Chapter 13 & 14

Question 1

1. In infants and children, a capillary refill time that is greater than _______ second(s) is a sign of poor peripheral perfusion

2

1

4

3

Answer 1

1

Question 2

2. Which of the following clinical signs is unique to anaphylactic shock?

Dizziness

Hypotension

Wheezing

Pallor

Answer 2

Wheezing

Question 3

3. Patients develop septic shock secondary to:

poor vessel function and severe volume loss.

an infection that weakens cardiac contractions..

weak vessel tone caused by nervous system damage.

failure of the blood vessels to adequately dilate.

Answer 3

poor vessel function and severe volume loss.

Question 4

4. Which of the following injuries would MOST likely cause obstructive shock?

Simple pneumothorax

Spinal cord injury

Cardiac tamponade

Liver laceration

Answer 4

Cardiac tamponade

Question 5

5 A 19-year-old male was stung multiple times by fire ants. He is experiencing obvious signs and symptoms of anaphylactic shock. You administer high-flow oxygen and give him epinephrine via intramuscular injection. Upon reassessment, you determine that his condition has not improved. You should:

transport him immediately and provide supportive care while en route.

repeat the epinephrine injection after consulting with medical control.

consider that he may actually be experiencing an acute asthma attack.

request a paramedic unit that is stationed approximately 15 miles away.

Answer 5

repeat the epinephrine injection after consulting with medical control.

Question 6

6. Shock is the result of:

the body’s maintenance of homeostasis.

temporary dysfunction of a major organ.

hypoperfusion to the cells of the body.

widespread constriction of the blood vessels.

Answer 6

hypoperfusion to the cells of the body.

Question 7

7. Capillary sphincters are:

under complete control of the voluntary portion of the nervous system.

circular muscular walls that regulate blood flow through the capillaries.

responsible for constricting to compensate for decreased cell perfusion.

capable of dilating in order to increase perfusion to crucial body organs.

Answer 7

circular muscular walls that regulate blood flow through the capillaries.

Question 8

8. Temporary, widespread vasodilation and syncope caused by a sudden nervous system reaction MOST accurately describes:

neurologic shock.

psychogenic shock

neurogenic shock.

vasovagal shock.

Answer 8

psychogenic shock

Question 9

9. A 20-year-old male has a large laceration to his wrist. He is holding a blood-soaked towel over the wound, but it continues to bleed rapidly. You should:

administer high-flow supplemental oxygen.

apply a tourniquet proximal to the wrist.

wrap the towel with pressure bandages.

apply pressure to the brachial artery.

Answer 9

apply a tourniquet proximal to the wrist.

Question 10

10. Pulmonary edema and impaired ventilation occur during:

septic shock.

anaphylactic shock.

neurogenic shock.

cardiogenic shock.

Answer 10

cardiogenic shock.

Question 11

11. Which of the following MOST accurately describes septic shock?

Viral infection of the blood vessels, vascular damage, and vasoconstriction

Bacterial infection of the nervous system with widespread vasodilation

Bacterial damage to the vessel wall, leaking blood vessels, and vasodilation

Widespread vasoconstriction and plasma loss due to a severe viral infection

Answer 11

Bacterial damage to the vessel wall, leaking blood vessels, and vasodilation

Question 12

12. All of the following conditions should make you suspect shock, EXCEPT:

severe infection.

anaphylaxis.

ischemic stroke.

spinal injury.

Answer 12

ischemic stroke.

Question 13

13. When assessing a patient with signs and symptoms of shock, it is important to remember that:

multiple fractures are the most common cause of hypovolemic shock.

blood pressure may be the last measurable factor to change in shock.

irreversible shock often responds well to a prompt blood transfusion.

the patient’s respirations are deep during the early stages of shock.

Answer 13

blood pressure may be the last measurable factor to change in shock.

Question 14

14. Hypovolemic shock caused by severe burns is the result of a loss of:
    platelets.

plasma.

red blood cells.

whole blood.

Answer 14

plasma.

Question 15

15. Which of the following is the ONLY action that can prevent death from a tension pneumothorax?

Positive-pressure ventilation with a bag-valve mask

Decompression of the injured side of the chest

Early administration of high-flow oxygen

Rapid administration of intravenous fluids

Answer 15

Decompression of the injured side of the chest

Question 16

16.In an acute injury setting, neurogenic shock is commonly accompanied by:

tachycardia

hypothermia.

diaphoresis.

hypovolemia.

Answer 16

tachycardia

Question 17

17. Which of the following statements regarding anaphylactic shock is correct?

Subsequent exposure after sensitization often produces a more severe reaction.

Anaphylactic shock is caused by immune system failure due to a toxic exposure.

Sensitized people will experience less severe reactions upon subsequent exposure.

Anaphylactic shock occurs immediately after a person is sensitized to an allergen.

Answer 17

Subsequent exposure after sensitization often produces a more severe reaction.

Question 18

18. A construction worker fell approximately 30 feet. He is semiconscious with rapid, shallow respirations. Further assessment reveals deformity to the thoracic region of his spine. His blood pressure is 70/50 mm Hg, his pulse is 66 beats/min and weak, and his skin is warm and dry. In addition to spinal immobilization and rapid transport, the MOST appropriate treatment for this patient includes:

assisted ventilation, preventing hyperthermia, and elevating his lower extremities.

oxygen via nonrebreathing mask, thermal management, and elevation of his legs.

oxygen via nonrebreathing mask, blankets for warmth, and elevation of his head.

assisted ventilation, thermal management, and elevation of the lower extremities.

Answer 18

assisted ventilation, thermal management, and elevation of the lower extremities.

Question 19

19. Distributive shock occurs when:

severe bleeding causes tachycardia in order to distribute blood to the organs faster.

an injury causes restriction of the heart muscle and impairs its pumping function.

widespread dilation of the blood vessels causes blood to pool in the vascular beds.

temporary but severe vasodilation causes a decrease in blood supply to the brain.

Answer 19

widespread dilation of the blood vessels causes blood to pool in the vascular beds.

Question 20

20. When treating an 80-year-old patient who is in shock, it is important to remember that:

medications older patients take for hypertension often cause an unusually fast heart rate.

compensation from the respiratory system usually manifests with increased tidal volume.

changes in gastric motility may delay gastric emptying, which increases the risk for vomiting.

the older patient’s central nervous system usually reacts more briskly to compensate for shock.

Answer 20

changes in gastric motility may delay gastric emptying, which increases the risk for vomiting.

Question 21

21. Clinical signs of compensated shock include all of the following, EXCEPT:

restlessness or anxiety.

cool and clammy skin.

absent peripheral pulses.

rapid, shallow breathing.

Answer 21

absent peripheral pulses.

Question 22

22. When assessing the pulse of an unresponsive infant, you should palpate the ______ artery.

Carotid

Femoral

Radial

Brachial

Answer 22

Brachial

Question 23

23. In most cases, cardiopulmonary arrest in infants and children is caused by

A drug overdose

a cardiac dysrhythmia

respiratory arrest.

severe chest trauma

Answer 23

respiratory arrest.

Question 24

24 Which of the following is NOT an indication to stop CPR once you have started?

You are physically exhausted

A physician directs you to do so

Care is transferred to a bystander

Pulse and respirations return

Answer 24

Care is transferred to a bystander

Question 25

25. Gastric distention will MOST likely occur when the airway is completely obstructed when you deliver minimal tidal volume if you ventilate a patient too quickly in patients who are intubated

Answer 25

if you ventilate a patient too quickly

Question 26

26. When performing chest compressions on an adult, the EMT should compress at least 1 inch greater than 2.4 inches between 1 inch and 2 inches at least 2 inches

Answer 26

at least 2 inches

Question 27

27. The gain benefit of using a mechanical piston device for chest compressions is: the elimination of rescuer fatigue that results from manual compressions. the minimal training required to correctly operate the device. the elimination of the need to place a firm, flat device under the patient. its ability to be used with any patient, regardless of age, weight, or body size.

Answer 27

the elimination of rescuer fatigue that results from manual compressions.

Question 28

28. Several attempts to adequately open a trauma patient's airway with the jaw thrust maneuver have been unsuccessful. You should try opening the airway by lifting up on the chin. carefully perform the head tilt-chin lift maneuver. tilt the head back while lifting up on the patient's neck suction the airway and reattempt the jaw-thrust maneuver.

Answer 28

carefully perform the head tilt-chin lift maneuver.

Question 29

29. Signs of a sudden severe upper airway obstruction include all of the following, EXCEPT: grasping the throat. inability to speak. acute cyanosis. forceful coughing

Answer 29

forceful coughing

Question 30

30. A patient should be placed in the recovery position when he or she: is semiconscious, injured, and breathing adequately. has experienced trauma but is breathing effectively. is unresponsive, uninjured, and breathing adequately has a pulse but is unresponsive and breathing shallowly.

Answer 30

is unresponsive, uninjured, and breathing adequately

Question 31

31. Abdominal thrusts in a conscious child or adult with a severe upper airway obstruction are performed: until he or she experiences cardiac arrest. in sets of five followed by reassessment about 1 inch below the xiphoid process. until he or she loses consciousness

Answer 31

until he or she loses consciousness

Question 32

32. Which of the following is considered an obvious sign of death and would not require the initiation of CPR? Pulselessness and apnea Agonal respiratory effort Severe cyanosis to the face Dependent blood pooling

Answer 32

Dependent blood pooling

Question 33

33, CPR should be initiated when; signs of putrefaction are present. the carotid pulse is very weak. valid living will is unavailable. rigor mortis is obvious.

Answer 33

valid living will is unavailable.

Question 34

34. Which of the following techniques should you use to dislodge a foreign body airway obstruction in a patient who is in an advanced stage of pregnancy or who is very obese? Back slaps Finger sweeps Chest thrusts Abdominal thrusts

Answer 34

Chest thrusts

Question 35

35. When ventilating an apneic adult with a bag-mask device, you should deliver each breath: quickly to ensure adequate ventilation. every 2 to 3 seconds (20 to 30 breaths/min). over a period of about 2 to 3 seconds. while watching for adequate chest rise.

Answer 35

while watching for adequate chest rise.

Question 36

36. After establishing that an adult patient is unresponsive, you should: manually open the airway. apply the AED and deliver a shock, if needed. assess for breathing and a pulse. immediately begin chest compressions.

Answer 36

assess for breathing and a pulse.

Question 37

37. You should attempt to maintain a chest compression fraction of at least. 60% 40% 50% 80%

Answer 37

80%

Question 38

38. In two-rescuer adult CPR, you should deliver compression to ventilation ratio of: 5: 1. 30. 2 15. 2. 5: 2.

Answer 38

30.2

Question 39

39. After _________ minutes without oxygen, permanent brain damage is possible. 7 1 to 2 2 to 3 4 to 6

Answer 39

4 to 6

Question 40

40. The MOST appropriate treatment for a patient with a mild upper airway obstruction includes: performing five back slaps and five abdominal thrusts. visualizing the airway and removing the obstruction. advising the patient not to make any attempts to cough. administering oxygen and transporting immediately.

Answer 40

administering oxygen and transporting immediately.

Question 41

41. Basic life support (BLS) is defined as: noninvasive emergency care that is used to treat conditions such as airway obstruction, respiratory arrest, and cardiac arrest. basic lifesaving treatment that is performed by bystanders while EMS providers are en route to the scene of an emergency. any form of emergency medical treatment that is performed by advanced EMTS, paramedics, physicians, and emergency nurses. invasive emergency medical interventions such as intravenous therapy, manual defibrillation, and advanced airway management.

Answer 41

noninvasive emergency care that is used to treat conditions such as airway obstruction, respiratory arrest, and cardiac arrest.

Question 42

42. Most prehospital cardiac arrests in adults occur as the result of: an acute ischemic stroke. a cardiac dysrhythmia. severe blunt trauma. obstruction of the airway.

Answer 42

a cardiac dysrhythmia.

Question 43

43. What is the minimum number of chest compressions that should be delivered per minute to a 4-month-old infant? 110 100 120 90

Answer 43

100

Question 44

44. 60-year-old man is found to be unresponsive, pulseless, and apneic. You should; start CPR and transport immediately. withhold CPR until he is defibrillated determine if he has a valid living will. begin CPR until an AED is available.

Answer 44

begin CPR until an AED is available.

Question 45

45. Neurogenic shock occurs when: there is too much blood to fill a smaller vascular container. failure of the nervous system causes widespread vasodilation. the spinal cord is severed and causes massive hemorrhaging. massive vasoconstriction occurs distal to a spinal cord injury.

Answer 45

failure of the nervous system causes widespread vasodilation.

Question 46

46. Hypotension in a child with blunt or penetrating trauma is particularly significant because: it often indicates the loss of half of his or her blood volume. the most likely cause of the hypotension is respiratory failure. it typically develops earlier in children than it does in adults. most children with hypotension die in the prehospital setting

Answer 46

it often indicates the loss of half of his or her blood volume.

Question 47

47. A 56-year-old male is found semiconscious by his wife. Your assessment reveals that his respirations are rapid and shallow, his pulse is rapid and irregular, and his blood pressure is low. The patient's wife states that he complained of left arm pain and nausea the day before, but would not allow her to call 9-1-1. The MOST likely cause of this patient's present condition is: dehydration from Gl virus. severe septic hypoperfusion. ruptured aortic aneurysm. acute myocardial infarction.

Answer 47

acute myocardial infarction.

Question 48

48. You are transporting a 33-year-old male who was involved in a major motor vehicle crash. You have addressed all immediate and potentially life-threatening conditions and have stabilized his condition with the appropriate treatment. With an estimated time of arrival at the hospital of 20 minutes, you should: repeat your secondary assessment. arrange for an ALS rendezvous reassess his condition in 5 minutes. take his vital signs in 15 minutes.

Answer 48

reassess his condition in 5 minutes.

Question 49

49. A 25-year-old unrestrained female struck the steering wheel with her chest when her car hit a tree while traveling at a high rate of speed. She has signs and symptoms of shock, which you suspect are the result of intrathoracic bleeding. Which of the following interventions will provide this patient with the greatest chance for Survival? High-flow oxygen administration Rapid transport to a trauma center Intravenous fluid administration Full immobilization of her spine

Answer 49

Rapid transport to a trauma center

Question 50

50. You are dispatched to a residence for a 40-year-old female who fainted. Upon your arrival, the patient isconscious and alert, and states that she is fine. Her husband tells you that she fainted after receiving news that her sister was killed in a car crash. You offer oxygen to the patient, but she refuses to accept it. At this point,your primary concern should be to: determine if she was injured when she fainted. advise her that she needs to go to the hospital. provide emotional support regarding her sister. obtain baseline vital signs and a medical history

Answer 50

determine if she was injured when she fainted.

Question 51

51. A 27-year-old male was stabbed in the chest during a disagreement at a poker game. As you approach him, you see that a knife impaled in his chest. Before you make physical contact with the patient, it is MOST important to: form a general impression. ask bystanders what happened. call for an ALS ambulance. follow standard precautions.

Answer 51

follow standard precautions.

Question 52

52. A 70-year-old female was recently discharged from the hospital following a total hip replacement. Today, she presents with restlessness, tachycardia, and a blood pressure of 90/64 mm Hg. Her skin is hot and moist. You should be MOST suspicious that she is experiencing: local infection, pump failure. decompensated shock. septic shock

Answer 52

septic shock

Question 53

53. You respond to a residence for a patient with a severe leg injury following an accident with a chainsaw. When you arrive, you find the patient, a 44-year-old male, lying supine in the backyard. He has a partial amputation of his right lower leg that is actively bleeding. The patient is conscious and breathing adequately; however, he is restless and his skin is diaphoretic. You should: assess the rate and quality of his pulse. immediately evaluate his airway. apply direct pressure to the wound. administer 100% supplemental oxygen

Answer 53

apply direct pressure to the wound.

Question 54

54. When performing CPR on a child, you should compress the chest: to a depth of 1 to 2 inches with one or two hands. until a radial pulse is felt. 80 to 100 times per minute

Answer 54

with one or two hands.

Question 55

55. Your initial attempt to ventilate an unresponsive, apneic 30-year-old man is met with resistance and you do not see the chest rise. Your second ventilation attempt is also unsuccessful. You should: perform a blind finger sweep. ventilate again with greater force. perform 30 chest compressions. suction the oropharynx.

Answer 55

perform 30 chest compressions.

Question 56

56. The impedance threshold device (ITD) may improve circulation during active compression-decompression CPR by: drawing all of the air out of the lungs in between chest compressions, which causes positive intrathoracic pressure and a reduction of blood return to the right side of the heart. limiting the amount of air that enters the lungs during the recoil phase between chest compressions, which results in negative intrathoracic pressure and improved cardiac filling. maximizing the amount of air in the lungs following chest recoil, which hyper inflates the lungs and forces more blood from the ventricle during each compression. maintaining increased intrathoracic pressure during the downward stroke of each chest compression, which forces more blood from both of the ventricles.

Answer 56

limiting the amount of air that enters the lungs during the recoil phase between chest compressions, which results in negative intrathoracic pressure and improved cardiac filling.

Question 57

57. A team of EMTs and paramedics are attempting to resuscitate a man who is in cardiac arrest while his wife and son are present. Which of the following should occur during the resuscitation attempt? Communication with the family should be minimal until the final outcome of the resuscitation attempt is known A law enforcement officer should prepare the family for the patient's death and contact the funeral home. Each member of the resuscitation team should update the family at various intervals throughout the attempt. One EMT should update the family on the interventions that have been performed and how the patient has responded.

Answer 57

One EMT should update the family on the interventions that have been performed and how the patient has responded.

Question 58

58. CPR is in progress on a pregnant woman. Shortly after manually displacing her uterus to the left, return of spontaneous circulation occurs. Which of the following would MOST likely explain this? Displacement of her uterus caused blood to flow backward, which increased blood flow to her heart. Displacement of her uterus allowed her lungs to expand more fully, which restored her pulse. Increased blood flow to her heart caused her ventricles to stop fibrillating, which restored her pulse. Pressure was relieved from her aorta and vena cava, which improved chest compression effectiveness.

Answer 58

Pressure was relieved from her aorta and vena cava, which improved chest compression effectiveness

Question 59

59. Which of the following maneuvers should be used to open a patient's airway when a spinal injury is suspected? Head tilt-neck lift Jaw-thrust Tongue-jaw lift Head tilt-chin lift

Answer 59

Jaw-thrust

Question 60

60. To ensure that you will deliver the appropriate number of chest compressions during one-rescuer adult CPR, you should compress the patient's chest at a rate of: at least 120 compressions per minute. 80 to 100 compressions per minute. 100 to 120 compressions per minute. no greater than 100 compressions per minute.

Answer 60

100 to 120 compressions per minute.

Question 61

61. You are off duty at a park when you witness an apparently healthy 12-year-old child suddenly collapse. There are no bystanders around, and your mobile phone is in your car. After confirming that the child is in cardiac arrest, you should: deliver five rescue breaths before starting chest compressions. perform chest compressions only until a bystander arrives call 9-1-1 and then return to begin CPR on the child. perform CPR for 2 minutes and then call 9-1-1.

Answer 61

call 9-1-1 and then return to begin CPR on the child.

Question 62

62. Which of the following statements regarding ventricular fibrillation (VF) is correct? Most patients in VF have a weak carotid pulse. VF results in an absence or forward blood flow. VF is a state of rapid ventricular contraction. Defibrillation is only indicated for witnessed VF.

Answer 62

VF results in an absence or forward blood flow.

Question 63

63. After an advanced airway device has been inserted during two-rescuer CPR, you should pause compressions to deliver ventilations deliver one rescue breath every 6 seconds decrease the compression rate to about 80 per minute. increase rescue breathing to a rate of 14 breaths/min.

Answer 63

deliver one rescue breath every 6 seconds

Question 64

64. The proper depth of chest compressions on a 9-month-old infant is: one third the diameter of the chest, or about 1.5 inches one half to two thirds the diameter of the chest two thirds the diameter of the chest, or about 2 inches one half the diameter of the chest, or about 1.5 inches

Answer 64

one third the diameter of the chest, or about 1.5 inches

Question 65

65. Complications associated with chest compressions include all of the following. EXCEPT: liver laceration rib fractures. a fractured sternum gastric distention.

Answer 65

gastric distention.

Question 66

66. While rescuer one is finishing his or her fifth cycle of 30 compressions, rescuer two should move to the opposite side of the patient's chest. give two breaths and prepare to start compressions suction the patient's mouth and give two more ventilations. assess for a carotid pulse for 15 seconds

Answer 66

move to the opposite side of the patient's chest.

Question 67

67. Initial treatment to dislodge a severe foreign body airway obstruction in a responsive infant involves: blind finger sweeps. back slaps. abdominal thrusts. bag-mask ventilation

Answer 67

back slaps.

Question 68

68. Your assessment of an unresponsive patient reveals that her breathing is inadequate. Your MOST immediate action should be to: administer high-flow oxygen move her to the ambulance stretcher. check her airway for obstructions. ventilate her with a bag-mask device.

Answer 68

check her airway for obstructions.

Question 69

69. Cardiogenic shock may result from all of the following, EXCEPT: increased preload. poor contractility. increased afterload. heart attack.

Answer 69

increased preload.

Question 70

70. Which of the following patients is in decompensated shock? A 23-year-old restless male with cool, clammy skin and tachycardia A 20-year-old female with absent radial pulses and dilated pupils A 32-year-old male with anxiety and a systolic blood pressure of 110 mm Hg A 28-year-old female with pale skin and rapid, shallow respirations

Answer 70

A 20-year-old female with absent radial pulses and dilated pupils

Question 71

71. Which of the following statements regarding the use of an AED in children is correct? if the patient is less than 1 year of age, an AED is preferred over a manual defibrillator. AEDs are not used in pediatric patients because they do not experience ventricular fibrillation. AEDS are only effective in pediatric patients if severe trauma is the cause of their cardiac arrest. AEDS can be used safely on infants and children by using pediatric pads and an energy reducer

Answer 71

AEDS can be used safely on infants and children by using pediatric pads and an energy reducer

Question 72

72. If gastric distention begins to make positive-pressure ventilation difficult, you should: increase the rate of ventilation. insert an oropharyngeal airway. reposition the patient's airway suction the patient's oropharynx

Answer 72

reposition the patient's airway