1
Q
- Alcohol potentiates Valium. This means that:
A) Valium makes alcohol a toxic substance.
B) alcohol antagonizes the effects of Valium.
C) alcohol enhances the effects of Valium.
D) the use of alcohol negates the use of Valium
A
C
2
Q
29. Patients with delirium tremens often experience: A) hallucinations. B) AV heart blocks. C) hypothermia. D) acute hypertension.
A
A
3
Q
- You have administered a total of 10 mg of Narcan to an unresponsive 30-year-old man whom you believe has overdosed on a narcotic. However, the patient remains unresponsive, is hypoventilating, and is bradycardic. Your transport time to the closest appropriate hospital is 40 minutes. You should:
A) insert a nasogastric tube to decompress his stomach, administer another 2 mg of Narcan, and transport.
B) continue assisted ventilation for 2 to 3 minutes, insert an advanced airway device, and transport immediately.
C) insert a laryngeal mask airway, transport at once, and begin an epinephrine infusion en route to the hospital.
D) insert an oropharyngeal airway, continue bag-mask ventilations at a rate of 20 breaths/min, and transport.
A
B
4
Q
- From an anatomic and physiologic perspective, inhaled toxins:
A) generally provide a large window of opportunity for treatment.
B) quickly reach the alveoli and rapidly gain access to the circulatory system.
C) typically take between 15 and 20 minutes to exert a systemic effect.
D) often take several hours before clinical signs and symptoms manifest.
A
B
5
Q
- When heroin passes through the liver:
A) the liver rapidly metabolizes the drug, removes the toxic ingredients, and excretes it via the renal system.
B) it rapidly becomes hepatotoxic, continues to exert narcotic effects, and causes liver failure within 24 to 36 hours.
C) it is metabolized into acetyl-morphine, which continues to exert narcotic effects that may outlast the effects of naloxone.
D) absorption through the rest of the body decreases markedly, allowing its narcotic effects to be reversed easily with naloxone.
A
C
6
Q
- The clinical presentation of a stimulant abuser includes:
A) excitement, hypertension, tachycardia, and dilated pupils.
B) somnolence, hypotension, bradycardia, and a staggering gait.
C) hypotension, tachycardia, constricted pupils, and hypothermia.
D) an irregular pulse, hyperpyrexia, hypotension, and bradycardia.
A
A
7
Q
67. In adult patients, oral ingestion of a caustic substance: A) is usually intentional. B) causes immediate death. C) contraindicates intubation. D) requires activated charcoal.
A
A
8
Q
106. During your assessment of a 33-year-old woman who you suspect is under the influence of a drug, the patient tells you that she was “listening to the painting on the wall” before you arrived. Her pulse rate and blood pressure are both elevated. This clinical presentation is MOST consistent with the use of: A) LSD. B) PCP. C) marijuana. D) methamphetamine.
A
A
9
Q
- Which of the following statements regarding alcoholism is correct?
A) A person who consumes alcohol is considered to be physically dependent if abrupt cessation of drinking causes withdrawal symptoms.
B) Patients with alcoholism typically do not become psychologically dependent on alcohol until they have been drinking for many years.
C) Delirium tremens occur any time a person suddenly stops drinking excessive amounts of alcohol, regardless of whether or not he or she is addicted.
D) Increased blood pressure and hallucinations are common physical manifestations when a short-term alcoholic slowly tapers his or her consumption.
A
A
10
Q
- Patients with alcoholism are prone to subdural hematomas and gastrointestinal bleeding because:
A) they fall more frequently than sober people.
B) their blood-clotting mechanisms are impaired.
C) they are at higher risk for violent assault.
D) alcohol causes significant immunocompromise.
A
B
11
Q
56. Signs and symptoms of organophosphate poisoning include: A) vomiting. B) tachycardia. C) constipation. D) pupillary dilation.
A
A
12
Q
- A 22-year-old man experienced an acid chemical burn to his left forearm. He complains of intense pain and tingling in his fingers. He is conscious and alert, and denies any other symptoms. You should:
A) cover the burn and transport at once.
B) begin immediate irrigation with water.
C) apply a light coat of baking soda to the burn.
D) administer oxygen via nonrebreathing mask.
A
B
13
Q
20. A middle-aged woman who has been taking 2 mg of clonazepam each day for 6 months finds that she now requires 4 mg each day to achieve the same effect. This is an example of: A) tolerance. B) drug abuse. C) habituation. D) physical dependence.
A
A
14
Q
87. Prehospital treatment for a patient who overdosed on aspirin may include: A) flumazenil. B) an antipyretic. C) calcium chloride. D) sodium bicarbonate.
A
D
15
Q
33. Your FIRST priority when dealing with a patient who may have overdosed is to: A) ascertain what the patient took. B) enter the scene carefully. C) request law enforcement. D) assess the patient's airway.
A
C
16
Q
- A person who is “speedballing” is:
A) highly addicted to methamphetamine, cocaine, and marijuana and mixes all three drugs together to achieve various levels of euphoria.
B) using cocaine in combination with heroin, by injecting them either underneath the skin or directly into a vein, in order to regulate the high.
C) packaging cocaine in small plastic bags and swallowing them for the purpose of transporting the cocaine from one location to another location.
D) using heroin to withdraw or detoxify himself or herself from cocaine by gradually increasing the amounts of heroin taken while decreasing the amounts of cocaine used.
A
B
17
Q
- Pulse oximetry will not provide a true assessment of arterial oxygenation in patients with carbon monoxide toxicity because:
A) the device falsely interprets oxyhemoglobin as carboxyhemoglobin.
B) carbon monoxide damages the computer chip inside the pulse oximeter.
C) the device cannot determine whether carbon monoxide or oxygen is bound to the hemoglobin.
D) carbon monoxide turns the blood dark red, which indicates low oxygen content.
A
C
18
Q
61. The MOST important prehospital treatment intervention for a patient with carbon monoxide poisoning is: A) high-flow oxygen. B) establishing vascular access. C) cardiac rhythm monitoring. D) monitoring pulse oximetry.
A
A
19
Q
- Priority care for an unresponsive patient who has overdosed on phenobarbital includes:
A) administering oxygen and giving naloxone.
B) administering diazepam to prevent seizures.
C) securing the airway and preventing aspiration.
D) observing the ECG closely for lethal dysrhythmias.
A
C
20
Q
- Management for an ingested poison focuses mainly on:
A) the prompt induction of vomiting.
B) administering a counteracting agent.
C) neutralizing the poison in the stomach.
D) treating the systemic effects that result.
A
C
21
Q
27. Which of the following is the MOST immediate danger to an unresponsive patient with acute alcohol intoxication? A) Acute hypovolemia B) Aspiration of vomitus C) Profound bradycardia D) Ventricular dysrhythmias
A
B
22
Q
- Tricyclic antidepressant medications:
A) are the first-line therapy for the treatment of depression.
B) may produce toxic effects with even minimal dosing errors.
C) generally require high doses to achieve a therapeutic effect.
D) are very safe because they have a large therapeutic window.
A
B
23
Q
84. Lithium is MOST commonly used to treat patients with: A) depression. B) schizophrenia. C) chronic anxiety. D) bipolar disorder.
A
D
24
Q
31. Which of the following interventions is influenced strongly by the amount of time that has elapsed since a patient ingested a toxic substance? A) Transport B) IV therapy C) Intubation D) Gastric lavage
A
D
25
38. Which of the following types of medications does NOT contain amphetamine?
A) Diet pills
B) Nasal decongestants
C) Drugs used to treat insomnia
D) Drugs used to treat attention deficit disorder
C
26
83. Which of the following statements regarding SSRIs is correct?
A) SSRIs have fewer anticholinergic and cardiac effects than tricyclics.
B) Bradycardia with AV heart block is a hallmark sign of SSRI toxicity.
C) The most popular SSRIs include Pamelor, Zonalon, and Norpramin.
D) They are the least preferred antidepressant because they are cardiotoxic.
A
27
```
63. When chlorine gas comes in contact with the body's mucous membranes, it forms:
A) boric acid.
B) a strong alkali.
C) sulfuric acid.
D) hydrochloric acid.
```
D
28
```
10. You would NOT expect a person using methamphetamine to present with:
A) insomnia.
B) bradypnea.
C) restlessness.
D) hypertension.
```
B
29
```
51. Cardiac arrest following a narcotic overdose is usually the result of:
A) seizures.
B) renal failure.
C) respiratory arrest.
D) a cardiac dysrhythmia.
```
C
30
```
4. Most of the blood's formed elements are:
A) platelets.
B) leukocytes.
C) electrolytes.
D) erythrocytes.
```
D
31
35. A 23-year-old woman with sickle cell disease presents with severe joint pain and a fever of 102.5°F. She is conscious and alert, and tells you that her symptoms began yesterday and suddenly worsened today. Her blood pressure is 118/76 mm Hg, pulse rate is 120 beats/min and regular, and respirations are 24 breaths/min with adequate depth. After applying high-flow oxygen and initiating transport, you should:
A) obtain a 12-lead ECG tracing, start a large-bore IV line, administer a 20-mL/kg normal saline bolus, and reassess her blood pressure.
B) monitor her oxygen saturation and cardiac rhythm, start an IV line with normal saline, administer 1 µg/kg of fentanyl, and reassess her vital signs.
C) establish vascular access, administer 2 to 5 mg of midazolam, monitor her cardiac rhythm, and notify the receiving facility as soon as possible.
D) ensure that she is in a comfortable position, cover her with a blanket, start an IV line at a keep-vein-open rate, and monitor her throughout transport.
B
32
14. If an individual has A-positive blood:
A) he or she can receive type AB blood.
B) his or her blood contains no ABO antigens.
C) his or her blood contains the Rh antigen.
D) his or her blood contains anti-A antibodies.
C
33
6. The hematocrit is the:
A) ratio of red blood cells to platelets.
B) overall proportion of red blood cells in the blood.
C) percentage of blood accounted for by the plasma.
D) percentage of hemoglobin found within red blood cells.
B
34
```
. You would expect a person's hematocrit to be low if he or she:
A) is dehydrated.
B) is hemorrhaging.
C) has polycythemia.
D) is losing plasma.
```
B
35
. In which of the following situations would a transfusion reaction MOST likely occur?
A) A person with type AB blood receives type O blood
B) A person with type O blood receives type AB blood
C) A person with type A-negative blood receives type O blood
D) A person with type B-positive blood receives type B-positive blood
B
36
17. Anemia resulting from an autoimmune disorder occurs when:
A) the body's red blood cells destroy certain white blood cells.
B) a patient receives blood of a type different than his or her own.
C) hemoglobin becomes desaturated due to a massive infection.
D) red blood cells are destroyed by the body's own antibodies.
D
37
```
22. Common central nervous system manifestations of anaphylactic shock include all of the following, EXCEPT:
A) anxiety.
B) headache.
C) confusion.
D) combativeness.
```
D
38
21. Cardiovascular effects of anaphylaxis include:
A) diaphoresis, bradycardia, and edema.
B) an irregular pulse, pallor, and pruritus.
C) peripheral vasoconstriction and cool skin.
D) tachycardia, flushed skin, and hypotension.
D
39
```
6. Which of the following medications causes the MOST IgE-mediated drug reactions in the United States?
A) Sulfa
B) Aspirin
C) Penicillin
D) Erythromycin
```
C
40
8. The longer the time between exposure to a substance:
A) the greater the chance of massive IgE antibody production.
B) the less likely a severe anaphylactic reaction will occur.
C) the greater the chance that severe anaphylaxis will occur.
D) the less likely that any kind of allergic reaction will occur.
B
41
16. Histamine release causes all of the following effects, EXCEPT:
A) vasodilation, which results in flushed skin and hypotension.
B) contraction of the smooth muscles of the respiratory system.
C) increased cardiac contractility, which results in hypertension.
D) increased vascular permeability, which results in tissue edema.
C
42
24. The three MOST significant indicators of anaphylactic shock are:
A) hives, chest tightness, and restlessness.
B) dyspnea, hypotension, and tachycardia.
C) pruritus, peripheral swelling, and urticaria.
D) dizziness, flushed skin, and abdominal pain.
B
43
27. Which of the following general statements regarding anaphylactic shock is correct?
A) In order to provide appropriate treatment, you must first determine what caused the allergic reaction.
B) In the presence of anaphylaxis, intervention takes precedence over identifying the offending antigen.
C) Anaphylactic shock would most likely occur following initial exposure to an offending antigen.
D) Most patients who carry a prescribed EpiPen are not completely aware of what substances they are allergic to.
B
44
```
33. Adults in anaphylactic shock should receive the ________ concentration of epinephrine via the ____ route in a dose of ____ mg.
A) 1:1,000, IM, 1
B) 1:1,000, IV, 0.5
C) 1:10,000, IV, 0.1
D) 1:10,000, IM, 0.5
```
C
45
44. You are caring for a 40-year-old man in obvious anaphylactic shock after being stung by a scorpion. The patient is responsive to pain only, has poor respiratory effort, and is hypotensive and tachycardic. Which of the following represents the MOST appropriate treatment sequence for this patient?
A) Immediate intubation, 0.5 mg epinephrine 1:1,000 SQ, two large-bore IV lines with normal saline, a 250-mL normal saline bolus, and 25 mg of Benadryl IM
B) Assisted ventilation, intubation if necessary, at least one large-bore IV with normal saline, 1 mg epinephrine 1:10,000 IV, and up to 50 mg of Benadryl IV or IM
C) High-flow oxygen via nonrebreathing mask, 0.1 to 0.5 mg epinephrine 1:1,000 IM, two large-bore IV lines with normal saline, and 20-mL/kg boluses of normal saline
D) Assisted ventilation, Combitube insertion, 25 to 50 mg of Benadryl IM followed immediately by 0.3 mg of epinephrine 1:1,000 SQ, and a large-bore IV with normal saline
B
46
. An antigen is MOST accurately defined as a:
A) chemical the immune system produces to destroy an allergen.
B) substance that causes the immune system to produce antibodies.
C) chemical mediator that deactivates foreign substances in the body.
D) harmless substance that the body does not recognize as being foreign.
B
47
```
31. In the absence of IV or IO access, the ____ route is the preferred route for the administration of epinephrine to a patient in anaphylactic shock.
A) IM
B) ET
C) SQ
D) intradermal
```
A
48
11. Following the primary response to a foreign substance, the body:
A) recognizes the substance as foreign, but does not produce antibodies until subsequent exposure.
B) utilizes macrophages to immediately destroy the substance and eliminate it from the body.
C) develops sensitivity and is able to recognize the substance following subsequent exposure.
D) releases massive amounts of antigen-specific antibodies, which produce a severe allergic reaction.
C
49
34. When administering an EpiPen to a 30-year-old man with a severe allergic reaction, you should recall that:
A) a 1:2,000 solution is used because the patient is an adult.
B) the SQ route is used in order to achieve a rapid effect.
C) 0.15 mg is the usual dose delivered by the adult EpiPen.
D) the drug cartridge contains 0.3 mg of a 1:1,000 solution.
D
50
39. Diphenhydramine (Benadryl) is used to treat allergic reactions because it:
A) binds to H2 receptors and blocks histamine release.
B) blocks the histamine effects at the H1 receptor sites.
C) destroys histamines and blocks their further release.
D) reverses the vasodilatory and bronchoconstrictive effects.
B
51
9. In contrast to cellular immunity, humeral immunity:
A) involves the use of antibodies dissolved in the blood plasma to fight off invading organisms.
B) is the result of the body's production of leukocytes called T cells that attack and destroy invaders.
C) is an acquired form of immunity that involves desensitization through the use of immunizations.
D) protects the body against foreign substances by antibodies that are located exclusively in the lymph nodes.
A
52
15. In contrast to acquired immunity, natural immunity occurs when:
A) the body is vaccinated, allowing it to produce antibodies without having to experience the disease itself.
B) groups of people are immunized against a substance, which protects vulnerable people in the group.
C) the mother passes antibodies to the fetus via the placenta, thus protecting the fetus against a variety of diseases.
D) the body encounters the antigen and experiences a full immune response with all the pathology of the disease.
D
53
```
20. Which of the following clinical signs or symptoms are MOST indicative of upper airway swelling in a patient experiencing a severe allergic reaction?
A) Hoarseness and stridor
B) Crackles and wheezing
C) Facial edema and coughing
D) Chest tightness and dyspnea
```
A
54
34. Diabetic ketoacidosis occurs when:
A) blood glucose levels rise above 250 mg/dL.
B) the renal system begins to excrete ketones.
C) the cells metabolize fat and produce ketones.
D) insulin production exceeds glucagon production.
C
55
```
25. Diabetic patients would MOST likely present with atypical signs and symptoms of:
A) bacterial pneumonia.
B) acute coronary syndrome.
C) an acute ischemic stroke.
D) viral or fungal meningitis.
```
B
56
```
26. Common symptoms of type 2 diabetes include all of the following, EXCEPT:
A) thirst.
B) dysuria.
C) fatigue.
D) blurred vision.
```
B
57
21. Type 1 diabetes that is secondary to an autoimmune disorder occurs when:
A) the body builds up antibodies that destroy the islets of Langerhans.
B) insufficient white blood cells predispose the pancreas to infection.
C) glucagon and insulin are destroyed by phagocytic white blood cells.
D) the patient experiences an allergic reaction to his or her own glucose.
A
58
22. A person with type 1 diabetes:
A) is often an older person whose pancreas does not produce adequate insulin.
B) can often control his or her diabetes with a proper diet and regular exercise.
C) is not as likely to experience hypoglycemia as a person with type 2 diabetes.
D) generally does not produce any insulin and requires daily insulin injections.
D
59
56. A 51-year-old man with type 2 diabetes presents with confusion, blurred vision, and signs of significant dehydration. According to the man's wife, he has had a fever and flu-like symptoms for the past few days. She further tells you that he has “stuck to his diet” as advised by his physician. His blood pressure is 90/50 mm Hg, pulse is 120 beats/min and weak, and respirations are rapid and shallow. You assess his blood glucose level, which reads “high.” This patient is MOST likely:
A) producing ketones due to fat metabolism.
B) experiencing hyperosmolar nonketotic coma.
C) significantly acidotic and requires bicarbonate.
D) hyperglycemic secondary to being dehydrated.
B
60
```
36. Unlike the patient with hypoglycemia, the patient with severe hyperglycemia:
A) usually does not vomit.
B) has a normal breath odor.
C) rapidly improves with treatment.
D) is tachypneic and hyperpneic.
```
D
61
19. When the pancreas does not produce enough insulin or the cells do not respond to the effects of the insulin that is produced:
A) the cells will metabolize oxygen and function normally.
B) glucose levels in the blood and urine will be elevated.
C) serum glucose levels will fall and brain damage may occur.
D) the body will stop making glucose as a protective mechanism.
B
62
23. Excessive alcohol consumption can lead to low blood glucose levels because:
A) alcohol destroys any insulin that is produced.
B) alcohol antagonizes the pancreatic beta cells.
C) alcohol blocks the pancreatic release of insulin.
D) alcohol depletes glycogen stores in the liver.
D
63
15. The release of glucagon into the bloodstream stimulates:
A) the liver to convert glycogen to glucose.
B) the liver to take in and store more glucose.
C) the cells to uptake sugar from the bloodstream.
D) the vessels to constrict, thus increasing blood pressure.
A
64
16. Which of the following statements regarding insulin is correct?
A) Insulin stimulates the conversion of glycogen to glucose.
B) An increase in insulin levels causes an increase in blood glucose.
C) Insulin is a pancreatic hormone that performs exocrine functions.
D) Insulin is the only hormone that decreases blood glucose levels.
D
65
31. Prior to administering 50% dextrose (D50) via IV push, it is MOST important to:
A) protect the airway with an endotracheal tube.
B) ensure that the IV line is patent and freely flowing.
C) confirm a blood glucose reading of less than 40 mg/dL.
D) draw blood for later analysis in the emergency department.
B
66
14. The endocrine component of the pancreas:
A) comprises the pancreatic duct.
B) comprises the islets of Langerhans.
C) releases epinephrine and norepinephrine.
D) secretes digestive enzymes into the duodenum.
B
67
43. The primary role of cortisol is to:
A) maintain an adequate blood pressure.
B) assist with the body's response to stress.
C) regulate the metabolism of carbohydrates.
D) decrease the body's inflammatory response.
B
68
35. Severe dehydration that commonly accompanies diabetic ketoacidosis is caused by:
A) prolonged compensatory hyperventilation.
B) decreased fluid intake secondary to hyperglycemia.
C) hyperglycemia-induced osmotic diuresis and vomiting.
D) the loss of key electrolytes such as sodium and potassium.
C
69
```
50. Signs and symptoms of hypothyroidism include:
A) tachycardia and hypertension.
B) hot, flushed skin and restlessness.
C) diarrhea and emotional lability.
D) bradycardia and sluggish reflexes.
```
D
70
23. If a patient with a behavioral emergency misperceives reality, you should:
A) disagree and correct the patient's perception.
B) avoid arguing about the patient's misperception.
C) conclude that he or she is suffering from schizophrenia.
D) agree with the patient to facilitate his or her cooperation.
B
71
32. Generalized anxiety disorder is characterized by:
A) symptoms for at least 1 month.
B) persistent and unproductive worrying.
C) feelings of grandeur and inattentiveness.
D) unreasonable fear of a particular situation.
B
72
```
17. A man who smiles pleasantly when he tells you of the recent death of his wife:
A) is thinking circumstantially.
B) has a disorder of perception.
C) has an inappropriate affect.
D) has delusions of persecution.
```
C
73
```
20. When assessing a patient with a behavioral emergency, the MOST important assessment tool you have is:
A) your mind.
B) a penlight.
C) a glucometer.
D) cardiac monitoring.
```
A
74
```
59. In hypochondriasis, patients have significant anxiety or fear that they:
A) will attempt to hurt others.
B) may have a serious disease.
C) are being undermedicated.
D) will go to sleep and not awake.
```
B
75
```
28. Which of the following is NOT a general guideline to follow when caring for a patient with a psychiatric problem?
A) Be indirect when possible.
B) Provide honest reassurance.
C) Remain confident in your abilities.
D) Maintain a nonjudgmental attitude.
```
A
76
```
35. Common signs and symptoms of a panic attack include all of the following, EXCEPT:
A) trembling and parasthesias.
B) a sensation of being smothered.
C) a prolonged loss of consciousness.
D) nausea and abdominal discomfort.
```
C
77
10. A patient who is confused:
A) cannot recall the events that preceded his or her illness.
B) should be given 50% dextrose to rule out hypoglycemia.
C) can usually be redirected by providing emotional support.
D) has an impaired understanding of his or her surroundings.
D
78
```
15. Accelerated thinking in which the mind skips very rapidly from one thought to the next is called:
A) confabulation.
B) circumstantial thinking.
C) perseveration.
D) flight of ideas.
```
D
79
```
43. Patients who alternate between mania and depression:
A) are referred to as bipolar.
B) present with a flat affect.
C) have multiple personalities.
D) have a history of schizophrenia.
```
A
80
50. Which of the following is NOT an identified risk factor for suicide?
A) Financial setback or loss of a job
B) A sudden improvement in depression
C) Hispanic woman older than 55 years of age
D) Recent loss of a significant relationship
C
81
68. When caring for a patient experiencing a psychotic episode, you should:
A) involve people the patient trusts.
B) be calm, direct, and straightforward.
C) first assess the situation for danger.
D) clearly identify yourself to the patient.
C
82
2. A psychiatric emergency:
A) generally occurs following the use of an illicit drug or excessive consumption of alcohol.
B) is caused by a chemical imbalance in the brain but does not interfere with activities of daily living.
C) exists when a person's abnormal behavior threatens the safety and well-being of himself or herself or others.
D) is generally the result of a short-term emotional crisis that is treated effectively with behavior modification.
C
83
25. Detecting disorders of perception is often difficult because:
A) patients are often hesitant to answer direct questions regarding hallucinations or illusions.
B) patients experiencing a behavioral emergency are generally agitated and uncooperative.
C) the paramedic's line of questioning is often too difficult or impossible for the patient to understand.
D) it is often difficult for the paramedic to determine the patient's baseline level of mentation.
A
84
```
21. At a minimum, you should be able to assess an emotionally disturbed patient's:
A) ability to recall.
B) blood pressure.
C) blood sugar level.
D) general appearance.
```
D
Paramedic
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