Chapter 15 - Emergency Care

Chapter 15 Multiple Choice 1. A. B. C. D. The three major parts of the brain are the: cerebellum, medulla, and occiput. brain stem, midbrain, and spinal cord. midbrain, cerebellum, and spinal cord. cerebrum, cerebellum, and brain stem. Answer: D Question Type: General Knowledge Page: 567 2. The most basic functions of the body, such as breathing, blood pressure, and swallowing, are controlled by the: A. brain stem. B. cerebrum. C. cerebellum. D. cerebral cortex. Answer: A Question Type: General Knowledge Page: 567 3. A. B. C. D. Muscle control and body coordination are controlled by the: cerebrum. cerebellum. brain stem. cerebral cortex. Answer: B Question Type: General Knowledge Page: 567 4. The left cerebral hemisphere controls: A. B. C. D. the right side of the face. heart rate and pupil reaction. the right side of the body. breathing and blood pressure. Answer: C Question Type: General Knowledge Page: 567 5. A. B. C. D. The anterior aspect of the cerebrum controls: touch. emotion. movement. vision. Answer: B Question Type: General Knowledge Page: 567 6. A. B. C. D. The spinal cord exits the cranium through the: foramen magnum. vertebral foramen. foramen lamina. cauda equina. Answer: A Question Type: General Knowledge Page: 568 7. A. B. C. D. Which of the following conditions would MOST likely affect the entire brain? blocked cerebral artery in the frontal lobe reduced blood supply to the left hemisphere ruptured cerebral artery in the occipital lobe respiratory failure or cardiopulmonary arrest Answer: D Question Type: General Knowledge Page: 568 8. A. B. C. D. Interruption of cerebral blood flow may result from all of the following, EXCEPT: a thrombus. an embolism. cerebral vasodilation. an acute arterial rupture. Answer: C Question Type: General Knowledge Page: 570 9. A. B. C. D. Which of the following MOST accurately describes the cause of an ischemic stroke? blockage of a cerebral artery acute atherosclerotic disease rupture of a cerebral artery narrowing of a carotid artery Answer: A Question Type: General Knowledge Page: 570 10. You are assessing a 49-year-old man who, according to his wife, experienced a sudden, severe headache and then passed out. He is unresponsive and has slow, irregular breathing. His blood pressure is 190/94 mm Hg and his pulse rate is 50 beats/min. His wife tells you that he has hypertension and diabetes. He has MOST likely experienced: A. acute hypoglycemia. B. a ruptured cerebral artery. C. a complex partial seizure. D. an occluded cerebral artery. Answer: B Question Type: Critical Thinking Page: 570 11. The MOST significant risk factor for a hemorrhagic stroke is: A. severe stress. B. hypertension. C. heavy exertion. D. diabetes mellitus. Answer: B Question Type: General Knowledge Page: 571 12. An area of swelling or enlargement in a weakened arterial wall is called: A. a thrombus. B. an aneurysm. C. an embolism. D. atherosclerosis. Answer: B Question Type: General Knowledge Page: 571 13. Which of the following clinical signs is MOST suggestive of a ruptured cerebral artery? A. unilateral hemiparesis B. confusion and weakness C. nasal discharge of blood D. sudden, severe headache Answer: D Question Type: General Knowledge Page: 571 14. A transient ischemic attack (TIA) occurs when: A. medications are given to dissolve a cerebral blood clot. B. a small cerebral artery ruptures and causes minimal damage. C. the normal body processes destroy a clot in a cerebral artery. D. signs and symptoms resolve spontaneously within 48 hours. Answer: C Question Type: General Knowledge Page: 571 15. A patient who is experiencing aphasia is: A. not able to swallow without choking. B. experiencing a right hemispheric stroke. C. unable to produce or understand speech. D. usually conscious but has slurred speech. Answer: C Question Type: General Knowledge Page: 572 16. A patient whose speech is slurred and difficult to understand is experiencing: A. aphasia. B. dysarthria. C. dysphagia. D. paraplegia. Answer: B Question Type: General Knowledge Page: 572 17. Which of the following conditions would be the LEAST likely to mimic the signs and symptoms of a stroke? A. hypoglycemia B. hypovolemia C. a postictal state D. intracranial bleeding Answer: B Question Type: General Knowledge Page: 572 18. A generalized seizure is characterized by: A. severe twitching of all the body’s muscles. B. a blank stare and brief lapse of consciousness. C. unconsciousness for greater than 30 minutes. D. a core body temperature of greater than 103°F (40°C). Answer: A Question Type: General Knowledge Page: 573 19. An absence seizure is also referred to as a: A. petit mal seizure. B. grand mal seizure. C. total body seizure. D. generalized motor seizure. Answer: A Question Type: General Knowledge Page: 573 20. Which of the following MOST accurately describes a simple partial seizure? A. a seizure that begins in one extremity B. a seizure that causes the patient to stare blankly C. a seizure that is not preceded by an aura D. a generalized seizure without incontinence Answer: A Question Type: General Knowledge Page: 573 21. The mental status of a patient who has experienced a typical seizure: A. progressively worsens over a period of a few hours. B. is easily differentiated from that of acute hypoglycemia. C. is likely to improve over a period of 5 to 30 minutes. D. typically does not improve, even after several minutes. Answer: C Question Type: General Knowledge Page: 574 22. Which of the following MOST accurately describes what the patient will experience during the postictal state that follows a seizure? A. hyperventilation and hypersalivation B. a rapidly improving level of consciousness C. confusion and fatigue D. a gradually decreasing level of consciousness Answer: C Question Type: General Knowledge Page: 574 23. Status epilepticus is characterized by: A. generalized seizures that last less than 5 minutes. B. an absence seizure that is not preceded by an aura. C. profound tachycardia and total muscle flaccidity. D. prolonged seizures without a return of consciousness. Answer: D Question Type: General Knowledge Page: 574 24. Which of the following conditions is NOT a common cause of seizures? A. poisoning or overdose B. severe hypovolemia C. acute hypoglycemia D. acute alcohol withdrawal Answer: B Question Type: General Knowledge Page: 575 25. Which of the following is a metabolic cause of a seizure? A. poisoning B. head trauma C. brain tumor D. massive stroke Answer: A Question Type: General Knowledge Page: 575 26. Which of the following medications is NOT used to treat patients with a history of seizures? A. phenytoin (Dilantin) B. hydromorphone (Dilaudid) C. carbamazepine (Tegretol) D. phenobarbital Answer: B Question Type: General Knowledge Page: 575 27. Febrile seizures: A. often result in permanent brain damage. B. are also referred to as petit mal seizures. C. are usually benign but should be evaluated. D. occur when a child’s fever progressively rises. Answer: C Question Type: General Knowledge Page: 575 28. You respond to a residence for a child who is having a seizure. Upon arrival at the scene, you enter the residence and find the mother holding her child, a 2-year-old male. The child is conscious and crying. According to the mother, the child had been running a high fever and then experienced a seizure that lasted approximately 3 minutes. You should: A. cover the child with wet towels and give oxygen via nasal cannula. B. transport the child to the hospital and reassure the mother en route. C. advise the mother to take her child to the doctor the following day. D. call medical control and request permission to give the child aspirin. Answer: B Question Type: Critical Thinking Page: 575 29. You arrive at a grocery store shortly after a 35-year-old male stopped seizing. Your assessment reveals that he is confused and incontinent of urine. The patient’s girlfriend tells you that he has a history of seizures and takes carbamazepine (Tegretol). When obtaining further medical history from the girlfriend, it is MOST important to: A. determine if the patient is a known alcohol abuser. B. obtain a description of how the seizure developed. C. determine when he was last seen by his physician. D. ask her how long the patient has been taking his medication. Answer: B Question Type: Critical Thinking Page: 575 30. A patient with an altered mental status is: A. completely unresponsive to all forms of stimuli. B. typically alert but is confused as to preceding events. C. usually able to be aroused with a painful stimulus. D. not thinking clearly or is incapable of being aroused. Answer: D Question Type: General Knowledge Page: 576 31. The principal clinical difference between a stroke and hypoglycemia is that patients with hypoglycemia: A. always take oral medications to maintain normal blood glucose levels. B. do not present with slurred speech or weakness to one side of the body. C. are typically alert and attempt to communicate with health care providers. D. usually have an altered mental status or decreased level of consciousness. Answer: D Question Type: General Knowledge Page: 576 32. When caring for a patient with documented hypoglycemia, you should be MOST alert for: A. a seizure. B. an acute stroke. C. respiratory distress. D. a febrile convulsion. Answer: A Question Type: General Knowledge Page: 576 33. You arrive at a local grocery store approximately 5 minutes after a 21-year-old female stopped seizing. She is confused and disoriented; she keeps asking you what happened and tells you that she is thirsty. Her brother, who witnessed the seizure, A. B. C. D. tells you that she takes phenytoin (Dilantin) for her seizures, but has not taken it in a few days. He also tells you that she has diabetes. In addition to applying high-flow oxygen, you should: administer one tube of oral glucose and prepare for immediate transport. place her in the recovery position and transport her with lights and siren. monitor her airway and breathing status and assess her blood glucose level. give her small cups of water to drink and observe for further seizure activity. Answer: C Question Type: Critical Thinking Page: 576–577 34. Individuals with chronic alcoholism are predisposed to intracranial bleeding and hypoglycemia secondary to abnormalities in the: A. brain. B. kidneys. C. liver. D. pancreas. Answer: C Question Type: General Knowledge Page: 577 35. Which of the following patients would MOST likely demonstrate typical signs of infection, such as a fever? A. a 3-month-old female who was born prematurely B. a 17-year-old male with depression and anxiety C. a 35-year-old female in the later stages of AIDS D. an 88-year-old male with chronic renal problems Answer: B Question Type: General Knowledge Page: 577 36. During the primary assessment of a semiconscious 70-year-old female, you should: A. insert a nasopharyngeal airway and assist ventilations. B. immediately determine the patient’s blood glucose level. C. ask family members if the patient has a history of stroke. D. ensure a patent airway and support ventilation as needed. Answer: D Question Type: Critical Thinking Page: 579 37. You are dispatched to a residence for a 66-year-old male who, according to family members, has suffered a massive stroke. Your primary assessment reveals that the patient is unresponsive, apneic, and pulseless. You should: A. assess the patient for a facial droop and hemiparesis. B. initiate cardiopulmonary resuscitation (CPR) and attach an automated external defibrillator (AED) as soon as possible. C. obtain a blood glucose sample to rule out hypoglycemia. D. perform CPR for 5 minutes before applying the AED. Answer: B Question Type: Critical Thinking Page: 579 38. You are caring for a semiconscious man with left-sided paralysis. His airway is patent and his respirations are 14 breaths/min with adequate tidal volume. Treatment for this patient should include: A. oxygen via a nonrebreathing mask, left lateral recumbent position, and transport. B. assisted ventilation with a bag-mask device, right lateral recumbent position, and transport. C. an oral airway, assisted ventilation with a bag-mask device, Fowler’s position, and transport. D. oxygen via a nonrebreathing mask, supine position with legs elevated 6″ to 12″, and transport. Answer: A Question Type: Critical Thinking Page: 579 39. Law enforcement has summoned you to a nightclub, where a 22-year-old female was found unconscious in an adjacent alley. Your primary assessment reveals that her respirations are rapid and shallow and her pulse is rapid and weak. She is wearing a medical alert bracelet that identifies her as an epileptic. There is an empty bottle of vodka next to the patient. You should: A. place a bite block in her mouth in case she has a seizure and transport at once. B. apply oxygen via a nonrebreathing mask, place her on her left side, and transport. C. assist ventilations, perform a rapid exam, and prepare for immediate transport. D. apply oxygen via nonrebreathing mask and transport her for a blood-alcohol test. Answer: C Question Type: Critical Thinking Page: 579 40. You are caring for a 70-year-old female with signs and symptoms of an acute stroke. She is conscious, has secretions in her mouth, and is breathing at a normal rate with adequate depth. You should: A. suction her oropharynx and apply 100% oxygen. B. insert an oral airway, apply oxygen, and transport. C. use a bag-mask device to assist her ventilations. D. place her on her side and prepare for rapid transport. Answer: A Question Type: Critical Thinking Page: 579 41. You arrive at the residence of a 33-year-old woman who is experiencing a generalized seizure. She has a small amount of vomitus draining from the side of her mouth. After protecting her from further injury, you should: A. place a bite block in between her teeth, apply high-flow oxygen via a nonrebreathing mask, and consider inserting a nasopharyngeal airway. B. wait for the seizure to stop, manually open her airway, insert an oropharyngeal airway, and assess her oxygen saturation with the pulse oximeter. C. restrain her extremities to prevent her from injuring herself, suction her airway to remove the vomitus, and assist her ventilations with a bag-mask device. D. maintain her airway with manual head positioning, suction her airway to remove the vomitus, insert a nasopharyngeal airway, and administer high-flow oxygen. Answer: D Question Type: Critical Thinking Page: 579 42. When obtaining medical history information from the family of a suspected stroke patient, it is MOST important to determine: A. when the patient last appeared normal. B. if there is a family history of a stroke. C. if the patient has been hospitalized before. D. the patient’s overall medication compliance. Answer: A Question Type: General Knowledge Page: 580 43. A 58-year-old male presents with confusion, right-sided weakness, and slurred speech. His wife is present and is very upset. As your partner is applying oxygen, it is MOST important for you to: A. list all of the patient’s current medications. B. obtain a complete set of baseline vital signs. C. administer glucose to rule out hypoglycemia. D. ask his wife when she noticed the symptoms. Answer: D Question Type: Critical Thinking Page: 580 44. A patient without a history of seizures experiences a sudden convulsion. The LEAST likely cause of this seizure is: A. epilepsy. B. a brain tumor. C. a serious infection. D. intracranial bleeding. Answer: A Question Type: General Knowledge Page: 581 45. Which of the following is NOT an assessment parameter included in the Cincinnati Prehospital Stroke Scale? A. speech B. arm drift C. memory D. facial droop Answer: C Question Type: General Knowledge Page: 582 46. When assessing arm movement of a patient with a suspected stroke, you should: A. observe for approximately 5 minutes. B. expect to see one arm slowly drift down to the patient’s side. C. ask the patient to close his or her eyes during the assessment. D. ask the patient to hold his or her arms up with the palms down. Answer: C Question Type: General Knowledge Page: 582 47. You are assessing the arm drift component of the Cincinnati Prehospital Stroke Scale on a 60-year-old woman. When she holds both of her arms out in front of her and closes her eyes, both of her arms immediately fall to her sides. You should: A. repeat the arm drift test and ensure that her palms are facing downward. B. repeat the arm drift test, but move the patient’s arms into position yourself. C. instruct the patient to keep her eyes open and then repeat the arm drift test. D. defer this part of the test and assess her for facial droop and slurred speech. Answer: B Question Type: Critical Thinking Page: 582 48. What Glasgow Coma Scale (GCS) score would you assign to a patient who responds to painful stimuli, uses inappropriate words, and maintains his or her arms in a flexed position? A. 6 B. 8 C. 9 D. 10 Answer: B Question Type: General Knowledge Page: 583 49. A 29-year-old male complains of a severe headache and nausea that has gradually worsened over the past 12 hours. He is conscious, alert, and oriented and tells you that his physician diagnosed him with migraine headaches. He further tells you that he has taken numerous different medications, but none of them seem to help. His blood pressure is 132/74 mm Hg, his pulse is 110 beats/min and strong, and his A. B. C. D. respirations are 20 breaths/min and adequate. In addition to high-flow oxygen, further treatment should include: assisting him with his migraine medication and transporting without lights and siren. placing him in a supine position and transporting with lights and siren to a stroke center. applying warm compresses to the back of his neck and transporting with lights and siren. dimming the lights in the back of the ambulance and transporting without lights and siren. Answer: D Question Type: Critical Thinking Page: 585 50. When transporting a stable stroke patient with unilateral paralysis, it is best to place the patient in a: A. recumbent position with the paralyzed side up. B. recumbent position with the paralyzed side down. C. sitting position with the head at a 45° to 90° angle. D. supine position with the legs elevated 6″ to 12″. Answer: B Question Type: General Knowledge Page: 585 51. A patient who is possibly experiencing a stroke is NOT eligible for thrombolytic (fibrinolytic) therapy if he or she: A. has had a prior heart attack. B. is older than 60 years of age. C. has a GCS score that is less than 8. D. has bleeding within the brain. Answer: D Question Type: General Knowledge Page: 585 52. Successful treatment of a stroke depends on whether: A. surgical intervention is performed to remove obstructive clots. B. medications are given to restore the function of infarcted cells. C. the stroke occurs within the left or right hemisphere of the brain. D. thrombolytic therapy is given within 3 hours after symptoms began. Answer: D Question Type: General Knowledge Page: 585