NREMT Paramedic Exam Prep

NREMT Paramedic Prep - 200 Questions You are called to assist an adult with chest pain. The patient has a cardiac history of two-posterior myocardial infarctions. He is conscious and alert, stating he is having a hard time breathing, and the chest pain worsens when he attempts to lay flat on his back. His skin is pale and hot, while auscultation of his lung sounds reveals mild crackles. He reports the pain worsens on deep inspiration and movement. Based on the patient's history, and signs and symptoms, which of the following should you suspect? B. A. Unstable angina pectoris B. Pericarditis C. Myocardial infarction D. Cardiomyopathy You are the first ambulance to arrive on the scene of a single-car accident. As you approach the scene, you see four patients, two have been ejected from their vehicle, and two are still in the vehicle. What should be your next course of action? A. Call medical control, and advise them of the situation B. Request additional resources, such as fire rescue, and additional ambulances to respond to the scene B. C. Begin immediate triage and treatment of the two patients ejected first while awaiting fire department response D. Notify the local trauma center so they can prepare for the patients A patient is experiencing a possible neurological emergency from a blunt force closed head injury. He is found to have abnormal pupillary reactions to light and has lost the ability to move his eyes from side to side to follow your finger movements. He is also unable to identify the number of fingers you are holding up. He reports he is able to see the fingers but is not able to focus enough to identify how many fingers are present. Which of the following cranial nerves should you suspect may be involved in his injury? D. A. Cranial nerves I, V, and VI B. Cranial nerves V and VII C. Cranial nerves IX and X D. Cranial nerves II, III, and IV 1 / 56 Simply put, shock is a state of hypoperfusion due to several different causes. Which one of the following types of shock would be considered distributive shock? A. Hypovolemic shock B. Cardiogenic shock C. C. Anaphylactic shock D. Toxic shock syndrome Which of the following is responsible for initiating the sympathetic response to shock during a traumatic event? A. Increased oxygen level and increased PCO2 B. Increased peripheral vascular resistance and alkalosis C. C. Decreased perfusion and increased acidosis D. Peripheral vasodilation and increased capillary permeability During which wave, complex, interval, or segment of an electrocardiogram tracing does the absolute refractory period take place in a normally functioning heart? A. S-T segment B. P-R interval D. C. P wave D. Q-T interval You are preparing to perform synchronized electrical cardioversion with a biphasic defibrillator on your unstable adult patient who is experiencing supraventricular tachycardia at 160 beats per minute on the monitor. Which of the following initial energy settings would be recommended if he was exhibiting a narrow complex, regular supraventricular tachycardia, in which his palpable carotid pulse matches the rhythm on the monitor? A. Synchronized cardioversion at 50-100 joules A. B. Defibrillation at 100 joules C. Synchronized cardioversion at 360 joules 2 / 56 D. Defibrillation at 360 joules Other than a stroke, what is a common cause of one-sided facial droop and paralysis in an adult patient who exhibits no other neurological findings? A. Amyotrophic lateral sclerosis (ALS) B. Multiple sclerosis D. C. Huntington's disease D. Bell's palsy You are on-scene with a patient who was struck by a car on her bicycle. She is conscious and alert but has a possible closed right mid-shaft femur fracture. The patient advises you that she is sixteen but does not need parental consent to be treated. Which of the following situations would make this statement true? A. She can be treated under implied consent because her injury may become life-threatening C. B. She is not an American citizen, visiting on a student visa C. She is an emancipated minor granted by the court D. She is an orphaned minor who lives alone Your adult patient is showing signs and symptoms of being severely hyperkalemic. Medical control recommends the administration of a high-dose nebulized albuterol treatment as well as calcium chloride. Why is high-dose albuterol being recommended for this patient? A. To improve the patient's ventilatory status D. B. To assist with metabolic acidosis C. To increase the amount of available calcium at the cellular level D. To help lower dangerous potassium levels When monitoring the electrical activity of a patient's heart, which standard limb lead records the difference in electrical potential between the left leg and the right arm when the left leg is positive and the right arm is negative? B. A. Augmented limb lead aVL B. 3 / 56 Bipolar limb lead II (LII) C. Bipolar limb lead III (LIII) D. Bipolar limb lead I (LI) You are evaluating a trauma patient who may have sustained a spinal cord injury. Which of the following would you expect to see in a trauma patient with a spinal cord injury with autonomic nervous system involvement? A. Bradycardia, hypotension, and a loss of sweating or shivering ability A. B. Bradycardia, hypertension, warm, dry skin, and numbness of fingertips C. Tachycardia, hypertension, one-sided paralysis, and amnesia D. Tachycardia, hypotension, diaphoresis, cool, and clammy skin You are on-scene with an adult patient exhibiting unusual activity and appears to be intoxicated. He is anxious and hyperactive. His heart rate and respirations are fast, but his blood pressure remains within normal range for his age. The patient denies alcohol or drug consumption but reports he has diabetes. His blood glucose level is found to be 54 milligrams per deciliter. How would hypoglycemia cause the patient to present with the above findings? A. The low blood sugar levels stimulate the sympathetic nervous system to trigger the release of epinephrine into the bloodstream to promote liver glycogenolysis B. Low blood sugar levels mimic alcohol intoxication in the brain because of elevated insulin levels in the bloodstream C. The elevated heart rate and respirations stimulate the adipose tissue to increase glucose and fatty acid uptake in an attempt to correct the blood glucose level D. The heart rate and respirations increase in an attempt to promote the natural production and release of glucagon by the alpha cells in the pancreas You are on scene at a motor vehicle accident, and your 20-year-old patient is entrapped. He is unconscious, unresponsive, and has a palpable carotid pulse that is weak and thready. His breathing is slow and shallow at four times a minute with equal chest wall expansion. There are no obvious deformity injuries or hemorrhage noted. Fire department on-scene has stabilized the vehicle and provided you and your partner a relatively safe environment to manage the entrapped patient. However, access is limited to the seated patient, and extrication is expected to take 4 / 56 A. another twenty minutes. After having your partner maintain cervical spine stabilization, which of the following would be the best choice for securing the patient's airway? A. Insert a nasal airway and administer high-flow oxygen therapy B. Use nasotracheal intubation techniques to gain complete control of the patient's airway and assist ventilation D. C. Intubate the patient using the blind orotracheal intubation technique to maintain in-line mobilization of the spine, then assist ventilation D. Insert a King LTD and begin assisting ventilations with a bag-valve mask You are on-scene with a 60-year-old COPD patient complaining of shortness of breath. During your exam, you note the presence of clubbed fingertips. Which of the following is most likely to cause this finding? A. Congestive heart failure especially left ventricular failure B. B. Long-term hypoxemia C. Hypocapnia resulting from low carbon-dioxide levels D. Hemoglobin saturated with red blood cells When involved in transporting a patient from the hospital (regardless of the destination), which of the following disease processes, along with HIV/AIDS, must be reported to the transporting crew members to prevent the accidental transmission of the disease? A. Shingles and pneumonia B. B. Hepatitis and tuberculosis C. ARDS and sepsis D. Syphilis and gonorrhea Which of the following patients best fits the criteria for a critical burn? A. A 10-year-old patient with superficial burns over 60% of the body B. A 15-year-old patient with full-thickness burns on the left upper/lower arm, non-circumferential 5 / 56 Which of the following patients best fits the criteria for a critical burn? A. A 10-year-old patient with superficial burns over 60% of the body B. A 15-year-old patient with full-thickness burns on the left upper/lower arm, non-circumferential C. A 60-year-old patient with partial-thickness burns across 25% of the body, not involving the hands, feet, face, or genitals C. D. A 20-year-old patient with partial-thickness burns on 25% of the body, not including the hands, feet, face, or genitals D. A 20-year-old patient with partial-thickness burns on 25% of the body, not including the hands, feet, face, or genitals Which of the following common toxic substances is a colorless, flammable, and extremely hazardous gas that smells like rotten eggs and is capable of affecting several body systems, especially the nervous system? A. Hydrogen sulfide A. B. Methyl bromide C. Halogenated hydrocarbon D. Hydrogen cyanide Your adult respiratory insufficiency patient's respirations are shallow and irregular at six times per minute. His SpO2 is 76 mm Hg, and you suspect carbon dioxide retention due to the decreased respiratory effort. Which of the following should you suspect? A. Respiratory alkalosis B. B. Respiratory acidosis C. Metabolic acidosis D. Metabolic alkalosis You are assessing an adult patient experiencing sudden-onset chest pain and dyspnea. He quickly exhibits jugular vein distension and cool, clammy skin. His trachea is midline, but there are palpable air pockets under the skin on his upper chest on the left side that feel as though they pop or vanish when you palpate them. What is this abnormal finding? A. 6 / 56 Subcutaneous emphysema B. Atelectasis A. C. Pitting edema D. Ascites You are treating a 68-year-old cardiac history patient experiencing chest pain. If it is determined at the hospital that he experienced an acute myocardial infarction of the septal wall, which of the coronary arteries was most likely occluded? A. Circumflex artery D. B. Right main coronary artery C. Posterior descending artery D. Left main coronary artery You are on-scene with a 70-year-old female who complains of being awakened in the middle of the night by sudden onset dyspnea and sweating. She is breathing 32 times per minute with inspiratory/expiratory wheezing and rales auscultated in all fields bilaterally, with an SpO2 of 88 percent on room air. Her heart rate is 136 beats per minute, showing an irregularly irregular sinus tachycardia on the monitor. Which of the following is most likely causing the patient's current signs and symptoms? C. A. Acute renal failure B. Chronic bronchitis C. Paroxysmal nocturnal dyspnea D. Acute respiratory distress syndrome Your adult female postpartum patient delivered her newborn with the assistance of her husband five minutes prior to your arrival on the scene. The infant's Apgar score is 10, and the baby seems to be fine. However, the mother continues to bleed heavily after an adequate fundal massage and encouraging the infant to breastfeed. Her current heart rate is 125 bpm; her blood pressure is 108/60, and she is breathing 22 times a minute with an SpO2 of 97. After ensuring a second infant is not present, which of the following interventions would medical command most likely recommend? A. Continue fundal massage, and pack the vagina with sterile ABD or trauma pads 7 / 56 D. B. Administer lactated Ringer's solution run wide open using macro-drip tubing under pressure C. Administer a fluid bolus of 1,000 mL of normal saline, and transport the patient in the Trendelenburg position D. Administer oxytocin infusion (1 unit per 100 mL of lactated Ringer's solution) at 20 to 30 gtts/min (micro-drip tubing) depending on bleeding severity Which of the following operational modes used in EMS communication can transmit voice as well as telemetry simultaneously? A. Trunk system mode B. B. Multiplex mode C. Duplex mode D. Simplex mode You are evaluating a 58-year-old who presented with sudden onset chest pain that radiates downward to his lumbar spine region. His peripheral pulses are present but unequal with a significant difference in blood pressure between his left and right arms. Which of the following conditions is most likely to cause the patient's presentation? B. A. A pulmonary embolus B. An aortic aneurysm dissection C. A cardiac tamponade D. A myocardial infarction You are ordered to administer 3 mg/min of lidocaine via intravenous infusion to your cardiac patient who presents with a heart rate greater than 130 beats per minute as well as greater than 10 multifocal PVCs every minute. Therefore, you quickly but carefully mix 2 grams of the medication in 500 mL of normal saline and attach micro-drip tubing to the solution bag. Which of the following drip rates would effectively deliver the ordered dose of lidocaine? D. A. 15 gtts/min B. 30 gtts/min C. 60 gtts/min D. 45 gtts/min You are ordered to administer 0.3 mL of epinephrine for a moderate allergic reaction. What is the preferred initial route of administration of epinephrine for an allergic reaction? B. A. Subcutaneous B. Intramuscular C. Intravenous D. Endotracheal You are called to assist an adult diabetic who was found unconscious in bed. On arrival, your patient is unresponsive with snoring 8 / 56 respirations and cool, clammy skin. Your glucometer will not power up, so blood glucose analysis is impossible at the present time. Which of the following would be most appropriate after controlling the patient's airway and delivering high-flow oxygen therapy? A. Administer glucagon to the patient intramuscularly in a large muscle group like the gluteal muscles B. Start an intravenous line, draw blood samples, and administer one amp of dextrose 50 percent (D50) B. C. Start an intravenous line, and draw blood samples before administering a glucose-containing IV fluid bolus D. Quickly establish an intravenous line, and transport the patient to the nearest hospital for blood glucose analysis prior to medication administration You arrive on-scene to a two-vehicle MVA. One vehicle is already being attended to by another ambulance, so you head to the other car. Your patient is a 40-year-old male, standing outside of his car. Immediately, you can see your patient slightly swaying on his feet, and his breath smells of alcohol, but he has no noticeable injuries. There is slight crumpling on the driver's side of his car, and airbags have been deployed. Your patient adamantly says that he is not injured, but upon an assessment of his mental faculties, he is unsure of what month it is or what city he is in at the time. The patient does admit that he has only had two beers and is not inebriated. What C-Spine precautions, if any, should you take? B. A. Patient is ambulatory, and the lack of ability to remember the city he is in or what month it is can be attributed to the shock of the crash and his being inebriated B. Patient will need full C-spine precautions, including a backboard. The patient will also immediately need your partner to administer manual C-spine and apply a cervical collar when possible. C. Patient does not need cervical precautions because he will be in police custody, and they are not qualified for these interventions D. Patient only needs a cervical collar, just in case his symptoms are caused by a head injury What can a paramedic expect to occur in a closed-head injury patient when the intracranial pressure increases and the mean arterial pressure decreases? A. The patient's cerebral blood flow decreases A. B. The patient has likely suffered a brainstem herniation C. A marked increase in the patient's blood glucose level D. The formation of an intracranial abscess When determining an estimated time of death on-scene, what is the terminology used to describe blood and fluid leaving the areas of the face, nose, and chin assisted by gravity and allowed to settle in the lowest parts of the body? A. Dependent lividity 9 / 56 B. Cyanosis A. C. Rigor mortis D. Post-partum blood pooling You are intubating a 26-year-old who is apneic. Once the endotracheal tube passes through the vocal cords, how much farther should the endotracheal tube be advanced before inflating the cuff and confirming proper placement? A. 0.5 to 1 inch A. B. Less than 1 cm C. 2 to 3 cm D. 1 to 2.5 inches You are cleaning the back of the truck after transporting a trauma patient to the emergency department. Which of the following contaminated items should not be placed in a plastic biohazard bag? A. Plastic IV catheter A. B. Nasopharyngeal or oral airway C. French suction catheter D. Blood-soaked gauze pads You suspect that your trauma patient may be experiencing the adverse effects of a crush injury after being entrapped under a fallen building for several hours before rescue. He is found to be wheezing with shortness of breath and hypotension with no obvious sign of chest wall/lung injury or blood loss. What is the most likely cause of these findings in a crush injury patient? A. A. Histamine release B. Atelectasis from the compressive forces C. Aortic dissection D. Thrombin formation Your adult asthma patient is experiencing a severe attack characterized by inspiratory and expiratory wheezes with potential airway compromise due to laryngospasm. Which of the following interventions would be most appropriate after oxygen therapy is applied? A. 2.5 to 5 mg of albuterol solution mixed with 3 mL of 0.9 normal saline and nebulized with 6-8 lpm of oxygen B. Rapid sequence intubation with sedation C. 0.31 mg of levalbuterol nebulized with 6-8 lpm of oxygen D. 0.3-0.5 mL (1:1000) of epinephrine delivered IM/SC; repeat in 15 minutes if needed 10 / 56 A. You are preparing to perform fluid replacement on an adult trauma patient who lost a significant amount of his circulating blood volume when you note the presence of a drastic systolic blood pressure decline from 100 mmHg to 86 mmHg systolic after the patient's bleeding is controlled. The patient has no obvious new bleeding, but his abdomen is distended and is painful on palpation. There are no obvious masses, bruises, or deformity, and he has active bowel sounds over the epigastric region. Which of the following intravenous fluids would be most appropriate in this situation if the medical command physician recommends a fluid challenge? D. A. 0.9% normal saline B. 0.45% sodium chloride C. 0.45% normal saline with 5% dextrose D. Lactated Ringer's solution What type of communication system operational mode is required for an EMS agency to be able to communicate simultaneously in both directions while also performing telemetry transmission? A. Multiplex mode A. B. Duplex mode C. Simplex mode D. Complex mode You suspect your adult trauma patient has a potential complete spinal cord transection. If so, which of the following would you expect to find? A. Total loss of pain and sensation below the waist bilaterally with some loss of movement below the waist C. B. Bradycardia associated with loss in vascular tone C. Total absence of pain, sensation, and movement (paralysis) below the point of the transection (injury) D. Right-sided paralysis with decreased sensation on the opposite side of the body You are on-scene with a patient who you suspect may be experiencing a myocardial infarction. He is conscious and alert, anxious, and has dilated pupils. He complains of substernal chest pain and admits to recent cocaine use. How does the use of cocaine increase the risk of experiencing an acute myocardial infarction? A. It speeds the heart rate to the point of asystole D. B. It causes the blood in the periphery to clot and travel to the coronary arteries C. It actually numbs the heart, making coronary perfusion difficult D. It causes coronary artery constriction and increases the chance of dislodging a thrombus or plaque 11 / 56 In which of the following situations would evaluating the ST segment elevation of a patient suffering from a suspected myocardial infarction not be indicated to determine if an infarction exists? A. When a pre-existing right bundle branch block is present D. B. When the patient is hypotensive C. In the presence of pulmonary edema D. In the presence of a left bundle branch block If an adult patient is experiencing the signs and symptoms of a myocardial infarction with perfusing arrhythmias, which of the following pre-hospital interventions will help to reduce the patient's cardiac preload and afterload? A. The intravenous administration of 2-4 mg of morphine per a medical-control physician's order B. The administration of various medications and dosages to control the specific dysrhythmias such as procainamide, atropine, verapamil, and others C. C. The administration of sublingual nitroglycerin therapy D. The administration of high-flow oxygen therapy (15 liters per minute) via a non-rebreather mask Your adult patient was entrapped by dirt up to his mid-abdominal area for a few hours while rescue crews worked to free him. Once on the cardiac monitor, why would tall, tented T waves become evident quickly? A. Hyperkalemia caused by the sudden influx of potassium B. Myocardial ischemia caused by decreased available oxygen for the myocardium A. C. Hypokalemia associated with the sudden release of the compressive force D. Cardiac tamponade associated with increased intrathoracic pressure and blood pressure The alpha, beta-1, and beta-2 receptors are important in the maintenance of heart rate and respiratory function. What can we expect to occur if a patient's beta-1 receptors are stimulated? A. Decrease in the diameter of the bronchioles to help retain carbon dioxide when needed B. B. Increased heart rate and strength of contraction C. Increase in the diameter of the bronchioles to let more air in and out during ventilation D. Decrease in the heart rate and the size of the bronchioles You are called to stage at a mass casualty incident involving exposure to possible chemical agents during the event. Knowing you will likely transport one or more patients from the scene that have been grossly decontaminated in the decontamination section, what measures can you take to minimize the possible contamination of your unit during the patient care/transport en12 / 56 counter? A. Use disposable equipment as much as possible, remove all equipment that will not likely be needed during transport, cover the patient and stretcher with plastic B. Patient should be transported in a full hazmat suit after gross decontamination to prevent infecting EMS and ER staff A. C. Cover the patient with sheets and blankets and administer oxygen via a non-rebreather mask to prevent spread of toxins D. Transport the patient on stretcher and treat appropriately. Decontamination has taken place so no further danger of contamination exists. You are monitoring the cardiac rhythm of your 60-year-old female patient with shortness of breath when you note the presence of a possible first-degree atrioventricular block in lead II on the EKG. Which of the following electrocardiogram abnormalities makes you think there is a first-degree AV block present? A. There are more than one P wave for each QRS complex B. A P-R interval greater than five small boxes (0.20 seconds) wide on the electrocardiogram tracing B. C. The P-R intervals become progressively longer until a QRS complex is dropped altogether D. The P waves are present but bear no relationship to the QRS complexes You are called to assist a 50-year-old cardiac history patient complaining of chest pain. On arrival, the patient rates his pain at an eight on the pain scale. His skin is cool, clammy, and diaphoretic with a SpO2 of 88 percent on room air. His respirations are at 33 per minute and shallow but clear. His heart rate is 40 beats per minute with a blood pressure of 90 systolic. Which of the following interventions would be inappropriate at this point? D. A. Intravenous access B. High-flow oxygen therapy C. Twelve-lead electrocardiogram analysis with continuous Lead II monitoring D. Nitroglycerin therapy You are called to assist a 20-year-old male for a severe headache. On-scene, you learn the patient was involved in an accident that caused a potential closed head injury. However, at the time of the accident, the patient refused EMS care, stating he felt fine. Today, he is experiencing headache, confusion, and visual disturbances. Which of the following injuries is most likely to cause this type presentation? C. A. Coup-contra-coup injury B. Diffuse axonal injury 13 / 56 C. Subdural hematoma D. Epidural hematoma An adult trauma patient suffered a fall from greater than 15 feet. When predicting the injuries associated with this type injury, the paramedic should evaluate the distance fallen, the position of the body on impact, and which of the following? A. The type of landing surface involved A. B. The ambient temperature at the time of the fall C. The patient's neurological status D. The body parts that were struck with the most force Negligence is divided into three categories. Which of the following is not one of the categories? A. Malfeasance D. B. Misfeasance C. Nonfeasance D. Milfeasance You are assessing a patient with an altered mental status and has a diabetic history. Which of the following would most likely indicate the patient is suffering from diabetic ketoacidosis? A. Cool, moist skin, wet mucous membranes, normal pulses and blood pressure, shallow respirations, and family members report increasing hunger and then nausea in the patient before calling 9-1-1 B. Red hot skin, wet mucous membranes, weak tachycardic pulses, hypotension, shallow rapid respirations, and family members report that the patient spoke of a loss of appetite for several days before calling 9-1-1 D. C. Dry, doughy-looking skin that is cool to the touch, unresponsiveness, bradycardic pulse, normal blood pressure, slow, shallow respirations, and family members report that the patient spoke of increasing intolerance to cold for several days before calling 9-1-1 D. Dry skin, dry mucous membranes, hypotension, shallow rapid respirations, and family members report that the patient spoke of increased thirst and frequent urination for several days before calling 9-1-1 What can the paramedic expect to find when evaluating the pupillary response of a patient suspected of suffering from herniation? A. Bilateral pupil dilation B. B. A unilaterally, unequal and non-reactive pupil C. Bilaterally, unequal and non-responsive pupils D. Sluggish response, but equal pupils In a trauma situation, it is acceptable to administer either normal saline or lactated Ringer's to your patient for volume replacement. What is the primary benefit of choosing lactated Ringer's? 14 / 56 A. It will stay in the vascular system longer, promoting blood pressure B. It has the ability to carry red blood cells C. C. It helps decrease acidosis in a hypovolemic patient D. It helps increase acidosis in the hypovolemic patient You are performing orotracheal intubation on an average-sized, apneic adult. At what depth marking should the airway be properly positioned 2 to 3 cm above the carina? A. 9 to 13 centimeters C. B. 29 to 32 centimeters C. 19 to 23 centimeters D. 32 to 36 centimeters Opioid antagonists reverse the symptoms of an opioid overdose. Which of the following medications would be effective in reversing the adverse effects of a benzodiazepine overdose? A. Naltrexone C. B. Alprazolam C. Flumazenil D. Naloxone You are working in a pre-hospital setting and are called for a 40-year-old male who was the victim of a stabbing. The patient has a blood pressure of 87/50 and a heart rate of 130. There is a large amount of blood on the scene. After applying direct pressure to the wound on the patient's arm and stopping the bleeding, of the following what would be the best intervention to mitigate the patient's blood pressure? A.Establish two large-bore IVs, and administer 2 liters of fluid D. B. Establish an IV, and administer a norepinephrine drip at 0.1-2mcg/kg/min, titrated to effect C. Establish an IV, and establish a dopamine drip to the patient at 5mcg/kg/min D. Establish an IV, and administer fluid to keep the patient's BP at or near 90 systolic While on-scene with a 70-year-old complaining of chest pain, what is one of the first indicators that should alert the paramedic to the probability that an acute myocardial infarction is occurring? A. The relief to some degree of chest pain after the administration of nitroglycerin B. The presence of chest pain not changed or relieved by oxygen therapy alone C. The presence of persistent chest pain not relieved by nitroglycerin therapy 15 / 56 C. D. Cyanosis around the patient's mouth, nose, and nail beds Your 23-year-old diabetic patient was found unresponsive with increased respirations, hypotension, and bradycardia. Family members state he recently had a tooth pulled and was prescribed Vicodin. Which of the following is most likely to cause the patient's presentation? A. Myasthenia gravis C. B. Metabolic alkalosis C. Ketoacidosis D. Narcotic overdose After assisting a full-term pregnant patient in the delivery of her newborn, the newborn remains bradycardic with a heart rate of 50 beats per minute and exhibits cyanosis around his mouth, nose, fingers, and toes. He is not responding well and appears lethargic following the five-minute APGAR assessment. What would be the best initial intervention at this point to increase his heart rate? A. Deliver adequate artificial ventilation after ensuring a definitive airway A. B. Administer epinephrine 1:10,000 at 0.1 mg/mL intravenously C. Administer a vasopressor agent intravenously per medical command recommendations D. "Fast and hard" chest compressions at more than 120 compressions per minute You are working an adult cardiac arrest patient who is not responding to electrical therapy. According to ACLS guidelines, what is the appropriate concentration and dosage of epinephrine in a cardiac arrest patient? A. 1mg IV/IO every 3-5 minutes with a concentration of 1:10,000 A. B. 0.1mg IV/IO every 3-5 minutes with a concentration of 1:1,000 C. 1mg IV/IO every 1-3 minutes with a concentration of 1:10,000 D. 0.1mg IV/IO every 3-5 minutes with a concentration of 1:10,000 While conducting an EKG on your post-myocardial infarction patient, you note the presence of consistently wide QRS complexes greater than 120 ms in duration. What does this most likely indicate? A. An intraventricular conduction delay or right/left bundle branch block B. A complete heart block indicating no relationship between the atria and ventricles C. The patient is likely suffering from a myocardial infarction currently 16 / 56 A. D. The patient has a congenital heart defect and should not require emergency care You are assessing a critical patient and considering the possibility of a reversible cause of his symptomatic slow heart rate. Which of the possibilities is most likely to cause a patient to present with a slow heart rate and associated signs/symptoms of bradycardia? A. Cardiac tamponade B. B. Hypoxia C. Pulmonary embolus D. Hypovolemia You are treating a COPD patient for mild shortness of breath when you note the presence of pursed lips and sighing-type respirations at 26/minute. Why would the patient present with pursed lips and frequent sighing? A. In an attempt to expel foreign bodies or irritants from the lower airway B. B. To prevent atelectasis from occurring at the end of exhalation C. To prevent pleural friction rub that is associated with pleurisy and pain D. To increase the size of the air sacs of the lungs to improve oxygenation You suspect your unconscious adult trauma patient may have increased intracranial pressure from a closed head injury. Due to the compression forces of increased intracranial pressure, at what level of brain injury would be expected if the patient is exhibiting Cheyne-Stokes respirations and is presenting with increasing blood pressure readings and a decreasing, reactive pulse rate? A. A. Cortex and upper brainstem B. Midbrain region C. Medulla oblongata D. Lower portion of the brainstem You are called to assist a pregnant female in the 24th week gestation period according to her due date. The pale 26-year-old patient is found supine in bed, complaining of dizziness/weakness with extreme nausea. The patient denies vaginal bleeding, amniotic fluid leakage, or abdominal pain. There are no signs of imminent birth or active labor. She reports receiving normal prenatal care with no associated problems found during the pregnancy. Her heart rate is 126-130 beats per minute; her blood pressure is 80 mmHg systolic while her skin is cool and pale. Which of the following conditions is most likely to cause the patient's presentation? A. Uterine rupture B. Spontaneous abortion C. Supine hypotension 17 / 56 C. D. Placenta previa You are dispatched to the scene of a one-vehicle motor collision. Upon your arrival at the scene, you note that the vehicle struck a tree on the driver side. The driver is the only patient, and she is still sitting in the driver seat of the vehicle. The vehicle is stable and has moderate damage noted to the driver side, which prevents the driver side door from opening. Which of the following would be the most appropriate way to extricate the patient from the vehicle? A. Break the driver side window and attempt to remove the patient through the window D. B. Open the rear driver side door and extricate the patient through the backseat C. Use a crowbar and pry open the driver door D. Open the passenger side door and extricate through the passenger side You are on-scene with a patient suspected of taking a large amount of meperidine hydrochloride. Which of the following interventions may be effective in reversing the adverse effects of the ingested medication? A. Activated charcoal D. Meperidine is an Opiate Analgesic B. Atropine C. Romazicon D. Naloxone Your adult status asthmaticus patient requires rapid sequence intubation due to rapidly increasing airway constriction. Which of the following would be most appropriate following tube placement confirmation? A. 3 mg of levalbuterol administered directly down the ET tube C. B. 2-5 mg of albuterol administered directly down the ET tube C. 2.5 mg of albuterol in 3-mL solution, nebulized and delivered with ventilation D. 1.25 mg of levalbuterol in 3-mL solution, nebulized and delivered with ventilation Several minutes after sealing your adult trauma patient's sucking chest wound with an occlusive dressing secured on three sides, he begins to experience increasing shortness of breath, jugular vein distension, decreasing unilateral breath sounds on the affected side, and his blood pressure is less than 90 systolic and falling. Repeated attempts to relieve the pressure at the occlusive dressing have proven ineffective. At this point, which of the following should be initiated? A. Remove the occlusive dressing and pull sucking chest wound open gently to allow air to escape the chest 18 / 56 D. B. Translaryngeal Jet Ventilation using a 10- or 14-gauge catheter that is an inch to an inch-and-a-half long C. Endotracheal intubation and positive pressure ventilations via forced air ventilator D. Immediate needle decompression using a 10- or 14-gauge catheter that is at least 2 or 2.5 inches long When treating an adult patient for a mild allergic reaction, with no respiratory distress or dyspnea, which medication is routinely administered either IM or IV for the treatment of an allergic reaction? A. Epinephrine D. B. Methylprednisolone C. Albuterol D. Diphenhydramine Epinephrine is effective in helping reverse the adverse effects of anaphylaxis. It is the drug of choice because it causes bronchodilation and vasoconstriction to improve respiratory effort and improve blood pressure. What other effect does epinephrine have on the patient's body during an anaphylactic reaction? A. It reduces the release of chemical mediators from the mast cells A. B. It is effective in reducing the inflammatory response of the reaction C. Increases the heart rate to improve peripheral perfusion D. It causes peripheral vasoconstriction to reduce the itching associated with the reaction What is the name of the legal document in which an individual specifies what medical treatments should and should not be done for him in the event he is unable to make his own medical care decisions? A. A do not resuscitate order (DNR) C. B. A will C. An advanced directive D. A personal directive You are preparing to initiate a rapid sequence intubation on a pediatric patient who is exhibiting a borderline hypotensive state with a decreased level of consciousness and hypoventilation. He is quickly becoming hypoxic with a SpO2 of 77% and a delayed capillary refill. Which medication would be most effective in sedating this patient for the procedure? A. Succinylcholine B. Midazolam 19 / 56 C. C. Ketamine D. Propofol You are preparing to intubate an apneic patient and decide to use a Macintosh blade. When using a curved blade on an adult, where should the tip of the laryngoscope blade be placed? A. Directly under the epiglottis C. B. Space below the vallecula C. Directly into the vallecula D. Directly on the epiglottis You have a 70-year-old female patient in cardiac arrest. Your partner begins compressions, and another paramedic on-scene begins ventilating with an OPA and BVM. You look over to the fridge and find the patient's DNR orders that state the patient does not want any life-saving procedures and looks to be signed and valid. However, the patient has many pictures of her family on the fridge, and pictures drawn for her by her grandchildren. There is no family on-scene. What are the next steps that you should take? A. Continue basic CPR and airway control, and transport to the hospital so they can determine whether or not to continue resuscitation B. B. Discontinue all resuscitation measures, and take the next steps of notifying your dispatch and/or local medical coroner, as laid out by protocol C. Follow full ACLS protocols for at least two minutes to assess whether the patient can be resuscitated, as the patient looks to have a very loving family and you want to make sure you can do everything you can D. Continue basic resuscitation, and attempt to get in contact with the family to determine whether or not you should discontinue You are on-scene assisting another crew with a childbirth call that quickly turned into a neonatal resuscitation. The newborn does not have a palpable brachial pulse, but muffled heart tones and the monitor confirm a sluggish heart rate of 55 beats per minute. After reassessing him after a few minutes of high-quality chest compressions and effective ventilations with 100% oxygen concentration, the patient's heart rate fails to respond. Which of the following would be considered a class IIa intervention for this patient? A. 0.1 mg/mL of a 1:10,000 concentration of epinephrine delivered via the intraosseous route B. 0.01 mg/mL of a 1:1,000 concentration of epinephrine delivered via the intramuscular route C. 0.25 mg/mL of a 1:1,000 concentration of epinephrine delivered via the endotracheal tube route D. 0.1 mg/mL of a 1:10,000 concentration of epinephrine delivered intravenously 20 / 56 D. Your adult trauma patient may be experiencing the adverse effects of a crush injury that triggered the sudden release of high levels of histamine. What would this usually cause? A. Bronchoconstriction and vasodilation B. Irregular, shallow respirations and a normotensive blood pressure A. C. Increased spontaneous respiration and unequal blood pressure readings in arms and legs D. Bronchodilation and vasoconstriction While evaluating the twelve-lead electrocardiogram tracing of your 66-year-old cardiac history patient for the possibility of an acute myocardial infarction, you note the presence of deep symmetrically inverted T waves. Which of the following is most likely the cause of this abnormal finding? A. Necrosis B. B. Ischemia C. Hyperkalemia D. Hypokalemia You are treating a 50-year-old male with a cardiac history currently complaining of chest pain. He is breathing at 20 times a minute, has an irregular heart rate of 136 beats per minute, and a blood pressure of 120/60. His twelve-lead-tracing indicates the presence of an ST-elevation myocardial infarction (STEMI). What makes the ST-elevation infarction treatment different from a non-STEMI patient's treatment? A. A non-ST elevation infarction may respond to fibrinolytics, so destination is important for this patient B. B. ST-elevation infarctions may respond to fibrinolytics, so time and destination are critical for this patient C. ST-elevation patients will need a fluid bolus to maintain an adequate blood pressure D. Nothing, both types will respond to fibrinolytic therapy equally Which of the following respiratory patterns is most likely to be present with an adult patient suffering the adverse effects of diabetic ketoacidosis? A. Bradypnea C. B. Central neurogenic hyperventilation C. Kussmaul respirations D. Cheyne-Stokes respirations Your adult patient presents with shortness of breath and chest pain. She reports the pain began last night and has worsened. She is breathing 28 times per minute with a SpO2 of 96 percent on room air. She reports the pain worsens when asked to take a deep breath. Lung sounds are equal with a grating sound heard on 21 / 56 inhalation. The patient's heart rate and blood pressure are normal. She is showing a sinus rhythm with a first-degree atrioventricular block present in lead II on the ECG. Which of the following is most likely the cause of her complaints? A. Pleurisy A. B. Asthma C. Acute myocardial infarction D. Bronchitis Your 49-year-old COPD patient is unconscious and exhibiting ineffective respirations. You quickly decide to attempt to control his airway and provide positive pressure ventilations. Which airway adjunct has a large distal end with an inflatable cuff that presses against the patient's esophageal sphincter while the proximal border of the airway device rests against the patient's tongue? C. A. King LTD airway B. Esophageal-Tracheal Combi-tube C. Laryngeal Mask Airway (LMA) D. Nasotracheal intubation Your adult patient has suffered a prolonged cardiac arrest interval and is receiving advanced cardiac life-support interventions. When administering medications intravenously, why should calcium chloride and sodium bicarbonate not be administered through the same IV line? A. Calcium chloride will precipitate/crystallize when mixed with sodium bicarbonate A. B. Calcium chloride will antagonize the effects of sodium bicarbonate C. Sodium bicarbonate will cause a rebound acidosis when mixed with calcium chloride D. Sodium bicarbonate will act as an agonist to the calcium chloride causing hypercalcemia To combat increasing ICP in a head injury, the body utilizes this principle: A. Monro-Kellie Principle A. B. Bernicke Principle C. Fick Principle D. Bernoulli's Principle Your adult patient called for help after he began to vomit bright red blood. On arrival, the patient is found to be tachycardic and bleeding freely from his mouth. His respirations are shallow, and his skin is cool with a blood pressure is 68 systolic. His only history involves liver disease from chronic alcoholism. He denies drinking recently. 22 / 56 What should be the goal of your pre-hospital intervention with this patient after ensuring his airway and applying oxygen therapy? A. Fluid resuscitation to maintain a systolic blood pressure of 80-90 systolic B. Fluid resuscitation to maintain a blood pressure of at least 100 systolic A. C. To control the hemorrhage with pharmacologic intervention D. Maintaining a high blood oxygen saturation to continue perfusion at the cellular level Your adult patient presents with dyspnea that developed over the last few days and worsened today. During auscultation of the patient's lungs, his vocal sounds become louder over the left lower lobe of his lung. What does this likely indicate? A. Consolidation (fluid, mucus) is present in the left lower lobe of the patient's lung A. B. Consolidation (clear lung sounds) is present everywhere but in the left lower lobe of the patient's lung C. A pneumothorax likely exists in the left lower lobe of the patient's lung D. The patient is likely experiencing an acute asthma attack Your adult patient was involved in a structure fire and received possible airway burns. The patient complains of shortness of breath, but there are no obvious burns noted in his oropharynx. However, his dyspnea fails to improve after several minutes of high-flow oxygen therapy, and his lung sounds reveal a grating sound during equal inspiration/exhalation. Which of the following should you suspect? A. A. A loss of pulmonary surfactant B. Bronchoconstriction C. Fluid accumulation in the small airways D. Associated rib fracture You are treating a post femoral fracture patient with suspected deep vein thrombosis in his right upper thigh. What should be the main concern while treating and transporting the patient to the hospital? A. Immobilize the right leg and apply hot packs to the suspected occlusion site to improve distal circulation B. Allow the patient to assume a position of comfort and monitor closely for a pulmonary embolism C. Fully immobilizing the patient and monitoring distal circulation, sensation, and heart tones D. Immobilizing the right leg and making sure it stays lower than the heart while assessing distal pulses 23 / 56 B. You are on-scene with a cardiac history patient experiencing unstable ventricular tachycardia that is not responding well to prehospital interventions. The patient and family want the patient transported to a hospital across town; however, there is a facility more capable of handling the cardiac event much closer. Which of the following would be most appropriate? A. Transport the patient to the closer facility, then explain to the patient and family on arrival at the appropriate facility C. B. Transport the patient to the facility of his or her choice, regardless of medical condition C. Explain the situation to the patient and family, then transport him to the closer facility to benefit the patient D. Tell the patient and family they have no choice and transport the patient to the closer facility Thyroid storm is caused by the acute hyperfunction of the thyroid gland and is a true medical emergency that requires emergent hospital intervention. Which of the following signs and symptoms would a paramedic expect a patient experiencing a thyroid storm to exhibit? A. Tachycardia, bradypnea, hypothermia, gastrointestinal upset, and listlessness C. B. Bradycardia, tachypnea, hypothermia, palpitations, and lethargy C. Tachycardia, tachypnea, hyperthermia, palpitations, and delirium D. Bradycardia, bradypnea, hyperthermia, confusion, and delirium Your adult hemodialysis patient is in cardiac arrest one hour after completing a dialysis treatment. He is found to be apneic and asystolic with adequate CPR in progress. Which of the following should be administered during the resuscitation attempt? A. Sodium bicarbonate and magnesium sulfate C. B. Amiodarone and magnesium sulfate C. Sodium bicarbonate and calcium chloride D. Potassium and dopamine After assisting a pregnant patient to deliver her full-term newborn at home, you quickly dry the infant and open his airway to help begin spontaneous respiration. However, after a few seconds, you realize the newborn has copious secretions in his airway preventing effective spontaneous respiration. Which of the following should you do to safely and effectively clear the infant's airway? A. Use a portable suction machine with a rigid suction catheter to suction his posterior airway B. Use a bulb syringe to suction his nose first and his mouth second 24 / 56 D. C. With assistance, use two bulb syringes to suction his mouth and nose simultaneously D. Use a bulb syringe to suction his mouth first and then his nose second You are called to assist an adult female with a possible allergic reaction. You arrive to find a 22-year-old patient who is just beginning to have difficulty breathing. She has itching, urticaria, and hives after a bee-sting. During the possible allergic reaction, what is occurring at the cellular level? A. The mast cells are retaining the vasoactive amines, resulting in a localized response to the sting D. B. The cells begin a hypermetabolic state associated with the patient's increased activity level after the sting C. An anaerobic metabolism has begun at the local level and is now moving into the vasculature D. The mast cells have degranulated, releasing serotonin and histamines into the general circulation If the city council in your area enacts a law concerning the classification of first responders, what type of law allows this to occur in the US? A. Civil law B. B. Legislative law C. Administrative law D. Common law You are treating a 20-year-old patient who sustained a full-thickness burn to his entire right lower leg. During your evaluation, it is quickly determined the patient has no sensation or distal pulses peripherally in the affected limb. If circulation is not quickly returned to the extremity, which of the following is most likely to occur? C. A. Crush injury syndrome B. Burn shock syndrome C. Compartment syndrome D. Lactic acidosis syndrome You are called to assist a 50-year-old patient with rapid-onset pain in his right lower calf. The patient denies trauma but has a past medical history of hypertension and heart disease. The right lower leg is cool and pale, and the patient reports cramp-like pain in the area that began while he was sitting. His left leg remains asymptomatic. Which of the following conditions should be suspected until proven otherwise? A. Acute femoral artery occlusion B. Acute iliac artery occlusion 25 / 56 A. C. Acute abdominal aorta occlusion D. Acute mesenteric artery occlusion You are responding to a possible assault call. You choose to park down the block from the house, as police have not yet made the scene safe. However, you see what looks to be a patient in distress in the upper story window. What would be the safest approach in this situation? A. Wait for responding police to control the situation and say that it is safe for EMS A. B. Wait for police to arrive, then grab your gear and go in with police to treat the patient C. Drive up to the driveway to get a better view of the patient's condition D. Head into the house to treat the patient since he could be critically hurt You are orally intubating a patient experiencing spasmodic closure of the vocal cords from laryngeal spasm. What is the best way to get the cords to allow the passage of the ET tube in this situation? A. Applying a copious amount of lubrication on the tube and vocal cords D. B. Apply steady cricoid pressure throughout the intubation C. Allow the tip of the stylet to exit the end of the tube to serve as a guide through the narrow opening D. A forceful upward pull of the jaw to reposition the airway Which of the following is not a cause of shock? A. Inability of RBCs to deliver oxygen to the tissues B. Decreased systemic vascular resistance C. C. Increased systemic vascular resistance D. Inadequate cardiac output Which of the following is considered a solution that contains molecules, such as proteins, that are too large to pass through the capillary membrane? A. Hypertonic solution D. B. Hypotonic solution C. Crystalloid solution D. Colloid solution Which of the following conditions is most likely to cause a patient to present with potentially reversible pulseless electrical activity on the monitor? D. A. Traumatic asphyxia B. Wolf Parkinson White syndrome 26 / 56 C. The R-on-T phenomenon D. Tension pneumothorax An adult patient who experiences the loss of his/her gag reflex following a closed-head and suspected spinal injury may have suffered an injury to which of the following cranial nerves? A. Cranial nerve X (vagus) B. Cranial nerve III (oculomotor) A. C. Cranial nerve XII (hypoglossal) D. Cranial nerve IX (glossopharyngeal) Your adult patient sustained a right index finger amputation at work. On arrival, first responders have the bleeding controlled with sterile dressings, and the patient is conscious, alert, and oriented. What is the best way to manage the patient's amputated finger during transport to the hospital? A. Do not wrap the finger. Gently place it in a sealed plastic bag, and place it on a towel in ice. B. Wrap the finger in gauze (moistened with normal saline), and seal the finger in a plastic bag before placing it on ice B. C. Rinse the gauze-wrapped finger using water, and place it in a plastic bag with ice D. Wrap it in gauze, and place the finger in close proximity to the patient's core to maintain the appropriate body temperature for re-attachment You are on-scene with a patient in cardiac arrest. You turn the monitor/defibrillator on and attach the pads to the patient. When it begins to analyze the patient's cardiac rhythm, it signals "low battery" and then shuts off. You have no other batteries available, and an electrical plug is not available. The patient subsequently dies despite adequate CPR and advanced airway and ventilation during transport. Which of the following could result? A. Manslaughter charges could be brought against the paramedic in charge of the unit B. Negligence charges could be brought against the paramedic in charge of the unit C. Battery charges could be brought against the entire service D. 27 / 56 B. Defamation charges could be brought against the entire crew on scene A patient suffering from an ST-elevation myocardial infarction or a presumably new-onset left bundle branch block may benefit from the use of fibrinolytic therapy if the agent is given promptly. How long does a patient have to receive the first fibrinolytic agent to salvage ischemic heart tissue? A. Within 12 hours of symptoms onset A. B. Within the first 90 minutes from symptom onset C. Within 24 hours of symptoms onset D. Within the first hour ("golden hour") from symptom onset You are working a 55-year-old patient in cardiac arrest. When it comes time to push amiodarone for ventricular fibrillation, you note that your stock of the preferred medication has been depleted on a previous call. What medication can be safely used in place of amiodarone in this situation? A. Epinephrine C. B. Cardizem C. Lidocaine D. Procainamide EMS communication over open airways is normally conducted through two-way radios of varying frequencies and controlled by the FCC. Of the frequency bands listed below, which one is strictly assigned to two-way communication or one-way paging, operating in the simplex mode? A. Very High Frequency (VHF), low and high bands between 32-170 MHz B. Ultra High Frequency (UHF) bands between 450-470 MHz C. Ultra High Frequency (UHF) bands up to 400 MHz D. Very High Frequency, low band (VHF) between 20-30 MHz Which of the following medications is used to prevent blood clot formation in patients with a-fib or pulmonary embolism, and decrease the risk of MI in patients with atherosclerosis as well as reduce the risk of stroke? A. Nitroglycerin 28 / 56 A. B. Lotensin C. Losartan D. D. Streptokinase Which of the following medical conditions or injuries is most likely to cause problems with both the internal and external processes of normal respiration? A. Lung cancer B. Chronic hypertension D. C. Congestive heart failure D. Emphysema You are ordered to administer a dopamine infusion to your 62-year-old, 75 kg, hypotensive, cardiac patient. The ordered dose is 10 mcg/kg/min, and you plan to use a micro-drip tubing set with the standard dopamine mixture of 800 mg in a 500 mL normal saline infusion bag. How many drops per minute will it take to deliver the ordered dose of dopamine properly? A. 28 gtts/min A. B. 42 gtts/min C. 14 gtts/min D. 56 gtts/min Which of the following medications may be effective in reversing the signs and symptoms of dystonia? A. Promethazine B. Morphine sulfate D. C. Lidocaine D. Diphenhydramine Due to automaticity, a cardiac cell can initiate electrical impulses. The more superior its location, the more intrinsic beats it is able to produce per minute. Which of the following is known as the chief 29 / 56 pacemaker of the heart? A. Sinoatrial node B. Purkinje fibers C. Bundle of His D. Atrioventricular node A. Which of the following would be your most appropriate action after the administration of 1mg of atropine fails to increase the heart rate of your symptomatic bradycardic patient's heart rate and cardiac output? A. Transcutaneous pacing (TCP) A. B. Synchronized cardioversion at 50 joules C. Repeat with another one-mg dose of atropine after 3-5 minutes D. Administer one mg of epinephrine intravenously How does nitroglycerin relieve ischemic cardiac chest pain? A. By increasing cardiac preload B. By increasing peripheral vascular resistance C. C. By reducing cardiac preload D. By decreasing myocardial oxygen consumption You arrive on-scene of a seizure call to find a 22-year-old patient actively seizing. Family on scene reports the patient has an epileptic seizure disorder that sometimes causes seizures that last a minute or two. Today, the seizure has lasted for longer than fifteen minutes prior to your arrival without a break in the tonic-clonic phase. Your attempts to gain IV access are restricted due to the ongoing seizure activity. Which of the following is the drug of choice for intramuscular injection to control the prolonged seizure in this situation? C. A. Thiamine B. 50 percent dextrose (D50) C. Lorazepam D. Etomidate 30 / 56 What condition is most likely to cause an adult female patient to present with non-traumatic lower abdominal quadrant pain reported as severe, agonizing, and often radiates to the patient's shoulders? A. Renal calculi C. B. Ovarian cyst rupture C. Ectopic pregnancy rupture D. Splenic rupture Which of the following is characterized by sudden onset malaise, weakness, anorexia, intermittent nausea, vomiting, and jaundiced skin? A. Peptic ulcer B. Cholecystitis D. C. Renal calculi D. Hepatitis Your unconscious closed head injury patient presents with a widened pulse pressure and bradycardia. Her pupils are sluggish to react, and she is exhibiting abnormal extension posturing. Her signs and symptoms lead you to believe she is experiencing increased intracranial pressure from the injury. What area of the brain is most likely impacted by the increase in pressure? A. Medulla C. B. Pons C. Midbrain D. Cortex Pericardial tamponade and hemorrhagic shock present very similarly in the pre-hospital environment. What is the best way, of those listed, to distinguish between the two diagnoses? A. Pericardial tamponade presents with jugular vein distension, and hemorrhagic shock normally does not cause jugular vein distension B. Pericardial tamponade patients present with cyanosis to the face, 31 / 56 A. neck, and upper chest while hemorrhagic shock presents with core cyanosis C. Hemorrhagic shock presents with hypotension, and pericardial tamponade presents with hypertension D. The presence of narrow complex tachycardia with hemorrhagic shock and wide complex tachycardia with pericardial tamponade After attempting to slow the bleeding associated with natural childbirth by non-invasive means, your patient continues to bleed significantly. Per medical direction, after ensuring a second fetus is not present, which of the following would be the most appropriate intervention for the new mother? A. Rapidly administer a 2-3 liter glucose-containing IV solution such as D5W using a pressure infusion B. Place ice packs on the abdomen and at the opening of the birth canal to promote clotting C. C. Mix 10 units of oxytocin to 1 liter of lactated Ringer's solution and run at 20-30 gtts/min D. Apply firm, direct pressure to the area above the pubic bone while inserting a sterile ABD pad into the opening of the birth canal Your newborn patient is in need of a fluid bolus to return his circulating blood volume to a near normal level after a bleeding injury has occurred, but the bleeding is now controlled. What is an acceptable fluid bolus amount for the newborn patient? A. 10 milliliters per kilogram of body weight over 5-10 minutes A. B. 25 milliliters per kilogram of body weight over an hour C. 100 milliliters total over 1-3 minutes and can be repeated twice D. 40 milliliters of normal saline delivered over one minute Your pediatric patient has been ill for several days leading you to suspect he may be dehydrated. Once on the electrocardiogram, it is evident the patient has an accelerated heart rate and abnormally flattened T waves. What is the most likely cause of this finding? A. Hyperglycemia D. B. Hyperkalemia C. Hypoglycemia 32 / 56 D. Hypokalemia Your cardiac patient has an unstable angina history and is suspected of experiencing an ischemic event. He presents with chest pain, cool and clammy skin, and diaphoresis. If the event is being caused by unstable angina pectoris, which medication may be used to prevent an increase in the size of a thrombus if one is present? A. Nitroglycerin C B. Morphine C. Aspirin D. Streptokinase What is the benefit of inducing mild hypothermia to a post-arrest patient who has a return of spontaneous circulation? A. Hypothermia reduces the body's need for stored energy (sugar) to maintain homeostasis B. Hypothermia increases blood flow to the brain and heart while reducing blood flow to the peripheral tissues C. C. It reduces intracranial pressure, the cerebral metabolic rate, and the brain's demand for oxygen D. It reduces the amount of oxygen and blood circulation needed to supply the tissues of the periphery Your adult patient is experiencing lightheadedness and shortness of breath. He is found to be bradycardic with a second-degree type II AV heart block on the electrocardiogram. His heart rate is 44, he is breathing 20 times per minute, and has a blood pressure of 90 systolic. He is cool and pale but denies chest pain. Which of the following would be most appropriate if the patient fails to respond to atropine? A. Administer 1 milligram of epinephrine C. B. Synchronized cardioversion at 10 joules C. Transcutaneous pacing D. Administer a 500-milliliter IV bolus of normal saline You are on-scene with an adult patient who has recently been diagnosed with diabetes but is unsure of what type. What is the 33 / 56 primary difference between type 1 and type 2 diabetes? A. Patients with type 1 diabetes take only insulin and have an onset of the disease late in life, whereas patients with type 2 diabetes take only oral medications to combat insulin resistance and have an onset early in life B. Type 1 and type 2 diabetes are treated best with insulin and the disease can strike at any time in life D. C. Patients with type 1 diabetes usually take oral glucose-control medications, and patients with type 2 diabetes take insulin only to control their blood sugar D. Patients with type 1 diabetes usually take insulin and have an onset of the disease early in life, whereas patients with type 2 diabetes usually take oral medications to combat insulin resistance and have an onset later in life Which of the following would be considered a major burn? A. Partial-thickness burns that are less than 20 percent of the total body surface area in children B. Partial-thickness burns less than 25 percent of the total body surface area in an adult C. C. Partial-thickness burn that involves the full circumference of an appendage or body part D. Full-thickness burns that are less than 10 percent of the total body surface area in adults You are on-scene with an unconscious 23-year-old male who has a possible closed head injury after a motorcycle accident. During your assessment, you determine the patient's blood pressure is elevated, his heart rate is slow, his pupils are reactive, and he is exhibiting Cheyne-Stokes type respirations. The patient reacts only to painful stimuli. Your assessment findings lead you to believe there is damage in what area of the brain? A. Frontal lobe D. B. Midbrain region C. Medulla oblongata D. Brainstem Your adult patient is experiencing a prolonged episode of paroxysmal supraventricular tachycardia but remains stable at the present 34 / 56 time. He denies chest pain, shortness of breath, and his skin is warm and dry. He has failed to convert to a normal sinus rhythm after receiving the max dosage of adenosine in succession. What is your next step? A. Administer verapamil C. B. Administer procainamide C. Obtain expert consultation about diagnosis and treatment D. Administer Adenocard You are treating a 38-year-old male patient with a cardiac history for generalized weakness. He is conscious and alert with warm, dry, skin and pink, moist mucosa. His heart rate is 46 beats per minute, and his blood pressure is 100/40. This prompts you to get a twelve-lead EKG tracing, as soon as possible. The tracing shows a second degree, type II AV block. This causes you to reconsider administering atropine to the patient; why? A. AHA guidelines state to not rely on atropine in Second Degree Type II AV Block or Third Degree AV Block A. B. AHA guidelines state that Lidocaine is indicated for Second Degree Type II AV Block C. Atropine is likely to cause a rebound hypertension to occur D. AHA guidelines suggest administering Epinephrine to a Second Degree Type II AV Block Your adult patient is experiencing symptomatic bradycardia with a heart rate of 40 bpm. Once on the monitor, it reveals the patient has a complete third-degree atrioventricular block and is found to be hypotensive as well. Which of the following medications should be avoided, if possible? A. Epinephrine D. B. Dopamine C. Dobutamine D. Atropine Preexcitation syndrome conditions, such as Wolff-Parkinson-White (WPW) or Lown-Ganong-Levine (LGL), do not pass through the AV node, so they can become life-threatening arrhythmias when tachycardia is present. What is the distinguishing feature of LGL not present in WPW patients? 35 / 56 A. Patients with Lown-Ganong-Levine syndrome have wide QRS complexes and delta wave B. Patients with Lown-Ganong-Levine have normal-appearing QRS complexes B. C. Patients with Wolff-Parkinson-White syndrome have normal QRS complexes D. Patients with Wolff-Parkinson-White syndrome are the only ones that have a delta wave present Which of the following can produce a sudden but temporary loss of consciousness most often associated with one or two minutes of nausea and vomiting prior to the loss of consciousness? A. Vasovagal syncope B. Cardiac syncope A. C. Transient ischemic attack D. Cerebrovascular accident You suspect your adult chest pain patient may be experiencing the onset of a myocardial infarction. Which of the following medical conditions may mask the severity of the infarction by suppressing the normal ST elevation often seen in onset myocardial infarctions? A. Pleurisy B. B. Diabetes C. Chronic hypertension D. Chronic obstructive pulmonary disease You are on-scene at a local residence with an adult cardiac arrest victim. The family initiated CPR prior to your arrival and states the patient was fine until her home dialysis treatment earlier in the day. Once on the cardiac monitor, the patient is exhibiting a wide complex of irregularly irregular rhythm without a palpable carotid pulse. Along with the administration of epinephrine, which of the following pharmacological agents may be indicated in this case? A. Adenosine B. Amiodarone 36 / 56 C. C. Sodium bicarbonate D. Atropine You are on-scene with a 40-year-old patient with an extensive cardiac history for his age. Today, he is complaining of chest pain that radiates to his jaw and left arm. His vital signs are stable; however, once on the cardiac monitor, he exhibits ST elevation in leads II, III, and aVf. With the EKG finding, which of the following should you suspect? A. A possible aortic dissection B. B. An inferior wall myocardial infarction C. A possible pulmonary embolus D. A septal wall myocardial infarction You are called to assist LE with an adult mental health patient who has minor abrasions after a scuffle with law enforcement officers. On the scene, the patient refuses EMS care for his injuries. Officers on the scene give you permission to treat the patient. Which of the following forms of consent would allow the paramedic to treat the patient without fear of violating his right to refuse care? A. Implied consent C B. Expressed consent C. Involuntary consent D. Informed consent You are called to assist a 55-year-old male who complains of sudden onset chest pain, dyspnea, and palpitations. On arrival, he is found semi-conscious with a pulse rate too fast to palpate and a blood pressure of 80 systolic. Once on the monitor, he is exhibiting an irregularly wide complex tachycardia, with a polymorphic QRS appearance, at nearly 200 per minute. Which of the following would be the most effective intervention for this patient? A. Administer procainamide at 20 mg/min IV infusion, per protocol B. Administer 6 mg of adenosine IVP, followed by 12 mg, twice for a total of 30 mg, per protocol C. Administer defibrillation per protocol 37 / 56 C D. Administer synchronized electrical cardioversion at 50-100 joules, per protocol Which of the following medications would most effectively block sympathetic nervous system stimulation of the beta cells in the heart, thereby reducing the heart rate and force of contraction? A. Aldactone B. Cardizem D C. Verapamil D. Propranolol You are on-scene with an apneic adult who collapsed one to two minutes prior to your arrival, according to bystanders. Which of the following endotracheal tube size ranges would be most appropriate for an average adult respiratory arrest patient who shows no signs of airway trauma or obstruction? A. 6.5-8.5 ET tube C B. 9.0-10.0 ET tube C. 7.5-8.5 ET tube D. 4.5-6.5 ET tube An adult asthma patient is experiencing laryngospasm and ineffective respirations, making orotracheal intubation impossible. So, you quickly decide to perform nasotracheal intubation. Which of the following tubes would be most appropriate for the procedure for an average height and weight adult? A. Cuffed 6.0-6.5 mm endotracheal tube A B. Uncuffed 7-8 mm endotracheal tube C. Uncuffed 6.0-6.5 mm endotracheal tube D. Cuffed 7-8 mm endotracheal tube You are on-scene with a 12-year-old trauma patient who has a large laceration on the inner aspect of his upper right arm with an estimated blood loss of around 15%. The bleeding has now decreased while the patient remains conscious, alert, and anxious. His skin is warm; his heart rate is 96 bpm, and his blood pressure is 108/50. After assessing the child, you believe the patient may be in hypovolemic shock. If so, which stage of shock is the patient most likely experiencing? 38 / 56 A. Stage 1 B. Stage 2 A C. Stage 3 D. Stage 4 An unresponsive adult trauma patient exhibits pale, cold, and clammy skin that appears ashen/cyanotic. He is breathing less than eight times a minute, has a heart rate of 32 beats a minute, and shows an irregular bradyarrhythmia on the monitor in lead II. He is experiencing frank hypotension that is barely palpable. Which of the following stages of shock is most likely causing his presentation? A. Irreversible shock A B. Uncompensated shock C. Reversible shock D. Compensated shock While assisting a full-term pregnant female in delivering her newborn, at what point should the paramedic consider suctioning the infant's nose and mouth? A. Only if there is meconium staining on the newborn's head once it delivers B. When the newborn's head is delivered B C. The newborn's nose and mouth should only be suctioned after the entire delivery is complete D. After the newborn has been dried and stimulated You are assisting a full-term pregnant patient in the delivery of her newborn at home. However, once the baby's head delivers and turns to accommodate the shoulders, the next few contractions fail to produce the newborn's shoulder. In this case, what should you do next? A. Using gentle pressure, guide the infant's head upward to facilitate the anterior shoulder, and then downward to release the posterior shoulder B. Using gentle pressure, guide the infant's head downward to facilitate the anterior shoulder and then upward to release the posterior 39 / 56 B shoulder C. Using gentle pressure, guide the infant's head back into the birth canal and rotate the infant's head in the opposite direction and see if the next contraction allows the shoulder passage D. Using gentle pressure on the infant's head with the palm of your gloved hand, expedite transport because delivery will require cesarean section at the hospital You are performing the 5-minute Apgar test on a newborn you just helped deliver in the field. What is the targeted SpO2 range at 5 minutes after birth? A. 75% to 80% B. 95% to 100% C C. 80% to 85% D. 90% to 95% You are on the scene of a vehicle accident with entrapment. Why is it so important to ensure the battery has been disconnected before attempting to enter the vehicle or extricate the driver? A. To make sure the vehicle is not capable of moving during the extrication process and injuring anyone involved B. To ensure any undeployed airbags do not discharge and cause an injury to the patient or anyone involved B C. To make sure that no one in contact with the vehicle gets electrocuted D. To prevent the possibility of a fire starting in the passenger compartment during the extrication process Which classification of personal protective clothing offers the highest respiratory system protection but a lower level of skin protection? A. Level D B. Level C C C. Level B D. Level A 40 / 56 For EMS professionals to determine death in the pre-hospital environment, which of the following criteria must be met by the paramedic? A. No electrical activity in the heart as confirmed by an EKG tracing indicating asystole B. Apnea with a gag reflex as indicated by an attempt to intubate or establish another means of advanced airway A C. Independent lividity noted to the low points of the patient's body with skin that is cold and clammy D. Pupils that are pinpoint, fixed, and non-reactive to light along with decreased muscle tone You are on-scene with an adult patient who was found with an extremely altered level of consciousness, and a small amount of blood noted on his lips. There are no other obvious signs of trauma during the primary assessment other than a small tongue laceration. After ensuring an adequate airway, you discover the patient's small tongue laceration appears consistent with biting his tongue. He also has obviously swollen gums that do not appear to be caused by trauma. His vital signs are found to be within normal limits, and his pupils react to light, but his level of consciousness continues to be decreased to painful stimuli only. With the limited findings, which of the following conditions is most likely to cause the patient presentation? C A. A diabetic seizure most likely caused the patient's presentation B. A metabolic coma is likely the cause of the patient's presentation C. An epileptic seizure is likely responsible for causing the patient's condition D. A cerebrovascular accident is likely the cause of the patient's condition Venous blood samples are often obtained in the pre-hospital setting for various tests to be performed at the hospital. What color tube stopper would a paramedic want to use if law enforcement at an accident requests the patients involved have their blood drawn at the scene to be tested for the possibility of alcohol intoxication at the hospital? A. Gray A B. Light blue C. Lavender 41 / 56 D. Green Your adult trauma patient suddenly becomes apneic during extrication from his extremely damaged vehicle in which he was the restrained driver. There are no obvious signs of chest trauma or crepitus noted. However, he is suspected of suffering a brain and/or spinal cord injury. If so, which of the following is most likely responsible for causing the patient to suffer respiratory arrest? A. Traumatic asphyxia B. Vagus nerve injury/compression C. Tension pneumothorax D. Phrenic nerve injury/compression You have just inserted a nasogastric (NG) tube in your intubated patient to relieve gastric distension. Which of the following confirmation means is most appropriate for determining the placement of an NG tube? A. Ensure the pre-measurement black line on the tube is located at the patient's nares B. Auscultate the epigastric region while injecting 20 to 30 mL of air into the NG tube B C. Roll the patient onto his left side, and apply suction for a few seconds D. Attach suction to the tube, and watch for the distension to decrease After intubating your apneic patient, what tube placement confirmation means should be assessed first? A. Auscultate each lung field for the presence of breath sounds B. Attach capnography to determine the presence of ventilatory waveform D C. Attach an end-tidal carbon dioxide detector D. Auscultate over the epigastric region for the presence or absence of breath sounds Which of the following medication types are used to decrease the workload of the heart by blocking sympathetic stimulation of receptors that work on the SA node and myocardial cells, thus decreasing the force of myocardial contraction and directly reducing a patient's heart rate? 42 / 56 A. Alpha-adrenergic agents B. Beta-blockers B C. Calcium-channel blockers D. Sodium-channel blockers Your 23-year-old diabetic patient was found unresponsive with increased respirations, hypotension, and bradycardia. Family members state he recently had a tooth pulled and was prescribed Vicodin. Which of the following is most likely to cause the patient's presentation? A. Myasthenia gravis C B. Metabolic alkalosis C. Ketoacidosis D. Narcotic overdose You are working a respiratory arrest patient and have just successfully placed a combi-tube in your apneic patient. What should you do if the chest fails to rise appropriately and gastric sounds are present? A. Secure tube, and ventilate through tube #1 B. Confirm placement with CO2 detector before ventilating through tube #1 C C. Remove the BVM from tube #1 and ventilate through tube #2 D. Pull the combi-tube back approximately 2 cm and reassess You are called to assist a 44-year-old male who was struck in the head with a large socket wrench at work. On arrival, the patient is conscious but confused; he complains he developed a sudden-onset severe headache moments after a wrench slipped off under pressure striking him in the temporal region of the skull. Co-workers state he was unconscious with abnormal posturing for about three minutes prior to EMS arrival. He states the headache went from the worst headache of his life to a dull throbbing headache and new-onset dizziness and nausea. His pupils are unequal with the right eye sluggish to respond while his grips remain equal but weak. As you continue your evaluation, he suddenly develops projectile vomiting and loses consciousness. Which of the following injuries is most likely to cause his presentation? 43 / 56 C A. Subdural hematoma B. Epidural hematoma C. Subarachnoid hematoma D. Intracerebral hematoma You are preparing to intubate an unconscious closed head injury patient with an increased intracranial pressure due to respiratory insufficiency and inability to control his airway. Concern at an additional increase in intracranial pressure prompts you to consider the intravenous administration of which of the following prior to an intubation attempt? A. Diazepam C B. Lorazepam C. Lidocaine D. Procainamide You are called to assist a pregnant female in the 24th week gestation period according to her due date. The pale 26-year-old patient is found supine in bed, complaining of dizziness/weakness with extreme nausea. The patient denies vaginal bleeding, amniotic fluid leakage, or abdominal pain. There are no signs of imminent birth or active labor. She reports receiving normal prenatal care with no associated problems found during the pregnancy. Her heart rate is 126-130 beats per minute; her blood pressure is 80 mmHg systolic while her skin is cool and pale. Which of the following conditions is most likely to cause the patient's presentation? C. A. Uterine rupture B. Spontaneous abortion C. Supine hypotension D. Placenta previa Several minutes after sealing your adult trauma patient's sucking chest wound with an occlusive dressing secured on three sides, he begins to experience increasing shortness of breath, jugular vein distension, decreasing unilateral breath sounds on the affected side, and his blood pressure is less than 90 systolic and falling. Repeated attempts to relieve the pressure at the occlusive dressing have proven ineffective. At this point, which of the following should be initiated? 44 / 56 A. Remove the occlusive dressing and pull sucking chest wound open gently to allow air to escape the chest B. Translaryngeal Jet Ventilation using a 10- or 14-gauge catheter that is an inch to an inch-and-a-half long D. C. Endotracheal intubation and positive pressure ventilations via forced air ventilator D. Immediate needle decompression using a 10- or 14-gauge catheter that is at least 2 or 2.5 inches long You are on-scene with a patient suspected of taking a large amount of meperidine hydrochloride. Which of the following interventions may be effective in reversing the adverse effects of the ingested medication? A. Activated charcoal D. B. Atropine C. Romazicon D. Naloxone While conducting an EKG on your post-myocardial infarction patient, you note the presence of consistently wide QRS complexes greater than 120 ms in duration. What does this most likely indicate? A. An intraventricular conduction delay or right/left bundle branch block B. A complete heart block indicating no relationship between the atria and ventricles A. C. The patient is likely suffering from a myocardial infarction currently D. The patient has a congenital heart defect and should not require emergency care Your adult status asthmaticus patient requires rapid sequence intubation due to rapidly increasing airway constriction. Which of the following would be most appropriate following tube placement confirmation? A. 3 mg of levalbuterol administered directly down the ET tube C. B. 2-5 mg of albuterol administered directly down the ET tube 45 / 56 C. 2.5 mg of albuterol in 3-mL solution, nebulized and delivered with ventilation D. 1.25 mg of levalbuterol in 3-mL solution, nebulized and delivered with ventilation When treating an adult patient for a mild allergic reaction, with no respiratory distress or dyspnea, which medication is routinely administered either IM or IV for the treatment of an allergic reaction? A. Epinephrine B. Methylprednisolone D. C. Albuterol D. Diphenhydramine You are dispatched to the scene of a one-vehicle motor collision. Upon your arrival at the scene, you note that the vehicle struck a tree on the driver side. The driver is the only patient, and she is still sitting in the driver seat of the vehicle. The vehicle is stable and has moderate damage noted to the driver side, which prevents the driver side door from opening. Which of the following would be the most appropriate way to extricate the patient from the vehicle? A. Break the driver side window and attempt to remove the patient through the window D. B. Open the rear driver side door and extricate the patient through the backseat C. Use a crowbar and pry open the driver door D. Open the passenger side door and extricate through the passenger side Your suspected myocardial infarction patient has exhibited ST elevation in Leads II, III, aVF on the electrocardiogram. What area of the heart do you suspect is being damaged? A. Lateral wall B. Inferior wall B. C. Anterior wall D. Septal wall 46 / 56 You are on-scene with an unconscious adult female who you suspect may be intoxicated. The patient's vital signs are within normal limits; however, her blood glucose level is low. Which of the following should be administered first to prevent Wernicke-Korsakoff syndrome, after initiating oxygen therapy and IV access? A. Thiamine A. B. Ondansetron 4 mg C. Narcan D. Dextrose 50 percent (D50) While administering normal saline to an adult patient experiencing hypovolemia, the medical command physician recommends the administration of warm normal saline, even though it is not a cold environment. Why would a physician (MCP) recommend warmed normal saline be administered to an adult hypovolemia patient? A. Warm saline has a better affinity to oxygen transport to the cells B. To help maintain a normal body temperature during hypovolemia B. C. Warm saline will require less energy to enter the systemic circulation D. It will increase the amount of cardiac output more rapidly Your adult patient has possibly sustained a closed-head injury following a motor vehicle accident that left him unconscious. He is exhibiting abnormal flexion of the arms and extension of his legs. What is the proper terminology for this finding? A. Decerebrate posturing B. B. Decorticate posturing C. Flaccidity D. Babinski's sign While en route back to your station from a call, you discover that you forgot to include important patient information on your patient care report. Which of the following would be most appropriate at this point? A. Document the information on the back of your original patient care report B. Contact the emergency department staff and notify them of your 47 / 56 C. error C. Complete an addendum, and return to the hospital to add it to the report D. Do nothing since you already left a copy of the patient care report at the hospital You are called to the scene of a cardiac arrest. On arrival, you find a 55-year-old male with a history of hypertension, COPD, and congestive heart failure, pulseless and apneic. His wife tells you that he collapsed about three minutes before your arrival. Your partner begins one-rescuer CPR, and another paramedic on-scene controls the airway. As you are applying your ECG leads, the patient's wife tells you that she wants you to let him die in peace. Which of the following would be most appropriate in this case? A. Perform rescue breathing only, and contact medical control C. B. Cease resuscitation only if the monitor does not indicate the presence of a potentially viable rhythm C. Continue performing resuscitation efforts, and ask if the patient has a DNR or living will D. Comply with her request, and cease all resuscitation efforts You are on-scene with a 55-year-old cardiac history patient who suddenly collapsed during dinner with his family. He is found to be pulseless and apneic with his family performing adequate CPR on arrival. His wife is distraught and hands you a legal DNR order signed by his physician. She states that he does not have a terminal illness and begs you to ignore the legal order and "do everything in your capabilities to save him!" Which of the following would be most appropriate in this situation? A. Contact medical control, and open his airway while awaiting approval for resuscitation before initiating full resuscitation efforts B. Take over CPR until you reach the ambulance, then stop all resuscitation efforts as per the legal order C. Advise the family to stop CPR, and explain they cannot override the legal DNR order D. Initiate full resuscitation efforts including advanced cardiac life support, and contact medical control During a detailed physical exam of your dyspneic 73-year-old female patient, you palpate small pockets of air in the subcutaneous tissue of the skin in the upper right region of her chest, just below her clavicle. Which of the following medical conditions is most 48 / 56 D. likely to cause this abnormal finding? A. Bacterial pneumonia B. Spontaneous pneumothorax B. C. Dry pleurisy D. Chronic obstructive pulmonary disease Which abnormal respiratory pattern is associated with structural or compressive lesions in the medullary respiratory center characterized by an irregular, cluster-type respiratory pattern? A. Agonal respiratory pattern B. Cheyne-Stokes respiratory pattern D. C. Biot's respiratory pattern D. Ataxic respiratory pattern Of the following, which patient will require an unsynchronized shock? A. A 63-year-old male presenting with monomorphic ventricular tachycardia B. A 78-year-old male presenting with unstable atrial fibrillation D. C. A 44-year-old female presenting with unstable atrial flutter D. A 39-year-old female presenting with polymorphic ventricular tachycardia Your adult trauma patient is experiencing severe pain from a femur fracture. He is conscious, alert and oriented, with a heart rate of 120 per minute; his respirations are 28 per minute, and his blood pressure is 78/30. He is begging you to administer something for pain. He states he is allergic to Vicodin and aspirin. Why would medical command most likely decline the request for morphine sulfate in this case? D. A. The patient is asking for narcotics inappropriately B. Because the Vicodin allergy makes morphine contraindicated C. The morphine can worsen the bleeding associated with a femur fracture 49 / 56 D. Patient is hypotensive Which of the following prefixes would a paramedic use when describing any condition within a patient's musculoskeletal joints? A. AngioB. Arthro- B. C. AlgiaD. ArterYour adult patient has sustained a blunt force, closed head injury while playing football at a family reunion. Which of the following symptoms leads you to believe the patient is suffering from an epidural hematoma? A. "Goose egg" noted on patient's head B. The patient is unconscious when you arrive on the scene and remains that way throughout transport C. C. The patient lost consciousness immediately following the injury, but regained consciousness quickly. He lost consciousness again just prior to calling 911. D. Sudden, severe headache When conducting a 12-lead electrocardiogram on a patient, which lead is located on the right side of the body and does not view a specific area of the heart? A. Lead V4 B. Lead I C C. aVR D. aVL When auscultating a patient's heart sounds, what does the first sound of the cardiac cycle indicate? A. Opening of the atrioventricular valves during ventricular systole B. Opening of the aortic and pulmonic valves, signaling ventricular systole 50 / 56 C. C. Closure of the atrioventricular valves during ventricular systole D. Closure of the aortic and pulmonic valves, signaling the initiation of ventricular diastole You are preparing to perform transcutaneous pacing to your symptomatic bradycardia patient after atropine fails to improve his condition and vital signs. What energy setting should be used initially in an attempt to gain electrical capture in a conscious patient? A. To the highest setting B. B. To the minimum setting C. 50 joules D. 80 joules You are on-scene with an unconscious adult patient. Bystanders report he fell from a third-story (> 40 ft) scaffolding while working on a building's exterior. His pulse is 120 beats per minute; his respirations are 16 per minute, and his blood pressure is within normal limits. The patient is lying supine with his arms flexed at the elbows and his hands in the anatomical position as if he were in the "hold up" position. An injury at what level of the spinal cord is most likely to cause the limited findings above? D. A. Spinal cord injury in the C1-C2 region B. Spinal cord injury at the S1-S2 region C. Spinal cord injury in the L4-L5 region D. Spinal cord injury in the C5-C6 region According to the American Heart Association, healthcare providers should not attempt to alter glucose concentration within a specific range because of the increased risk of hypoglycemia. What is the suggested range? A. 60-90 mg/dL B. B. 80-110 mg/dL C. 186-202 mg/dL D. 110-160 mg/dL 51 / 56 Which complex, interval, or segment of an electrocardiogram tracing represents the early part of ventricular repolarization? A. ST segment B. PR interval A. C. QT interval D. QRS complex Your adult anaphylaxis patient is suffering from hypotension that is not responding to epinephrine. Which of the following medications is capable of combating hypotension associated with anaphylaxis when epinephrine fails to improve blood pressure? A. Cimetidine A. B. Albuterol C. Hydrocortisone D. Ipratropium The human body regulates homeostasis by communicating at the cellular level through the nervous and endocrine systems. Which of the following is responsible for serving as the command and control center for linking the systems together? A. Hypothalamus A. B. Adrenal gland C. Thyroid gland D. Pituitary gland Your adult cardiac arrest patient is in refractory ventricular fibrillation. He has failed to respond to three defibrillation attempts and a single dose of epinephrine. Therefore, you decide to administer the next medication in the sequence, amiodarone. What would be the proper first and second dose of the medication? A. Amiodarone 300 mg via IV bolus first dose and 150 mg the second IV dose B. Amiodarone 1 mg IV bolus first dose and 3 mg the second IV dose total C. Amiodarone 150 mg via IV bolus first dose and 350 mg the second 52 / 56 A. IV dose D. Amiodarone 300 mg via IV bolus first dose and repeated doses of 250 mg IV push You are called to the scene where a 36-year-old male was shot in the back while running away from an assailant. While treating and attempting to stabilize the patient, what should be done with the clothing he was wearing? A. Lay them to the side when they are cut or taken off; notify the officers on scene to allow them to gather the evidence properly B. Place all cut or removed clothing between the patient's legs on the stretcher during transport to ensure the items make it to the emergency department where law enforcement will gather them properly D. C. Place them in a plastic evidence bag, do not seal the bag; label it with the time, date, and your name with affiliation; and give it to law enforcement on scene D. Place them in a paper bag along with the disposable latex gloves you were wearing when you took or cut the clothing off; seal the bag listing the items it contains; document patient's name, time/date, and your name and title on the bag If there is a civil claim against a paramedic, which of the following must be proven? A. Malfeasance B. Libel D. C. Misfeasance D. Negligence If a paramedic commits a scope of practice violation, which of the following may result? A. Civil charges B. Negligence charges D. C. Defamation charges D. Criminal charges The CHARTE method and SOAP method are two methods utilized by paramedics to complete the narrative portion of the patient care report. Which of the following is not a component of the CHARTE 53 / 56 method? A. Transport B. Etcetera (etc.) B. C. Assessment D. Chief complaint Which of the following would be an early sign of a possible aortic dissection? A. A narrowing pulse pressure and tachycardia B. A sudden rise in systolic blood pressure and fall in diastolic blood pressure C. C. Blood pressure difference of 20 mmHg or more in the upper extremities D. A reddish-blue discoloration of the skin above the shoulders When considering the administration of cardiac medication to a severely hypothermic patient in cardiac arrest, which of the following is true? A. Cardiac medications are appropriate as long as warm fluid is being administered and active rewarming procedures initiated B. IV medication may be administered but spaced at longer than standard intervals C. C. The patient will most likely not respond to cardiac medication and allow toxic accumulation of the medications D. The patient will best respond to higher than normal doses of cardiac medications Which of the following medical conditions is most likely to cause enlarged airspace beyond the terminal bronchioles with collapse and destruction of the alveoli? A. Pneumonia D. B. Asthma C. Bronchitis 54 / 56 D. Emphysema Your patient is experiencing an allergic reaction to a bee sting, causing a natural release of histamine and other mediators by the body. What will the release of histamine and the mediators do for the patient? A. Hypotension and bronchospasm A. B. Bronchodilation and hives C. Bradycardia and hypertension D. Tachycardia and lacrimation Your adult trauma patient has a potential internal injury allowing bleeding into the thoracic cavity. As a general rule, where should the patient's mean arterial pressure (MAP) be maintained while treating and transporting the patient to the hospital? A. MAP of 50 mmHg to 55 mmHg D. B. MAP of 35 mmHg to 40 mmHg C. MAP of 85 mmHg to 90 mmHg D. MAP of 60 mmHg to 65 mmHg You are treating and transporting a 26-year-old female involved in an MVA. She has multiple injuries, but all associated hemorrhage is controlled. The patient is exhibiting signs and symptoms of hypovolemic shock. During treatment and transport, you infuse one liter of lactated Ringer's solution, and the patient remains hypotensive. Once at the hospital, which of the following is most likely to be administered immediately upon arrival? A. O-negative whole blood containing plasma B. B. O-negative packed red blood cells C. O-positive packed red blood cells D. O-positive whole blood without plasma You are transporting a 20-year-old pregnant female from a local hospital to a medical facility that specializes in high-risk pregnancies when you note the patient is experiencing unexplained hypotension and bradycardia. The patient has a patent IV and is being administered magnesium that was initiated by hospital staff. On the cardiac monitor, the patient presents with a lengthening 55 / 56 PR interval and signs of an impending high-degree nodal block. Which of the following interventions would be most appropriate in this case? A. Increase the magnesium sulfate infusion rate, and administer a 1,000 mL normal saline bolus to support the patient's blood pressure B. Stop the magnesium sulfate infusion immediately, and administer the appropriate dose of calcium chloride to correct the adverse effects of magnesium toxicity B. C. Continue the infusion, but administer potassium chloride to counteract the adverse effects of the magnesium chloride administration D. Reduce the infusion by half, and administer dextrose 50% to counteract the adverse cardiac effects caused by the magnesium chloride infusion When forced to deal with a fire, which type of fire extinguisher would be most effective for suppressing ordinary combustible material that smells like gasoline? A. ABC all-purpose fire extinguisher B. Type B fire extinguisher A. C. Class C fire extinguisher D. Type A fire extinguisher Your patient is found dead after missing in the woods for several days. The patient has full-body rigor mortis and independent lividity posteriorly. There is no obvious decay present, but a definite smell accompanies the patient. With the limited findings, how long do you feel the patient may have been deceased prior to finding him? A. 12 to 14 hours A. B. Less than an hour C. Between one and six hours D. 24 hours 56 / 56