indicated, current guidelines suggest that it should occur within minutes of ingestion.

A) 60 B) 120 C) 180 D) 240 Answer: A Explanation: A) Gastric lavage, if indicated, should occur within 60 minutes of ingestion of toxic substances.

B) Gastric lavage, if indicated, should occur within 60 minutes of ingestion of toxic substances.

C) Gastric lavage, if indicated, should occur within 60 minutes of ingestion of toxic substances.

D) Gastric lavage, if indicated, should occur within 60 minutes of ingestion of toxic substances.

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4) A common toxidrome consisting of decreased level of consciousness, respiratory depression, and miosis involves: A) Anticholinergic overdose.

B) Amphetamine overdose.

C) Cocaine overdose.

D) Opiate overdose.

Answer: D Explanation: A) Anticholinergic overdose can be remembered by the mnemonic, "Hot as hell, blind as a bat, dry as a bone, red as a beet, and mad as a hatter."

B) Amphetamine overdose is characterized by dilated pupils, anxious behavior, and tachypnea.

C) Cocaine overdose is characterized by dilated pupils, anxious behavior, and tachypnea.

D) Correct.

Page Ref: 311 5) The mnemonic DUMBELS is helpful in determining the toxidrome associated with: A) Opiate overdose.

B) Anticholinergic overdose.

C) Cholinergic overdose.

D) Heroin overdose.

Answer: C Explanation: A) There is not a common mnemonic for narcotic overdose.

B) The mnemonic for anticholinergic overdose is, "Hot as hell, blind as a bat, dry as a bone, red as a beet, and mad as a hatter."

C) Correct.

D) There is not a common mnemonic for narcotic overdose.

Page Ref: 312 6) SSRIs, SNRIs, and other antidepressant medications are associated with: A) Serotonin syndrome.

B) Anticholinergic overdose.

C) Sympathomimetic syndrome.

D) Neuroleptic syndrome.

Answer: A Explanation: A) Correct.

B) Anticholinergic overdose is associated with the mnemonic "Hot as hell, blind as a bat, dry as a bone, red as a beet, and mad as a hatter."

C) Sympathomimetic medications include alpha and beta stimulating agents.

D) Neuroleptic medications are associated with antipsychotic medications such as Haldol.

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7) A dose of is predictive of hepatotoxicity in a patient who has overdosed on acetaminophen.

A) 1 gram B) 5 grams C) 7.5 grams D) 0.75 grams Answer: C Explanation: A) A dose of 7.5 grams or greater of acetaminophen is predictive of hepatotoxicity in the average adult patient. Other factors, such as alcohol ingestion may alter this level.

B) A dose of 7.5 grams or greater of acetaminophen is predictive of hepatotoxicity in the average adult patient. Other factors, such as alcohol ingestion may alter this level.

C) A dose of 7.5 grams or greater of acetaminophen is predictive of hepatotoxicity in the average adult patient. Other factors, such as alcohol ingestion may alter this level.

D) A dose of 7.5 grams or greater of acetaminophen is predictive of hepatotoxicity in the average adult patient. Other factors, such as alcohol ingestion may alter this level.

Page Ref: 313 8) Butyrophenones and phenothiazines are members of a classification of medications known as .

A) Narcotics B) Amphetamines C) Neuroleptics D) Anticholinergics Answer: C Explanation: A) Narcotics are opiate based medications.

B) Amphetamines are sympathomimetic medications.

C) Correct.

D) Anticholinergics include: tricyclic antidepressants, antihistamines, phenothiazines, and antiparkinsonian medications.

Page Ref: 315 9) You are treating a patient who has overdosed on a large amount of diazepam and is experiencing profound sedation and respiratory depression. After providing supportive care, you should consider administering which of the following medications?

A) Naloxone B) Flumazenil C) Dextrose D) Sodium bicarbonate Answer: B Explanation: A) Naloxone is a narcotic antagonist.

B) Correct.

C) Dextrose is indicated in hypoglycemia.

D) Sodium bicarbonate is an alkalinizing agent used in barbiturate overdose.

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10) is an antidote for known beta blocker overdose.

A) Glucagon B) Epinephrine C) Dextrose 50% D) Calcium chloride Answer: A Explanation: A) Correct.

B) Epinephrine is indicated in cardiac arrest and anaphylaxis.

C) Dextrose is indicated in hypoglycemia.

D) Calcium chloride is contraindicated when beta blockers have been taken.

Page Ref: 317 11) Which of the following regimens is CORRECT regarding the use of amyl nitrate in the treatment of cyanide overdose?

A) Administer an IV infusion at rate of 100 mEq/hr until symptoms are mitigated.

B) One to two inhalants crushed and inhaled. Repeat every minute until the patient has been delivered to the ED. C) A single ampule should be administered IV bolus.

D) Amyl nitrate is not indicated in cyanide overdose.

Answer: B Explanation: A) Amyl nitrate should not be administered IV. B) Correct.

C) Amyl nitrate should not be administered IV. D) Amyl nitrate is indicated in cyanide overdose.

Page Ref: 321 12) The contains sodium thiosulfate, sodium nitrate, and amyl nitrate and is useful in the treatment of cyanide poisoning.

A) Pasadena Cyanide Antidote Kit B) Cyanokit C) Cyclic Antidote Kit D) California Cyanide Antidote Answer: A Explanation: A) Correct.

B) The Cyanokit contains hydroxocobalamin, a chemical precursor to B-12.

C) No such kit exists.

D) No such kit exists.

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13) The hallmark of tricyclic antidepressant overdose is: A) Respiratory depression.

B) Lethargy.

C) Nausea and vomiting.

D) Cardiac arrhythmias.

Answer: D Explanation: A) This is characteristic of opiate overdose.

B) Lethargy is present with many overdose situations and is not specific.

C) Nausea and vomiting is present with many orally ingested toxins.

D) Correct.

Page Ref: 326 14) The paramedic should maintain a high index of suspicion of digitalis overdose because digitalis: A) Causes respiratory depression.

B) Is frequently abused.

C) Has a narrow therapeutic index.

D) Is commonly prescribed for bradycardia and may worsen the situation.

Answer: C Explanation: A) This is not a common side effect of digitalis.

B) Digitalis is not categorized as a drug of abuse.

C) Correct.

D) Digitalis is prescribed to help control rapid ventricular rates associated with atrial fibrillation.

Page Ref: 328 15) Which of the following statements regarding the use of naloxone is FALSE? A) Naloxone competes for opiate receptor sites.

B) Naloxone antagonizes the effects of opiates.

C) Naloxone displaces narcotic molecules from receptor sites.

D) Naloxone is effective in reversing respiratory depression associated with diazepam overdose.

Answer: D Explanation: A) This is true regarding naloxone.

B) This is true regarding naloxone.

C) This is true regarding naloxone.

D) Correct. Naloxone is an opioid antagonist and will not have an effect on benzodiazepines.

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16) The dosage of naloxone when treating suspected narcotic overdose is: A) 0.1-0.2 mg IV bolus.

B) 1-2 mg IV bolus.

C) 1-2 mcg/kg IV. D) 10-20 mg IV bolus.

Answer: B Explanation: A) Dosage of Narcan when treating suspected narcotic overdose is 1-2 mg IV/IO. B) Dosage of Narcan when treating suspected narcotic overdose is 1-2 mg IV/IO. C) Dosage of Narcan when treating suspected narcotic overdose is 1-2 mg IV/IO. D) Dosage of Narcan when treating suspected narcotic overdose is 1-2 mg IV/IO. Page Ref: 335 17) are present in commercial insecticides and although rare, toxic exposures may prove to be fatal.

A) Narcotics B) Tricyclic antidepressants C) Organophosphates D) Carbamazepines Answer: C Explanation: A) Narcotics are not found in insecticides.

B) Tricyclic antidepressants are not found insecticides.

C) Correct.

D) Carbamazepines are not found in insecticides.

Page Ref: 335 18) You are treating a farm worker who has been found unconscious after becoming soaked in a pesticide that he was using on his fields. The exposure occurred earlier in the day. The patient presents with excessive salivation, tearing, constricted pupils, hypotension, and bradycardia.

After initial supportive treatments have been rendered, which of the following would the paramedic MOST likely administer?

A) Atropine sulfate, 1 mg initially, repeated every 1 5 minutes; up to 100 mg may be administered to this patient.

B) Pasadena Cyanide Kit should be administered as directed.

C) Epinephrine 1 mg, every 3-5 minutes IVP. D) Naloxone 1-2 mg repeated every 5 minutes until cessation of bradycardia.

Answer: A Explanation: A) Correct.

B) The Pasadena Cyanide Kit should be administered in suspected cyanide overdose. This overdose is most likely organophosphate poisoning.

C) Epinephrine is administered in situations involving cardiac arrest and anaphylaxis.

D) Naloxone is used in suspected narcotic overdose.

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19) is useful in the treatment of organophosphate poisoning because it chemically removes the phosphate group that was transferred from the organophosphate.

A) Atropine B) Cyanokit C) Pralidoxime D) Norepinephrine Answer: C Explanation: A) Atropine is useful in reversing the bradycardia associated with organophosphate poisoning.

B) The Cyanokit is useful in treating cyanide poisoning.

C) Correct.

D) Norepinephrine is used as a vasopressor in severe hypotension not due to hypovolemia.

Page Ref: 338

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Prehospital Emergency Pharmacology, 8e (Bledsoe/Clayden) Chapter 14 Medications Used in the Treatment of Behavioral Emergencies 1) causes are behavioral problems that arise from within a person resulting from an acute manifestation of an underlying illness.

A) Organic B) Situational C) Intrapsychic D) Environmental Answer: C Explanation: A) Organic causes results from a disturbance in the patient's chemical or physical state.

B) Situational causes are related to events that occur outside the patient's control.

C) Correct.

D) Environmental causes are related to events that occur outside the patient's control.

Page Ref: 346 2) causes of behavioral emergencies typically can be linked to a specific incident or series of events.

A) Interpersonal B) Organic C) Intrapsychic D) Excited delirium Answer: A Explanation: A) Correct.

B) Organic causes result from a disturbance in the patient's biochemical or physical state.

C) Intrapsychic causes arise from a person resulting from an acute manifestation of an underlying illness.

D) Excited delirium results from either a psychotic episode and/or intoxication with drugs.

Page Ref: 347 3) When treating behavioral emergencies, it is important to remember that: A) Many behavioral illness emergencies involve conditions that are not treatable.

B) All behavioral emergencies are treated in the same manner with chemical or physical restraint.

C) Most behavioral illness emergencies are minor and do not require emergency medical service treatment or transport.

D) Many behavioral emergencies have a metabolic and treatable cause.

Answer: D Explanation: A) Many behavioral emergencies have a metabolic and treatable cause.

B) Behavioral emergencies are different and many do not require restraint.

C) Although some behavioral emergencies are minor, treatment or transport is often indicated to maintain safety of patient and/or bystanders.

D) Correct.

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4) When encountering a patient exhibiting bizarre or irrational behavior, the paramedic should: A) Always assume the incident to be a psychotic episode and involve police assistance with restraining the patient.

B) Assume that the patient behavior is a regular occurrence and only provide transport at the request of the family.

C) Always consider metabolic and treatable causes.

D) Utilize chemical and physical means of restraint prior to initiating any other treatment modalities.

Answer: C Explanation: A) There are many causes of bizarre and irrational behavior that are not related to psychosis.

B) Assumptions should not be made related to the reason of unusual behavior and the paramedic should consider treatable, underlying causes.

C) Correct.

D) Restraint should be used as a last resort and only when necessary to prevent harm to rescuers, bystanders, or the patient.

Page Ref: 347 5) You are attending to a patient who is experiencing delirium, psychomotor agitation, and physiological excitation. The patient's family reports that they have never seen the patient act in this manner. You suspect: A) Excitable delirium.

B) Interpersonal causes.

C) Environmental causes.

D) Intrapsychic causes.

Answer: A Explanation: A) Correct. These answers are the classic triad related to excitable delirium.

B) Interpersonal causes are related to an event that is overwhelming and stressful to the patient.

C) Environmental causes result from stimuli outside the patient.

D) Intrapsychic causes result from underlying disease processes.

Page Ref: 347 6) All of the following may be exhibited by a patient suffering excitable delirium EXCEPT: A) Psychomotor agitation.

B) Hypothermia.

C) Delirium with agitation.

D) Respiratory arrest.

Answer: B Explanation: A) Psychomotor agitation is experienced during ED. B) Correct. The patient experiencing ED experiences HYPERthermia.

C) Delirium with agitation is experienced with ED. D) Respiratory arrest is experienced with ED. Page Ref: 347

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7) The most potentially life-threatening problem for a patient experiencing excitable delirium is/are .

A) Tachycardia B) Hypotension C) Hyperthermia D) Tachypnea Answer: C Explanation: A) While tachycardia may be a problem, it is not the most severe threat to the patient.

B) Hypotension is not a classic symptom of ExDT. C) Correct.

D) Tachypnea is experienced, but generally not a life-threatening problem.

Page Ref: 347 8) The primary treatment of excitable delirium is: A) Use of sedatives such as Valium.

B) Reversal agents such as flumazenil or Narcan.

C) Using physical restraint to prevent the patient from harming themselves.

D) Generally speaking, no treatment is required.

Answer: A Explanation: A) Correct.

B) Flumazenil and Narcan are used for reversal of narcotics and benzodiazepines that are not causes of ExDT. C) While physical restraints may be employed, they are not the primary treatment and may cause further harm if they are the only modality used.

D) The patient with ExDT who is not treated is at risk for cardiopulmonary arrest.

Page Ref: 348 9) is a major tranquilizer useful in the management of acute psychotic episodes.

A) Morphine B) Flumazenil C) Diazepam D) Haloperidol Answer: D Explanation: A) Morphine is a narcotic pain medication.

B) Flumazenil is a benzodiazepine antagonist.

C) While diazepam may be useful, it is not a major tranquilizer.

D) Correct.

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10) Because of the mild alpha-adrenergic blocking effects of droperidol, the paramedic should be alert for signs of .

A) Bradycardia B) Hypotension C) Bradypnea D) Hypertension Answer: B Explanation: A) Alpha-adrenergic blockade may cause vasodilation resulting in hypotension. It does not affect the heart rate.

B) Correct.

C) Alpha-adrenergic blockade does not affect breathing.

D) Alpha-adrenergic stimulation would cause hypertension by constricting arterioles. Blockade causes relaxation of those vessels.

Page Ref: 350 11) You are treating a patient who is experiencing mild withdrawal symptoms following the cessation of alcohol ingestion. The patient's family reports that the patient has recently tried to quit drinking after years of abuse. The patient has tremors, severe nausea with some vomiting, tachycardia, and weakness. Which of the following treatments would be MOST likely?

A) Allow the patient to have no more than 30 cc of alcohol by mouth.

B) Administer 10 mg of morphine to keep the patient calm during transport.

C) Administer 25 mg of Thorazine IM. D) Give naloxone for any suspected narcotic use.

Answer: C Explanation: A) Alcohol is not given for withdrawal symptoms in the prehospital environment.

B) Morphine is administered for pain relief and would not benefit this patient.

C) Correct. Thorazine is indicated for mild withdrawal symptoms.

D) Narcan would not be indicated in this situation.

Page Ref: 351 12) Indications for the use of olanzapine (Zyprexa) include: A) Alcohol withdrawal.

B) Acute psychosis and Alzheimer's disease.

C) Excitable delirium.

D) Nausea and vomiting refractory to other agents.

Answer: B Explanation: A) Thorazine is indicated for alcohol withdrawal.

B) Correct.

C) Sedation with benzodiazepines is indicated with excitable delirium.

D) Droperidol is indicated as a second-line antiemetic.

Page Ref: 354

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13) Which of the following statements regarding the use of diazepam is FALSE? A) Diazepam potentiates the effects of GABA in the CNS. B) Diazepam is a skeletal muscle relaxant.

C) Diazepam produces sedation by binding with opiate receptors in the CNS. D) Diazepam is a relatively short-acting medication.

Answer: C Explanation: A) This is a true statement regarding diazepam.

B) This is a true statement regarding diazepam.

C) Correct. Diazepam does not bind with opiate receptors. Diazepam exerts its actions by enhancing the effects of endogenous GABA. D) This is a true statement regarding diazepam.

Page Ref: 355 14) You are summoned to the scene of a suspected cocaine overdose. The patient has been subdued and restrained with handcuffs by police on scene. The patient is sweating profusely, extremely agitated, and screaming profanities loudly. Vital signs reveal tachycardia, tachypnea, and hypertension. The MOST appropriate treatment for this patient is to: A) Ensure safety, allow the police to transport the patient as there is no antidote for cocaine overdose.

B) Have the police remove the handcuffs, initiate an intravenous line and give 5-10 mg diazepam IVP. C) Administer flumazenil to reverse the effects of the cocaine.

D) Administer diazepam 2-5 mg intramuscularly to the patient.

Answer: D Explanation: A) This patient is at risk for cardiopulmonary arrest due to excited delirium and needs emergency care.

B) This potentially may put the rescuer at risk of harm from the patient and may not be the best course of action.

C) Flumazenil is a benzodiazepine antagonist and will have no effect on cocaine overdose.

D) Correct.

Page Ref: 356 15) When comparing midazolam to diazepam, a significant difference is that: A) Midazolam is 3-4 times more potent than diazepam.

B) Midazolam may also be used as an effective analgesic medication.

C) The effects of midazolam are long-lasting; therefore, it should be used with extreme caution.

D) Midazolam does not enhance GABA receptors in contrast to diazepam.

Answer: A Explanation: A) Correct.

B) Midazolam has no analgesic effects and should not be used for control of pain.

C) Midazolam, like diazepam, is short-lasting in duration.

D) Midazolam enhances the effects of GABA. Page Ref: 357

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16) Concurrent administration of hydroxyzine with many analgesics will: A) Antagonize the effects.

B) Enhance the effects.

C) Be contraindicated.

D) Have no effect on the narcotic medications.

Answer: B Explanation: A) Hydroxyzine will enhance rather than antagonize.

B) Correct.

C) Because of its antihistamine-like effects, it is sometimes desirable to administer hydroxyzine with many narcotics.

D) Hydroxyzine will enhance the effects of many narcotics.

Page Ref: 359

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Prehospital Emergency Pharmacology, 8e (Bledsoe/Clayden) Chapter 15 Medications Used in the Treatment of Gastrointestinal Emergencies 1) Medications that are used to treat nausea and vomiting are referred to as .

A) Narcotics B) Antiemetics C) Antagonists D) Agonists Answer: B Explanation: A) Narcotics are analgesics from the opiate (or chemically related to) family.

B) Correct.

C) An antagonist opposes the effects of another medication.

D) An agonist produces a desired result.

Page Ref: 363 2) Because of the untoward effects caused by the phenothiazines, are now preferred in the treatment of nausea and vomiting in the prehospital field.

A) Serotonin antagonists B) Antiarrhythmics C) Analgesics D) Benzodiazepines Answer: A Explanation: A) Correct.

B) Antiarrhythmics are not preferred in the management of nausea.

C) Analgesics are utilized for pain control.

D) Benzodiazepines are utilized for skeletal muscle relaxation and sedation.

Page Ref: 363 3) Antiemetics are often administered with narcotics: A) To cause sedation prior to cardioversion attempts.

B) To relieve abdominal pain.

C) As a cathartic agent.

D) To potentiate the narcotic effect and alleviate nausea.

Answer: D Explanation: A) Benzodiazepines are used for sedation prior to cardioversion.

B) Antiemetics do not relieve abdominal pain.

C) Antiemetics do not have cathartic effects.

D) Correct.

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4) Sensory input, such as smells or sights, may causes stimulation of the which then initiates the vomiting reflex.

A) Cerebral cortex B) Cerebrum C) Chemoreceptor trigger zone D) Opiate receptor sites Answer: C Explanation: A) The cerebral cortex is responsible for intelligence, personality, motor function, planning and organization, and touch sensation.

B) The cerebrum is for higher functions of the brain.

C) Correct.

D) Opiate receptors respond to opiate stimulation producing analgesia.

Page Ref: 364 5) The prototypical serotonin antagonist that is sometimes used in the prehospital field is .

A) Ondansetron (Zofran) B) Promethazine (Phenergan) C) Prochlorperazine (Compazine) D) Haloperidol (Haldol) Answer: A Explanation: A) Correct.

B) Promethazine is an antihistamine.

C) Prochloroperazine is a dopamine antagonist.

D) Haldol is a dopamine antagonist.

Page Ref: 364 6) A danger of utilizing an antihistamine with a patient suffering from asthma is that: A) The actions of an antihistamine potentiate the bronchodilators.

B) Resultant tachycardia occurs.

C) Antihistamines thicken bronchial secretions.

D) Tachypnea will ensue.

Answer: C Explanation: A) Because they can thicken bronchial secretions, antihistamines should not be used with people experiencing asthma.

B) Because they can thicken bronchial secretions, antihistamines should not be used with people experiencing asthma.

C) Because they can thicken bronchial secretions, antihistamines should not be used with people experiencing asthma.

D) Because they can thicken bronchial secretions, antihistamines should not be used with people experiencing asthma.

Page Ref: 364

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7) Which of the following represents an appropriate dosing regimen for using ondansetron (Zofran)?

A) Administer 4-8 mg IV/PO. B) Administer 4-8 mg IV/SQ. C) Administer 4-8 mg SQ/IM. D) Administer only by intravenous route as ordered.

Answer: A Explanation: A) Correct.

B) Zofran is not indicated for subcutaneous injection.

C) Zofran is not indicated for subcutaneous injection.

D) Although it may be given intravenously, it may also be administered orally making the answer "Administer 4-8 mg IV/PO" more appropriate.

Page Ref: 365 8) The paramedic should use caution when administering ondansetron (Zofran) to a patient who has: A) Been taking narcotic medications.

B) Experienced the signs and symptoms of alcohol withdrawal.

C) Only experienced nausea, but no vomiting.

D) Taken serotonin antagonists for another medical condition.

Answer: D Explanation: A) Zofran has an indication for a patient experiencing nausea as a side effect of narcotic analgesics.

B) Zofran may be useful in alleviating the nausea and vomiting associated with withdrawal symptoms.

C) Zofran would be indicated in this patient.

D) Correct.

Page Ref: 371 9) An antiemetic that potentiates the depressant effects on the CNS of narcotics, sedatives or hypnotics, and alcohol and no longer used commonly by emergency medical services is .

A) Ondansetron (Zofran) B) Dolasetron (Anzemet) C) Promethazine (Phenergan) D) Prochlorperazine (Compazine) Answer: C Explanation: A) Zofran is a serotonin antagonist having less effect on CNS depressants.

B) Dolastron is a serotonin antagonist having less effect on CNS depression.

C) Correct.

D) Prochlorperazine has weak anticholinergic properties having less effect on CNS depression.

Page Ref: 367

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10) You are attending to an intoxicated patient who is very disoriented, uncoordinated, and complaining of severe nausea. Which of the following is MOST correct regarding the use of promethazine (Phernegan)?

A) Promethazine should be given in reduced dosages in a patient who is under the influence of CNS depressants.

B) When using promethazine in a patient who has been drinking, it should only be given intramuscularly to avoid absorption that would be too rapid.

C) Promethazine is the drug of choice when a patient is experiencing severe nausea and will allow the patient to protect their own airway.

D) Promethazine should not be given if a patient has used a large amount of any CNS depressant.

Answer: D Explanation: A) Promethazine should be avoided if the patient is under the influence of other central nervous system depressants.

B) Promethazine should be avoided if the patient has been drinking alcohol, a central nervous system depressant.

C) Promethazine does not promote maintenance of the airway because of its depressant effects.

D) Promethazine is contraindicated in any patient who has received large doses of CNS depressants.

Page Ref: 367 11) Metoclopramide is contraindicated in which of the following conditions?

A) A diagnosis of gastroesophageal reflux disease (GERD) B) A patient with a recent onset of nausea C) A patient suffering from a gastrointestinal ulcer that is bleeding D) History of heart burn following meals Answer: C Explanation: A) GERD is an indication for the use of metoclopramide.

B) Nausea and vomiting is an indication for nausea.

C) Correct. Reglan is contraindicated if the patient has a GI bleed.

D) This would be an indication.

Page Ref: 370 12) The standard dose of promethazine when used to potentiate the effects of narcotics is which of the following?

A) 25 mg B) 50 mg C) 2.5 mg D) It is contraindicated to give promethazine concomitantly to a patient who is receiving narcotic analgesics.

Answer: A Explanation: A) Correct.

B) 25 mg is the recommended dosage of promethazine if being used to potentiate narcotics.

C) 25 mg is the recommended dosage of promethazine if being used to potentiate narcotics.

D) Promethazine is indicated to potentiate narcotics and combat the side effect of nausea from the narcotics.

Page Ref: 368 4

13) Metoclopramide exerts its effects by blocking .

A) Anticholinergic receptor sites B) Histamine 2 receptor sites C) Dopaminergic receptor sites D) Opiate receptor sites Answer: C Explanation: A) Metoclopramide exerts its effects by blocking dopaminergic receptor sites.

B) Metoclopramide exerts its effects by blocking dopaminergic receptor sites.

C) Metoclopramide exerts its effects by blocking dopaminergic receptor sites.

D) Metoclopramide exerts its effects by blocking dopaminergic receptor sites.

Page Ref: 370

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Prehospital Emergency Pharmacology, 8e (Bledsoe/Clayden) Chapter 16 Sedation and Pain Management 1) The process of alleviating pain is: A) Anesthesia.

B) Analgesia.

C) Sedation.

D) Anesthetics.

Answer: B Explanation: A) Anesthesia is causing the cessation of sensory perception.

B) Correct.

C) Sedation is a reduction of the patient's level of consciousness and an impairment of their ability to respond to external stimuli.

D) Anesthetics are medications used to produce an alteration in sensory perception.

Page Ref: 374 2) A medication that relieves anxiety that a patient might experience is known as a/an: A) Anxiolytic.

B) Sympatholytic.

C) Parasympathomimetic.

D) Analgesic.

Answer: A Explanation: A) Correct.

B) A sympatholytic opposes the effects of the sympathetic nervous system.

C) A parasympathomimetic is a medication that mimics the actions of the parasympathetic nervous system.

D) An analgesic is a medication that is used to alleviate pain.

Page Ref: 375 3) Which of the following statements regarding the use of moderate sedation is TRUE? A) The patient is sedated to a point where they cannot be aroused.

B) Moderate sedation is designed for relief of anxiety.

C) Cardiac function is impaired.

D) The patient is able to respond to verbal or tactile stimulation.

Answer: D Explanation: A) This is a characteristic of deep sedation.

B) This is a characteristic of mild sedation.

C) Cardiac function is preserved with all levels of sedation.

D) Correct.

Page Ref: 375

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4) A narcotic analgesic that has both agonistic and antagonistic activities on opiate receptor sites is: A) Morphine.

B) Meperidine.

C) Butorphanol tartrate (Stadol).

D) Fentanyl.

Answer: C Explanation: A) Morphine has agonist properties as it is a true opiate.

B) Meperidine binds to opiate receptors in the brain; it is rarely used in emergency care.

C) Correct.

D) Fentanyl binds with opiate receptors causing an agonist effect.

Page Ref: 376 5) A contraindication for the use of morphine sulfate is: A) Moderate pain.

B) Hypotension.

C) Tachycardia.

D) Congestive heart failure.

Answer: B Explanation: A) Morphine is indicated for moderate to severe pain.

B) Correct. Morphine has vasodilatory effects that may cause harm in a hypotensive/hypovolemic patient.

C) Tachycardia is not a contraindication for morphine and may be exacerbated by pain.

D) Morphine reduces preload and myocardial oxygen demand and is useful in the treatment of CHF. Page Ref: 377 6) Morphine has been determined to have potential for abuse and is an addictive medication.

Therefore, the FDA has scheduled morphine as a Schedule narcotic.

A) I B) II C) III D) IV Answer: B Explanation: A) Morphine has been determined to be a Schedule II narcotic and requires special handling that the provider must be aware of.

B) Morphine has been determined to be a Schedule II narcotic and requires special handling that the provider must be aware of.

C) Morphine has been determined to be a Schedule II narcotic and requires special handling that the provider must be aware of.

D) Morphine has been determined to be a Schedule II narcotic and requires special handling that the provider must be aware of.

Page Ref: 377

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7) When utilizing morphine for pain management, the paramedic should: A) Be prepared to administer naloxone.

B) Never exceed 10 mg.

C) Only administer intramuscularly in the field.

D) Utilize Romazicon as an antagonist for respiratory depression should it occur.

Answer: A Explanation: A) Correct. Naloxone is a narcotic antagonist that can reverse the effects of respiratory depression.

B) 2-10 mg is a standard dose range, but the paramedic can continue to administer in 2 mg increments titrated to pain or respiratory rate.

C) Morphine may be administered IM, however, IV administration is preferred if rapid relief of pain is desired.

D) Romazicon is utilized for benzodiazepine reversal.

Page Ref: 377 8) You are treating a patient who has experienced a fracture of his right forearm while playing sports. The patient is alert, oriented, with normal vital signs. He reports pain is an "8" on a 10point system. The patient has a history of depression and has taken phenelzine (Nardil) for many years with no problems. Which of the following is TRUE regarding the use of Demerol for this patient?

A) Because Nardil is used for depression, you should only administer half the initial dosage and have naloxone available for respiratory depression.

B) The patient will most likely have developed a tolerance for narcotics and may require larger than normal doses.

C) A standard dose of meperidine will be suitable for this patient.

D) Demerol should not be used for this patient.

Answer: D Explanation: A) Nardil should not be used with Demerol.

B) Nardil should not be used with Demerol.

C) Nardil should not be used with Demerol.

D) Correct. Nardil is a monoamine oxidase inhibitor (MAOI). The use of meperidine (Demerol) has occasionally caused severe and sometimes fatal reactions when an MAOI has recently beentaken.

Page Ref: 380 9) An advantage to the use of fentanyl (Sublimaze) when compared to morphine or meperidine is that: A) It is not a narcotic analgesic.

B) It has less emetic effect than other narcotic analgesics.

C) It does not produce the respiratory depression that accompanies morphine and meperidine.

D) Romazicon is an effective antagonist.

Answer: B Explanation: A) Fentanyl is considered a narcotic analgesic.

B) Correct.

C) Fentanyl may produce respiratory depression that is seen with other narcotic analgesics.

D) Naloxone is a narcotic antagonist for fentanyl. Romazicon is a benzodiazepine antagonist.

Page Ref: 381 3

10) When administering fentanyl, an advantage is that: A) It may be administered intranasally.

B) It may only be administered IV which makes administration more reliable.

C) The dosage is the same as morphine.

D) It lasts 4-5 times longer than other narcotic analgesics.

Answer: A Explanation: A) Correct. This is an advantage when an IV is not or can not be established.

B) Fentanyl may be administered intranasally or intravenously.

C) The dosage of fentanyl is 25-100 mcg. Morphine is 2-10 mg.

D) Fentanyl is a short-lasting narcotic analgesic.

Page Ref: 382 11) When Nitronox has been removed from the patient who has been using it for pain relief, it will: A) Be effective for at least 30-45 minutes before its half-life is diminished.

B) Cause respiratory depression as the effects grow weaker.

C) Quickly dissipate from the patient's system.

D) Eliminate all pain that the patient is experiencing.

Answer: C Explanation: A) Nitronox rapidly dissipates from the patient's system once removed.

B) Dissipation of the narcotic-like effects will eliminate side effects C) Correct.

D) Symptoms of pain may return following the removal of Nitronox.

Page Ref: 382 12) The use of Nitronox is contraindicated in a patient with a history of: A) COPD. B) Musculoskeletal injury.

C) Moderate burns.

D) Hyperventilation.

Answer: A Explanation: A) Correct.

B) Musculoskeletal injury is an indication for the use of Nitronox.

C) Moderate burns are an indication for Nitronox.

D) Hyperventilation is an indication for Nitronox.

Page Ref: 383

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13) It is important to remember when treating a narcotic-dependent patient that: A) They should not be given any other narcotics due to the potential of increasing their dependency.

B) All narcotic dosages should be reduced by at least one-half to avoid significant respiratory depression.

C) Stadol and Nubain may cause withdrawal to the narcotic-dependent patient.

D) Stadol has agonist effects that make it the preferred medication for narcotic dependent patients while not increasing dependence.

Answer: C Explanation: A) Although narcotic addicted, many patients (such as cancer and other patients requiring pain relief) may need pain medications.

B) Dependence may also produce tolerance requiring larger than normal doses to the narcotic addicted patient.

C) Correct. Because of the agonistic/antagonistic effects, both medications may produce withdrawal.

D) Although Stadol has agonist effects, its antagonistic effects may produce withdrawal Page Ref: 386 14) A nonsteroidal anti-inflammatory medication capable of producing analgesia and is useful in the management of moderate to severe pain is .

A) Ketorolac B) Meperidine C) Diazepam D) Naloxone Answer: A Explanation: A) Correct.

B) Meperidine is a narcotic analgesic.

C) Diazepam is a benzodiazepine.

D) Naloxone is a narcotic antagonist.

Page Ref: 386 15) A nonsteroidal anti-inflammatory medication that is the MOST common cause of acute liver failure is .

A) Ibuprofen B) Ketorolac C) Depo-Medrol D) Acetaminophen (Tylenol) Answer: D Explanation: A) Acetaminophen is metabolized in the liver and overdosage may lead to hepatic toxicity. It is the most common cause of acute hepatic failure.

B) Acetaminophen is metabolized in the liver and overdosage may lead to hepatic toxicity. It is the most common cause of acute hepatic failure.

C) Acetaminophen is metabolized in the liver and overdosage may lead to hepatic toxicity. It is the most common cause of acute hepatic failure.

D) Acetaminophen is metabolized in the liver and overdosage may lead to hepatic toxicity. It is the most common cause of acute hepatic failure.

Page Ref: 389 5

16) causes a disassociation between the limbic system and the cortical system that result in a seemingly awake patient who is disassociated with the environment.

A) Ketamine B) Ativan C) Diazepam D) Etomidate Answer: A Explanation: A) Correct.

B) Ativan is a benzodiazepine that enhances the effects of endogenous GABA. C) Diazepam is a benzodiazepine that enhances the effects of endogenous GABA. D) Etomidate is nonbarbiturate and nonbenzodiazepine medication with a very short half-life.

Page Ref: 393 17) A sedative that has the best safety profile of all the sedative/hypnotics that is very short-lived and indicated in rapid sequence intubation is: A) Ketamine B) Midazolam C) Etomidate D) Morphine Sulfate Answer: C Explanation: A) Ketamine is a disassociate medication with a half-life of 1-2 hours.

B) Midazolam is a benzodiazepine with potent effects.

C) Correct.

D) Morphine is a narcotic analgesic, not a sedative.

Page Ref: 394 18) Propofol allows the health care provider to: A) Provide for maintenance of sedation during a procedure.

B) Allow sedation and pain control post-procedure because of its short half-life.

C) Allow the patient to self-administer for adequate sedation.

D) Utilize either naloxone or flumazenil (Romazicon) for antagonism should the patient overdose with self-administration.

Answer: A Explanation: A) Correct.

B) Propofol is not considered an analgesic.

C) Propofol is not designed to be self-administered by the patient. Nitronox is a selfadministered medication.

D) The effects of propofol are not antagonized by naloxone or flumazenil (Romazicon).

Page Ref: 395

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19) Of the medications that produce neuromuscular blockade, depolarizing agent.

A) Propofol B) Succinylcholine C) Vecuronium D) Pancuronium Answer: B Explanation: A) Propofol is not a neuromuscular blocker.

B) Correct.

C) Vecuronium is a nondepolarizing agent.

D) Pancuronium is a nondepolarizing agent.

Page Ref: 397

is the only one that is a

20) All of the following are correct regarding the use of succinylcholine EXCEPT which statement?

A) It is a short-acting, long-lasting neuromuscular blocker.

B) It is a depolarizing agent.

C) It should be administered by experienced personnel.

D) It causes fractures if used in the pediatric patient.

Answer: A Explanation: A) It is a short-acting, short-lasting agent.

B) Succinylcholine is a depolarizing agent C) When using succinylcholine, the most experienced paramedic should administer the medication.

D) Succinylcholine may cause fractures in the pediatric population.

Page Ref: 398 21) Pancuronium bromide is a neuromuscular blocker that causes the patient to experience flaccid paralysis following administration.

A) Fast-acting, short-lasting B) Fast-acting, long-lasting C) Slow-acting, short-lasting D) Slow-acting, long-lasting Answer: B Explanation: A) Pancuronium bromide is a fast-acting, long-lasting nondepolarizing agent.

B) Pancuronium bromide is a fast-acting, long-lasting nondepolarizing agent.

C) Pancuronium bromide is a fast-acting, long-lasting nondepolarizing agent.

D) Pancuronium bromide is a fast-acting, long-lasting nondepolarizing agent.

Page Ref: 400

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22) The normal adult dosage of vecuronium is: A) 1-2 mg/kg IV. B) 100-200 mg IV. C) 0.08-0.1 mg IV. D) 0.08-0.1 mg/kg.

Answer: D Explanation: A) The correct adult dosage when using vecuronium is 0.08-0.1 mg/kg.

B) The correct adult dosage when using vecuronium is 0.08-0.1 mg/kg.

C) The correct adult dosage when using vecuronium is 0.08-0.1 mg/kg.

D) The correct adult dosage when using vecuronium is 0.08-0.1 mg/kg.

Page Ref: 402 23) Neuromuscular blocking agents have no effect on consciousness, therefore, the paramedic should: A) Administer following a sedative/hypnotic.

B) Only utilize neuromuscular blockers when a patient has lost consciousness.

C) Remember to utilize only small amounts of the neuromuscular blocker if necessary.

D) Only use neuromuscular blockade during seizures.

Answer: A Explanation: A) Correct.

B) Neuromuscular blockers may be necessary when the patient is conscious and alert.

C) The correct dosage range must be administered to be effective.

D) Seizures only represent one indication of neuromuscular blockade.

Page Ref: 404

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Prehospital Emergency Pharmacology, 8e (Bledsoe/Clayden) Chapter 17 Weapons of Mass Destruction 1) Nerve agents exert their effects on the autonomic nervous system by causing: A) Excessive sympathetic stimulation.

B) Excessive parasympathetic stimulation.

C) Fatal arrhythmias early in the progression of symptoms.

D) Asphyxiation.

Answer: B Explanation: A) Excessive parasympathetic stimulation occurs when acetylcholine receptors are occupied by the agent causing continuous stimulation.

B) Correct.

C) Although fatal arrhythmias (bradycardia) may occur, this occurs late in the progression of symptoms.

D) Excessive parasympathetic stimulation occurs when acetylcholine receptors are occupied by the agent causing continuous stimulation.

Page Ref: 410 2) agents may be delivered as vapors, aerosols, or liquids and may be delivered by conventional or nonconventional means.

A) Radiological B) Biological C) Nuclear D) Chemical Answer: D Explanation: A) Chemical agents may be delivered as vapors, aerosols, or liquids and may be delivered by conventional or nonconventional means.

B) Chemical agents may be delivered as vapors, aerosols, or liquids and may be delivered by conventional or nonconventional means.

C) Chemical agents may be delivered as vapors, aerosols, or liquids and may be delivered by conventional or nonconventional means.

D) Chemical agents may be delivered as vapors, aerosols, or liquids and may be delivered by conventional or nonconventional means.

Page Ref: 410 3) Chemicals used in the production of nerve agents are known as _.

A) Sympathomimetics B) Sympatholytics C) Organophosphates D) Chocking agents Answer: C Explanation: A) Sympathomimetics are agents that mimic the effects of the sympathetic nervous system.

B) Sympatholytics work against the sympathetic nervous system.

C) Correct.

D) Chocking agents cause pulmonary destruction ultimately leading to death.

Page Ref: 410 1

4) Which of the following chemical agents binds to acetylcholinesterase inhibiting the breakdown of acetylcholine at autonomic nervous system synapses?

A) Chlorine B) Sarin C) Phosgene D) Gamma radiation Answer: B Explanation: A) Chlorine is a chocking agent which causes pulmonary destruction.

B) Correct. Sarin is an organophosphate that interacts with acetylcholinesterase.

C) Phosgene is a chocking agent which causes pulmonary destruction.

D) Gamma radiation is a radiological agent. Its effects are widespread.

Page Ref: 410 5) A mnemonic helpful in identifying the effects seen when exposure to a nerve agent has occurred is: A) AMPLE. B) "Hot as hell, blind as a bat, dry as a bone, red as a beet, and mad as a hatter."

C) SLUDGEM. D) OPQRST. Answer: C Explanation: A) AMPLE is used for obtaining history of present illness.

B) This describes the effects of anticholinergic overdose.

C) Correct.

D) OPQRST is utilized in obtaining the history of present illness.

Page Ref: 411 6) The is a kit containing antidotes for nerve agent exposure.

A) Mark I kit B) Pasadena Kit C) Cyanokit D) SLUDGEM kit Answer: A Explanation: A) Correct.

B) The Pasadena Kit is an antidote for cyanide poisoning.

C) The Cyanokit is available as an antidote for cyanide poisoning.

D) SLUDGEM is a mnemonic useful in remembering the effects of excessive cholinergic stimulation.

Page Ref: 411

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7) Pralidoxime is useful in treating nerve agent exposure because it: A) Antagonizes the bradycardia associated with nerve agent exposure.

B) Causes sympathetic stimulation that counteracts the excessive parasympathetic stimulation.

C) Frees the bound acetylcholinesterase so that it can then remove the acetylcholine from receptor sites in the synapse.

D) Pralidoxime is contraindicated in situations where a patient has been exposed to a nerve agent.

Answer: C Explanation: A) Pralidoxime does not antagonize bradycardia.

B) Pralidoxime is not a sympathomimetic.

C) Correct.

D) Pralidoxime is indicated for nerve agent exposure.

Page Ref: 411 8) Which of the following BEST describes the dosing regimen when using Mark I kits for nerve agent exposure?

A) Administer the contents of one kit only to a patient.

B) The paramedic may not administer Mark I kits unless blisters have begun to form on the skin.

C) After the initial dose, the paramedic may administer one kit every five minutes until drying of secretions and improvement in ventilatory statues.

D) Repeat doses are based on an increase in the heart rate to greater than 60 beats per minute.

Answer: C Explanation: A) Following the initial administration of a Mark I kit, the paramedic may continue one kit every five minutes based on drying of secretions and an overall improvement of ventilatory status.

B) Following the initial administration of a Mark I kit, the paramedic may continue one kit every five minutes based on drying of secretions and an overall improvement of ventilatory status.

C) Following the initial administration of a Mark I kit, the paramedic may continue one kit every five minutes based on drying of secretions and an overall improvement of ventilatory status.

D) Following the initial administration of a Mark I kit, the paramedic may continue one kit every five minutes based on drying of secretions and an overall improvement of ventilatory status.

Page Ref: 412 9) An agent that has a dark brown oily liquid composition and is very persistent and difficult to remove from the skin is referred to as a/an .

A) Nerve agent B) Vesicant C) Asphyxiant D) Radiological agent Answer: B Explanation: A) Nerve agents may be liquid, vapor, or both and can be inhaled or absorbed.

B) Correct.

C) An asphyxiant is an inhaled gas that interferes with respiration.

D) A radiological agent emits ionizing radiation.

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10) Mustard, lewisite, and phosgene oxime are examples of .

A) Vesicants B) Nerve agents C) Radiological agents D) Chocking agents Answer: A Explanation: A) Correct.

B) Sarin, soman, tabun, and VX are nerve agents.

C) Radiological agents emit ionizing radiation such as alpha, beta, and gamma waves.

D) Chocking agents include ammonia, chlorine, and phosgene (different that phosgene oxime).

Page Ref: 412 11) is a deadly virus responsible for causing hemorrhagic fever and causes death in 50-90 percent of all victims.

A) Smallpox B) Botulism C) Tabun D) Ebola Answer: D Explanation: A) Smallpox is a virus thought to be eradicated by the WHO. B) Botulism is a lethal bacterium.

C) Tabun is a nerve agent.

D) Correct.

Page Ref: 415 12) A deadly toxin derived from the processing of castor beans is A) Botulism B) Smallpox C) Ricin D) Sarin Answer: D Explanation: A) Botulism is a bacterium.

B) Smallpox is a virus.

C) Correct.

D) Sarin is a nerve agent.

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13) Which of the following statements regarding the bacteria anthrax is TRUE? A) It is often seen in veterinary practice, can be spread from person to person, and a vaccine is available.

B) Anthrax cannot live outside the host and is easily destroyed.

C) Intestinal anthrax is more lethal than inhalational anthrax due to the incubation time.

D) There is currently no treatment for anthrax exposure, only supportive care.

Answer: A Explanation: A) Correct.

B) Anthrax can live outside the host in extreme environments and may remain dormant.

C) Inhalational anthrax is more lethal because of its effects on the respiratory system.

D) Anthrax is treated with antibiotic (frequently many), and the monoclonal antibody, raxibacumab.

Page Ref: 417 14) The MOST common form of plague that is transmitted by rodents through the bite of infected fleas is _.

A) Tularemia B) Bubonic C) Pneumonic D) Botulinum Answer: B Explanation: A) Tularemia is known as rabbit fever or deer fly fever.

B) Correct.

C) Pneumonic plague is contracted by inhalation of the organism.

D) Botulinum most often occurs from undercooked or improperly prepared foods.

Page Ref: 417 15) occurs when radioactive materials get onto the body or clothing of the victim.

A) Irradiation B) Contamination C) Ingestion D) Exposure Answer: B Explanation: A) Irradiation occurs when the energy from radiation damages a person's cell.

B) Correct.

C) Ingestion in the intake (orally) of contaminated materials.

D) Exposure is being in an area where radioactive materials may be present.

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16) Of the following, which form of radiation has the highest potential to cause harm?

A) Alpha B) Beta C) Charlie D) Gamma Answer: D Explanation: A) Alpha radiation can be blocked easily and outside the body, do not present a danger to humans unless ingested.

B) Beta radiation typically does not penetrate to internal organs.

C) There is no "Charlie" radiation.

D) Correct. Gamma radiation has substantial penetration and may substantially damage living tissues.

Page Ref: 419 17) When considering the damaging effects of radiation, which of the following should be considered?

A) Alpha radiation is harmless and of no concern.

B) Time, distance, and shielding will provide the basis for protection.

C) Never approach a victim who has been exposed to gamma radiation as it is potentially lethal to the rescuer.

D) There is no shielding currently available for the effects of gamma radiation.

Answer: B Explanation: A) Alpha radiation may present a significant risk of danger if ingested.

B) Correct.

C) A victim exposed generally causes no risk unless the source is nearby and emitting the radiation.

D) Lead is an effective shield against gamma radiation.

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