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NREMT Practice Test Bank, Exams of Nursing

NREMT Practice Test Bank NREMT Practice Test Bank

Typology: Exams

2023/2024

Available from 09/05/2024

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NREMT Practice Test Bank - Multiple
Choice
Hypoglycemia and acute ischemic stroke can present similarly because:
• A:both oxygen and glucose are needed for brain function.
• B:the majority of stroke patients have a history of diabetes.
• C:the most common cause of a stroke is hypoglycemia.
• D:they are both caused by low levels of glucose in the blood. -
• A:both oxygen and glucose are needed for brain function.
Reason: Although stroke and hypoglycemia are two distinctly different conditions, their
signs and symptoms are often similar. This is because the brain requires both oxygen
and glucose to function normally. An acute ischemic stroke is caused by a lack of
oxygen to a part of the brain due to a blocked cerebral artery, whereas hypoglycemia
(low blood glucose level) deprives the entire brain of glucose. In either case, the patient
presents with signs of impaired brain function (ie, slurred speech, weakness, altered
mental status). Both conditions may lead to permanent brain damage or death if not
treated promptly.
When dealing with an emotionally disturbed patient, you should be MOST concerned
with:
• A:gathering all of the patient's medications.
• B:safely transporting to the hospital.
• C:whether the patient could harm you.
• D:obtaining a complete medical history. -
You selected C; This is correct!
Reason: When managing any patient with an emotional or psychiatric crisis, your
primary concern is your own safety. Safely transporting the patient to the hospital is
your ultimate goal. If possible, you should attempt to obtain a medical history and
should take any of the patient's prescribed medications to the hospital. However, this
should not supercede your own safety or interfere with safely transporting the patient.
You are at the scene where a man panicked while swimming in a small lake. Your initial
attempt to rescue him should include:
• A:rowing a small raft to the victim.
• B:reaching for the victim with a long stick.
• C:throwing a rope to the victim.
• D:swimming to the victim to rescue him. -
You selected B; This is correct!
Reason: General rules to follow when attempting to rescue a patient from the water
include "reach, throw, row, and then go." In this case, you should attempt to reach the
victim by having him grab hold of a large stick or similar object. If this is unsuccessful,
throw the victim a rope or flotation device (if available). If these are not available, row to
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NREMT Practice Test Bank - Multiple

Choice

Hypoglycemia and acute ischemic stroke can present similarly because:

  • A:both oxygen and glucose are needed for brain function.
  • B:the majority of stroke patients have a history of diabetes.
  • C:the most common cause of a stroke is hypoglycemia.
  • D:they are both caused by low levels of glucose in the blood. - ✔• A:both oxygen and glucose are needed for brain function. Reason: Although stroke and hypoglycemia are two distinctly different conditions, their signs and symptoms are often similar. This is because the brain requires both oxygen and glucose to function normally. An acute ischemic stroke is caused by a lack of oxygen to a part of the brain due to a blocked cerebral artery, whereas hypoglycemia (low blood glucose level) deprives the entire brain of glucose. In either case, the patient presents with signs of impaired brain function (ie, slurred speech, weakness, altered mental status). Both conditions may lead to permanent brain damage or death if not treated promptly. When dealing with an emotionally disturbed patient, you should be MOST concerned with:
  • A:gathering all of the patient's medications.
  • B:safely transporting to the hospital.
  • C:whether the patient could harm you.
  • D:obtaining a complete medical history. - ✔You selected C; This is correct! Reason: When managing any patient with an emotional or psychiatric crisis, your primary concern is your own safety. Safely transporting the patient to the hospital is your ultimate goal. If possible, you should attempt to obtain a medical history and should take any of the patient's prescribed medications to the hospital. However, this should not supercede your own safety or interfere with safely transporting the patient. You are at the scene where a man panicked while swimming in a small lake. Your initial attempt to rescue him should include:
  • A:rowing a small raft to the victim.
  • B:reaching for the victim with a long stick.
  • C:throwing a rope to the victim.
  • D:swimming to the victim to rescue him. - ✔You selected B; This is correct! Reason: General rules to follow when attempting to rescue a patient from the water include "reach, throw, row, and then go." In this case, you should attempt to reach the victim by having him grab hold of a large stick or similar object. If this is unsuccessful, throw the victim a rope or flotation device (if available). If these are not available, row to

the patient in a small raft (if available). Going into the water to retrieve the victim is a last resort. The rescuer must be a strong swimmer because patients who are in danger of drowning are in a state of blind panic and will make every attempt to keep themselves afloat, even if it means forcing the rescuer underwater. How should you classify a patient's nature of illness if he or she has a low blood glucose level, bizarre behavior, and shallow breathing?

  • A:Behavioral emergency
  • B:Altered mental status
  • C:Respiratory emergency
  • D:Cardiac compromise - ✔The correct answer is B; Reason: The nature of illness (NOI) is the medical equivalent to mechanism of injury (MOI). Altered mental status should be the suspected NOI in any patient with any fluctuation in level of consciousness, which can range from bizarre behavior to complete unresponsiveness. Causes of an altered mental status include hypo- or hyperglycemia, head trauma, stroke, behavioral crises, drug overdose, and shock, among others. A young female is unresponsive after overdosing on an unknown type of drug. Her respirations are slow and shallow and her pulse is slow and weak. Which of the following drugs is the LEAST likely cause of her condition?
  • A:Seconal
  • B:Heroin
  • C:Cocaine
  • D:Valium - ✔The correct answer is C; Reason: Of the drugs listed, cocaine would be the least likely cause of the patient's condition. Cocaine is a central nervous system (CNS) stimulant; you would expect her to be hypertensive, tachycardic, tachypneic, and perhaps even violent. Heroin, Valium, and Seconal are all CNS depressants and could explain her condition. Heroin is an illegal narcotic (opiate), Valium is a benzodiazepine sedative-hypnotic drug, and Seconal is a barbiturate. Narcotics, benzodiazepines, and barbiturates are all CNS depressants. When taken in excess, they cause a decreased level of consciousness, respiratory depression, bradycardia, and hypotension. Activated charcoal is contraindicated for a patient who is:
  • A:conscious and alert and has ingested a large amount of Motrin.
  • B:emotionally upset and has ingested two bottles of aspirin.
  • C:agitated and claims to have ingested a bottle of Tylenol.
  • D:awake and alert and has swallowed a commercial drain cleaner. - ✔You selected D; This is correct! Reason:Activated charcoal adsorbs (sticks to) many ingested substances, preventing them from being absorbed into the body by the stomach or intestines. In some cases, you may give activated charcoal to patients who have ingested certain substances, if approved by medical control or local protocol. Activated charcoal is contraindicated for patients who have ingested an acid or alkali (ie, drain cleaner) or a petroleum product

Reason:Weight loss, fever, and night sweats could indicate tuberculosis or HIV/AIDS; however, the dark purple lesions on the skin, which are called Kaposi's sarcoma, are malignant skin tumors and are a classic finding in patients in the later stages of AIDS. A 48-year-old male became acutely hypoxic, experienced a seizure, and is now postictal. The MOST effective way to prevent another seizure is to:

  • A:dim the lights in the back of the ambulance.
  • B:place him in the recovery position.
  • C:administer high-flow supplemental oxygen.
  • D:give him oral glucose if he can swallow. - ✔You selected C; This is correct! Reason:You should administer high-flow oxygen to all patients who are actively seizing and to patients who experienced a seizure and are postictal. This is especially true if the seizure was caused by hypoxia. Increasing the oxygen content of the blood, which minimizes hypoxia, may prevent another seizure. The recovery position is appropriate for uninjured patients with a decreased level of consciousness and adequate breathing; it will help maintain the airway and facilitate drainage of secretions from the mouth, but will not prevent another seizure. Oral glucose may prevent another seizure if hypoglycemia was the cause of the seizure. You should dim the lights in the back of the ambulance to help prevent any seizure, not just those that are caused by hypoxia. Which of the following conditions would be the LEAST likely to be present in a patient who was submerged in water?
  • A:Spinal injury
  • B:Gastric distention
  • C:Hyperglycemia
  • D:Laryngospasm - ✔You selected C; This is correct! Reason: Many factors can contribute to or result from a submersion injury (eg, drowning, near-drowning). It is not uncommon for a person to experience a spinal injury after diving head first into shallow water, especially if he or she is under the influence of alcohol. When a swimmer panics, he or she initially swallows large amounts of water, resulting in gastric distention. Gastric distention can cause aspiration if the patient regurgitates water during rescue breathing; protect the airway! During the panic phase, the victim expends a tremendous amount of energy (and glucose) from flailing around in the water, possibly resulting in hypoglycemia. Inhaling even a small amount of fresh or salt water can severely irritate the larynx, which sends the muscles of the larynx and vocal cords into spasm (laryngospasm), resulting in airway blockage and hypoxia. A 42-year-old male presents with fever, a severe headache, and a stiff neck. He is conscious, but confused. His wife tells you that he does not have any medical problems and does not take any medications. You should be MOST suspicious for:
  • A:acute stroke.
  • B:influenza.
  • C:meningitis.
  • D:tuberculosis.

✔You selected C; This is correct! Reason:Meningitis is an inflammation of the protective coverings of the brain and spinal cord (meninges). Common signs and symptoms of meningitis include fever, headache, neck stiffness (nuchal rigidity), and vomiting. An altered mental status is common in severe cases. Meningococcal meningitis, caused by a bacterium, is the most contagious and potentially fatal type of meningitis. The patient's signs and symptoms are not consistent with acute stroke, tuberculosis (TB), or influenza (the flu). Although fever is common with both TB and the flu, neither causes neck stiffness. Acute stroke may be associated with a headache, especially a hemorrhagic stroke; however, stroke patients typically do not have a fever. All of the following are signs of gastrointestinal bleeding, EXCEPT:

  • A:melena.
  • B:hematemesis.
  • C:tachycardia.
  • D:hemoptysis. - ✔You selected D; This is correct! Reason:Signs and symptoms of gastrointestinal (GI) bleeding include abdominal pain; vomiting blood (hematemesis); the passage of dark, tarry stools (melena); and bright red rectal bleeding (hematochezia). If blood loss is significant, the patient may have signs of shock (eg, tachycardia, diaphoresis, tachypnea, hypotension). Hemoptysis (coughing up blood) is a sign of a pulmonary injury, not GI bleeding. A 24-year-old female presents with a rash to her left leg and swollen, painful knee joints. She tells you that she and her friends returned from a hiking trip in the mountains a week ago. She is conscious and alert with a blood pressure of 112/62 mm Hg, a pulse of 84 beats/min, and respirations of 14 breaths/min. Her symptoms are MOST likely the result of:
  • A:Rocky Mountain spotted fever.
  • B:tetanus.
  • C:Lyme disease.
  • D:a localized allergic reaction. - ✔You selected C; This is correct! Reason:The patient's symptoms and her history of a recent hiking trip are consistent with Lyme disease, which was the result of a tick bite. Ticks can carry two infectious diseases: Lyme disease and Rocky Mountain spotted fever. Both are spread through the tick's saliva, which is injected into the skin when the tick attaches itself. The first symptom of Lyme disease, a rash that may spread to several parts of the body, begins about 3 days after the bite of an infected tick. The rash may eventually resemble a target bull's-eye pattern in one third of patients. After a few more days or weeks, painful swelling of the joints, particularly the knees, occurs. If recognized and treated promptly with antibiotics, many patients recover completely. Rocky Mountain spotted fever, which is not limited to the Rocky Mountains, occurs within 7 to 10 days after being bitten by an infected tick. Its symptoms include nausea, vomiting, headache, weakness, paralysis, and possibly cardiopulmonary failure.

A 16-year-old, 125-pound male ingested a bottle of aspirin approximately 20 minutes ago. Medical control orders you to administer activated charcoal in a dose of 1 g/kg. How much activated charcoal should you administer?

  • A:54 g
  • B:60 g
  • C:51 g
  • D:57 g - ✔You selected D; This is correct! Reason: First, you must determine the patient's weight in kilograms (kg). Either of the following formulae can be used to convert pounds to kilograms: Formula 1: weight (in pounds) ÷ 2.2 = weight in kg. Formula 2: weight (in pounds) ÷ 2 - 10% = weight in kg. On the basis of the above formulae, a 125-pound patient weighs 57 kg. Using formula 1, the equation is as follows: 125 (weight in pounds) ÷ 2.2 = 56.81 (57 [rounded to the nearest tenth]). Using formula 2, the equation is as follows: 125 (weight in pounds) ÷ 2 = 62.5 (63 [rounded to the nearest tenth] - 6.3 (10% of 63) = 56.7 (57 [rounded to the nearest tenth]). Since the drug order is for 1 g/kg, you should administer 57 g of activated charcoal to your 125-pound patient. Which of the following is the MOST significant finding in a patient with a severe headache?
  • A:Pain in both legs
  • B:Chest discomfort
  • C:Unilateral weakness
  • D:Abdominal tenderness - ✔You selected C; This is correct! Reason: Unilateral weakness (weakness on one side of the body) is a clinically significant finding in a patient with a headache because it could indicate a stroke (ischemic or hemorrhagic). Abdominal, chest, and leg pain are not common complaints associated with a headache, although they should be noted and investigated if they are present. When caring for a patient with severe hypothermia who is in cardiac arrest, you should:
  • A:perform rescue breathing only.
  • B:perform BLS and transport.
  • C:avoid using the AED.
  • D:hyperventilate the patient. - ✔The correct answer is B; Reason:Patients with severe hypothermia (core body temperature < 86°F) who are in cardiac arrest should be managed with basic life support (chest compressions and ventilations), passive external rewarming (ie, removal of wet clothing, applying warm blankets) and rapid transport to the hospital where they can be actively rewarmed. Because cold muscle is a poor conductor of electricity, defibrillation, if indicated, should be limited to 1 attempt until the patient's body temperature has been increased. Cardiac arrest patients with severe hypothermia generally do not respond to defibrillation.

Hyperventilation should be avoided as this may increase intrathoracic pressure and impair blood flow back to the heart. You should not attempt to actively rewarm a patient with moderate or severe hypothermia in the field because:

  • A:rewarming too quickly can cause a fatal cardiac dysrhythmia.
  • B:the risk of inadvertently inducing hyperthermia is too high.
  • C:it is painful for the patient and you cannot give analgesic drugs.
  • D:active rewarming has been shown to cause severe hypertension. - ✔You selected A; This is correct! Reason:When caring for a patient with hypothermia, your goal is to prevent further heat loss; this involves removing wet clothing, applying warm blankets, and allowing the patient's body temperature to rise gradually and naturally (passive rewarming). If the patient is moderately or severely hypothermic, you should not try to rewarm him or her actively (placing heat on or into the body). Rewarming too quickly may cause a fatal cardiac dysrhythmia, such as ventricular fibrillation (V-Fib). Active rewarming may also cause rewarming shock, a condition in which the blood vessels dilate when heat is applied to the body, resulting in significant hypotension. For these reasons, active rewarming should only be performed in the controlled setting of a hospital. You respond to a grocery store where a 39-year-old man reportedly experienced a seizure. When you arrive at the scene, a clerk begins to escort you to the patient. She tells you that the man stopped seizing about 5 minutes ago. If the patient truly experienced a seizure, you will MOST likely find that he:
  • A:has a slow heart rate.
  • B:is fully conscious and alert.
  • C:is not breathing and is cyanotic.
  • D:is confused and disoriented. - ✔You selected D; This is correct! Reason: Most seizures are followed by a postictal phase, in which the patient is unresponsive at first and then gradually regains consciousness. In most cases, the postictal patient appears dazed, confused, or disoriented; in some cases, he or she is combative. The postictal phase typically lasts from 5 to 30 minutes. During the seizure, the patient is often not breathing or is breathing inadequately; however, when the seizure stops, breathing usually resumes. You will also find that most postictal patients are tachycardic; this is the result of an adrenalin surge that occurs during the tonic- clonic phase of the seizure. You are called to a local park for an ill person. It is a hot day and the humidity is high. When you arrive, a bystander directs you to the patient, a young male who is semiconscious. His skin is flushed, hot, and moist. Your FIRST action in the management of this patient should be to:
  • A:begin rapid cooling measures.
  • B:ensure an open airway.
  • C:administer high-flow oxygen.
  • D:move him to a cool area. - ✔You selected D; This is correct!
  • B:move him to a supine position by rotating the entire upper half of his body as a single unit.
  • C:stabilize his head as you remove it from the water and open his airway by tilting his head back.
  • D:grab him by his clothing, remove him from the pond, and assess for breathing and a pulse. - ✔The correct answer is B; Reason:After safely reaching a drowning victim, you should first turn him to a supine position by rotating the entire upper half of the body as a single unit; protect the cervical spine as you do this because a spinal injury cannot be ruled out. Open the patient's airway, without manipulating the neck, and begin rescue breathing while still in the water. Float a buoyant backboard under the patient, secure him to it, and remove him from the water. After removing the victim from the water, assess for a pulse. If the victim is pulseless, begin CPR, dry him off, and apply the AED as soon as possible. Which of the following patients with diabetes is the BEST candidate for oral glucose?
  • A:A confused patient who has cool, clammy skin
  • B:A semiconscious patient with pale, clammy skin
  • C:An unresponsive patient who took too much insulin
  • D:A confused patient with suspected hyperglycemia - ✔You selected A; This is correct! Reason:Oral glucose is indicated for patients with diabetes who are in insulin shock (hypoglycemic crisis), or for any patient with symptomatic hypoglycemia (as documented by glucometer). The patient must be conscious and alert enough to be able to swallow the glucose, which comes in a tube of gel. If the patient is unresponsive or otherwise unable to swallow the glucose, you should provide rapid transport, providing the appropriate airway management en route, and consider an ALS intercept. A 40-year-old woman presents with widespread hives that she noticed about 45 minutes after taking penicillin. She is conscious and alert and denies difficulty breathing. Her breath sounds are clear to auscultation bilaterally, her vital signs are stable, and her oxygen saturation is 94%. She tells you she is allergic to wasps and has an epinephrine auto-injector. You should:
  • A:assist her in administering epinephrine via her auto-injector.
  • B:give high-flow oxygen and administer 100 mg of Benadryl.
  • C:give supplemental oxygen and transport her to the hospital.
  • D:advise her that she can probably drive herself to the hospital. - ✔You selected C; This is correct! Reason:The patient is experiencing an allergic reaction, but she is not in anaphylactic shock. Urticaria (hives) is common to all allergic reactions, regardless of severity; however, wheezing and hypotension, which she does not have, are specific to anaphylaxis. Although she carries an epinephrine auto-injector for her allergy to wasps, she was not stung by a wasp. Furthermore, the absence of wheezing and hypotension negates epinephrine administration. Give supplemental oxygen (in a concentration sufficient to maintain an SpO2 of greater than 94%) and transport her to the hospital.

Because it can take up to an hour for signs of a severe allergic reaction to manifest, the patient should not drive herself. Diphenhydramine (Benadryl), an antihistamine, is an appropriate drug based on her presentation; however, it is not typically carried on a BLS unit. Furthermore, the correct dose is 25 to 50 mg. Immediately following a generalized motor seizure, most patients are:

  • A:hyperactive.
  • B:confused.
  • C:apneic.
  • D:awake and alert. - ✔You selected B; This is correct! Reason:After a generalized (grand mal) motor seizure, the patient typically will be confused, sleepy, or in some cases, combative. This is referred to as the postictal phase. The patient's level of consciousness typically improves within 30 minutes. In many cases, the patient's respirations will be fast (tachypnea) following a seizure; this is the body's attempt to eliminate excess carbon dioxide that accumulated in the blood during the seizure. When assessing a conscious patient who overdosed on a drug, you should FIRST determine:
  • A:if there is a history of prior overdose.
  • B:the patient's weight in kilograms.
  • C:the type of medication ingested.
  • D:when the medication was ingested. - ✔You selected C; This is correct! Reason: When assessing a patient who has overdosed on a drug, you should first determine what was ingested, which will provide you with immediate information about whether or not the substance is toxic. You should then find out when the medication was ingested. This information will provide medical control (or poison control) with the information needed to direct the most appropriate treatment. The patient's weight also should be estimated in kilograms in the event that an antidote is required. Information regarding prior drug overdoses would normally be obtained during the SAMPLE history. Which of the following actions should be carried out during the primary assessment of an unresponsive patient?
  • A:Assessing the skin
  • B:Obtaining a blood pressure
  • C:Palpating the cranium
  • D:Auscultating the lungs - ✔You selected A; This is correct! Reason:Components of the primary assessment for both responsive and unresponsive patients include assessing and managing the airway and assessing and managing circulation, which includes controlling any major bleeding; assessing the rate, regularity, and quality of the pulse; and assessing the color, condition, and temperature of the skin. When restraining a violent patient, you should make sure that:
  • A:the patient is restrained using maximal force.
  • D:proceed to the ambulatory patient, sit him down, and assess his mental status. - ✔You selected D; The correct answer is A; Reason:The process of triaging multiple victims of a lightning strike is different than the conventional triage methods used during a mass-casualty incident. When a person is struck by lightning, respiratory or cardiac arrest, if it occurs, usually occurs immediately. Those who are conscious following a lightning strike are much less likely to develop delayed respiratory or cardiac arrest; they usually survive. Therefore, you should focus your efforts on those who are in respiratory or cardiac arrest. This process, called reverse triage, differs from conventional triage, where such patients would ordinarily be classified as deceased. A 32-year-old man who was stung by a bee has diffuse hives, facial swelling, and difficulty breathing. When he breathes, you hear audible stridor. What does this indicate?
  • A:Narrowing of the two mainstem bronchi
  • B:Swelling of the upper airway structures
  • C:Narrowing of the bronchioles in the lungs
  • D:Swelling of the lower airway structures - ✔You selected B; This is correct! Reason:This patient is experiencing a severe allergic reaction (anaphylaxis). Stridor, which is a high-pitched sound heard on inhalation, indicates swelling of the structures and tissues of the upper airway. If not promptly treated, the patient's airway may close completely, resulting in respiratory arrest. Narrowing of the bronchioles in the lungs causes wheezing, a whistling sound that may be heard during inhalation, exhalation, or both. A behavioral crisis is MOST accurately defined as:
  • A:any reaction to an event that interferes with the activities of daily living or has become unacceptable to the patient, family, or community.
  • B:an acute psychiatric emergency characterized by violent behavior, mood swings, and a loss of connection to reality.
  • C:a persistent feeling of sadness, despair, or hopelessness that incapacitates the patient and prevents him or her from interacting socially.
  • D:a chronic mental health problem in which the patient experiences frequent thoughts of suicide or other self-destructive behavior. - ✔You selected A; This is correct! Reason:The definition of a behavioral crisis or emergency is any reaction to an event that interferes with the activities of daily living (eg, bathing, dressing, eating) or has become unacceptable to the patient, his or her family, or the general community. Some patients react to an event with violent behavior or suicidal thoughts; others react with depression. Regardless of the reaction, it significantly interferes with the patient's life or is unacceptable to his or her family and/or the community You are called to an assisted living center where an attendant found a 72-year-old man unresponsive. The patient had recent hip surgery and has been taking Vicodin for pain. His respirations are slow and shallow and his pulse is slow and weak. You should:
  • A:apply the AED in case he develops cardiac arrest.
  • B:request an ALS ambulance to respond to the scene.
  • C:begin ventilation assistance with a bag-mask device.
  • D:apply high-flow oxygen via a nonrebreathing mask. - ✔You selected C; This is correct! Reason:Vicodin is a combination of hydrocodone and acetaminophen (APAP), the active ingredient in Tylenol. Hydrocodone is a potent narcotic analgesic. When taken in excess, it can suppress the central nervous system and cause respiratory depression, bradycardia, and hypotension. Initial management of any patient who has overdosed on a medication of this type is to ensure a patent airway and support breathing. Because the patient is breathing inadequately (slow and shallow), immediate ventilation assistance is needed. Consider requesting an ALS ambulance if transport time to the nearest hospital will be lengthy. Paramedics can administer a drug called naloxone (Narcan) to reverse the effects of narcotic drugs. The AED is not indicated for this patient; it is only applied to patients in cardiac arrest. In the patient with diabetes, insulin shock typically presents with:
  • A:clammy skin and a rapid onset.
  • B:dry skin and a slow onset.
  • C:dry skin and a rapid onset.
  • D:clammy skin and a slow onset. - ✔The correct answer is A; Reason:In the patient with diabetes, insulin shock (hypoglycemic crisis) presents with cool, clammy skin and a rapid onset. The brain is critically dependent on glucose and responds quickly when the body is in short supply. Diabetic coma (hyperglycemic crisis) typically presents with warm, dry skin and a slow onset, sometimes occurring over a period of days. Your FIRST action in managing a patient with an altered mental status should be to:
  • A:determine if the patient is breathing adequately.
  • B:administer one tube of oral glucose.
  • C:administer high-flow supplemental oxygen.
  • D:ask a family member how the patient normally acts. - ✔You selected A; This is correct! Reason:When treating a patient with an altered mental status, you must first ensure a patent airway and determine if the patient is breathing adequately. If the patient is breathing adequately, administer supplemental oxygen and continue your assessment. If the patient is not breathing adequately (ie, fast or slow rate, shallow breathing [reduced tidal volume]), assist his or her ventilations. It is important to ask a family member, if available, how the patient normally acts; this will help establish a baseline. Before administering oral glucose, you should assess the patient's blood glucose level to determine if hypoglycemia is the cause of his or her problem and then decide if the patient is able to swallow the glucose, if indicated. If the patient is unable to swallow, do

incoherent words, can be the result of a diabetic problem, alcohol intoxication, or drug ingestion. All of these can cause an altered mental status. The odor of alcohol suggests intoxication as a potential cause of his problem, but cannot be quantified. Just because the patient's eyes or closed or he has a tired appearance does not necessarily indicate that he has an altered mental status. Hypoxia-induced unresponsiveness during a submersion injury is usually the result of:

  • A:a cardiac dysrhythmia.
  • B:associated hypothermia.
  • C:laryngospasm.
  • D:water in the lungs. - ✔You selected C; This is correct! Reason: When a patient falls into the water or becomes panicked when in the water, he or she begins to swallow large amounts of water. Even a small amount of water near the larynx can cause a spasm, which closes off the airway. This results in hypoxia, loss of consciousness, and cardiac dysrhythmias. If the patient is not removed from the water at once and treated aggressively, hypoxia and acidosis will eventually result in cardiac arrest. Which of the following conditions would MOST likely cause flushed skin?
  • A:Low blood pressure
  • B:Blood loss
  • C:Hypothermia
  • D:Exposure to heat - ✔You selected D; This is correct! Reason:Whenever the body temperature rises (ie, heat exposure, fever), the peripheral blood vessels dilate, which draws warm blood to the skin and gives it a flushed (red) appearance. Blood loss, shock, low blood pressure (hypotension), and hypothermia generally cause the skin to become pale; these conditions cause peripheral vasoconstriction, which shunts blood away from the skin. Which of the following mechanisms cause respiratory and circulatory collapse during anaphylactic shock?
  • A:Bronchodilation and vasodilation
  • B:Bronchoconstriction and vasoconstriction
  • C:Bronchoconstriction and vasodilation
  • D:Bronchodilation and vasoconstriction - ✔You selected C; This is correct! Reason:During anaphylaxis, histamines released from the immune system cause two negative effects that result in shock (hypoperfusion): vasodilation, which causes the blood pressure to fall and bronchoconstriction, which impairs breathing. A 50-year-old female complains of severe pain to the right lower quadrant of her abdomen. You should:
  • A:palpate the left upper quadrant of her abdomen first.
  • B:keep her supine with her legs fully extended.
  • C:quickly palpate that area first to assess for rigidity.
  • D:suspect that she has an acute problem with her liver. - ✔You selected A; This is correct! Reason:When assessing a patient with abdominal pain, determine where the pain is most severe (in this case, the right lower quadrant) and then palpate the quadrant furthest from that area first (in this case, the left upper quadrant). If you palpate the painful area first, the patient is less likely to allow you to assess the remainder of his or her abdomen; it also causes the patient unnecessary pain. Pain to the right lower quadrant suggests a problem with the appendix (eg, appendicitis), not the liver. Patients with abdominal pain commonly prefer to lie on their side with their legs drawn into their abdomen; this position often provides pain relief by taking pressure off of the abdominal muscles. If the patient prefers this position, do not discourage it. A 30-year-old man with a history of schizophrenia cut his wrists and is bleeding profusely. He is confused, combative, and has slurred speech. With the assistance of law enforcement personnel, you and your partner physically restrain him in order to provide care and transport. In this situation, a court of law would MOST likely:
  • A:conclude that you should have had a court order to restrain.
  • B:determine that the patient had decision-making capacity.
  • C:agree that you and your partner are guilty of assault and battery.
  • D:consider your actions in providing care to be appropriate. - ✔You selected D; This is correct! Reason:An adult with decision-making capacity (ie, a mentally competent adult) has the legal right to refuse medical treatment, even if that treatment involves lifesaving care. In psychiatric cases, however, a court of law would likely consider your actions in providing lifesaving care to be appropriate, particularly if you have a reasonable belief that the patient would harm him- or herself or others without your intervention. In addition, a patient who is in any way impaired, whether by mental illness, medical condition, or intoxication, may not be considered competent to refuse treatment and transport. If you are unsure of a patient's decision-making capacity, err on the side of treatment and transport. Few would argue that it would be easier to defend why you treated a patient than to justify or defend why you abandoned a patient. After removing a patient from the water, your assessment reveals that he is not breathing and is continuously regurgitating large amounts of water. You should:
  • A:perform abdominal thrusts to remove the water.
  • B:begin rescue breathing after he stops regurgitating.
  • C:alternate suctioning with artificial ventilations.
  • D:place him on his side and press on his abdomen. - ✔You selected C; This is correct! Reason:In cases where a patient is not breathing and is regurgitating (passively vomiting) secretions at the same time, you must address both issues. This is accomplished most effectively by suctioning for 15 seconds and then ventilating for 2 minutes. This alternating sequence should be repeated until all secretions are cleared from the airway. You should turn the patient onto his side to facilitate drainage of liquid, but do not apply pressure to his abdomen. Manual gastric decompression, which

A 46-year-old man presents with generalized weakness and shortness of breath after he was bitten on the leg by a rattlesnake. His blood pressure is 106/58 mm Hg and his pulse rate is 112 beats/min. In addition to supplemental oxygen, further treatment for this patient should include:

  • A:ice packs to the wound and splinting.
  • B:proximal arterial constricting band and splinting.
  • C:splinting and lowering of the affected part.
  • D:elevation of the affected part and ice packs. - ✔The correct answer is C; Reason:Care for a patient with a bite from a pit viper (rattlesnake, copperhead, water moccasin) includes keeping the patient calm, administering supplemental oxygen, splinting the affected part, and keeping it below the level of the heart. Do NOT apply ice to a snakebite; this will cause local vasoconstriction and may force the venom deeper into the patient's circulation. If a constricting band is applied, it should be proximal to the bite and should be tight enough to slow venous return only, not cut off arterial supply. Which of the following is a later sign of hepatitis?
  • A:Fever and vomiting
  • B:Jaundice
  • C:Loss of appetite
  • D:Fatigue - ✔You selected B; This is correct! Reason: Early signs and symptoms of viral hepatitis include loss of appetite (anorexia), vomiting, fever, fatigue, and muscle and joint pain. Jaundice (yellow sclera and skin) and right upper quadrant abdominal pain are not common early manifestations of hepatitis; they usually develop within 1 to 2 weeks into the disease process. A 60-year-old male complains of a tearing sensation in his abdomen. He tells you the pain began suddenly and feels like someone is sticking a knife into his abdomen. He is conscious and alert with a blood pressure of 148/88 mm Hg, a pulse of 120 beats/min, and respirations of 22 breaths/min. In addition to administering high-flow oxygen, you should:
  • A:perform a rapid head to toe assessment and prepare for transport.
  • B:auscultate over his epigastrium to assess for bowel sounds.
  • C:vigorously palpate his abdomen to assess for a pulsating mass.
  • D:transport at once and be prepared to treat him for severe shock. - ✔The correct answer is D; Reason:Given the onset and nature of the patient's pain (eg, sudden onset, tearing sensation), you should suspect that he has an acute dissection of the abdominal aorta. Administer high-flow oxygen and transport him at once. Acute aortic dissection can quickly cause an aneurysm, which could rupture and cause profound shock. Therefore, you must carefully monitor him and be prepared to treat him accordingly. Unnecessary or vigorous palpation of his abdomen could cause his aorta to rupture and should be avoided. A rapid head-to-toe assessment is indicated for trauma patients with a significant mechanism of injury and unresponsive medical patients; this patient falls into

neither of these categories. Auscultating bowel sounds in the field is time-consuming, will yield little information, and only delays transport. Which of the following statements regarding the function of insulin is correct?

  • A:It stimulates the liver to release glucose into the bloodstream.
  • B:It facilitates the uptake of glucose from the bloodstream into the cell.
  • C:It causes the pancreas to produce glucose based on the body's demand.
  • D:It promotes the entry of glucose from the cell into the bloodstream. - ✔You selected B; This is correct! Reason:Insulin is a hormone produced by the beta cells in the Islets of Langerhans of the pancreas. It promotes the uptake of glucose from the bloodstream into the cells where it is used in the production of energy. Glucagon, a hormone produced by the alpha cells in the pancreas, facilitates the conversion of glycogen to glucose (glycogenolysis) in the liver. The liver does not produce glucose; it produces glycogen, a complex sugar that the body cannot utilize until it has been converted to glucose, a simple sugar. A 72-year-old woman is found unresponsive in her poorly ventilated home. Her skin is flushed, hot, and dry, and her respirations are rapid and shallow. She is wearing a medical alert bracelet that states she is a diabetic and is allergic to sulfa drugs. You should be MOST suspicious for:
  • A:acute ischemic stroke.
  • B:a diabetic complication.
  • C:heat stroke.
  • D:anaphylactic shock. - ✔You selected C; This is correct! Reason: The patient's signs and symptoms are consistent with classic heat stroke. Unlike exertional heat stroke, which usually affects otherwise healthy people who exert themselves in the heat for long periods of time, classic heat stroke commonly affects children and older adults, and typically occurs when the patient is in a hot, poorly ventilated space for a prolonged period of time. Significant underlying medical problems (eg, hypertension, diabetes, heart disease) increase the patient's risk for classic heat stroke. Both exertional and classic heat stroke present with hot, flushed skin; however, patients with exertional heat stroke may have moist skin, usually from residual perspiration, whereas patients with classic heat stroke typically have dry skin. A 36-year-old male, who is a known diabetic, presents with severe weakness, diaphoresis, and tachycardia. He is conscious, but confused. His blood pressure is 110/58 mm Hg, pulse is 120 beats/min and weak, and respirations are 24 breaths/min. The glucometer reads error after several attempts to assess his blood glucose level. In addition to high-flow oxygen, medical control will MOST likely order you to:
  • A:transport only and closely monitor him.
  • B:assist the patient in taking his insulin.
  • C:give him a salt-containing solution to drink.
  • D:give at least one tube of oral glucose. - ✔You selected D; This is correct!