Study Flashcards by Mike Rotch

Infants and children in shock:
A) typically become hypotensive sooner than adults because of a relative decrease in total blood volume.
B) generally remain alert for longer periods than adults despite a significant decrease in cerebral perfusion.
C) compensate more efficiently than adults by increasing heart rate and peripheral vascular resistance.
D) maintain end-organ perfusion longer than adults, making capillary refill time a less reliable perfusion indicator.

Ans: C
Page: 2036
Type: General Knowledge

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Atrial kick is defined as: A) the blood that flows passively into the ventricles. B) pressure on the AV valves during ventricular contraction. C) an attempt of the atria to contract against closed valves. D) increased preload pressure as a result of atrial contraction.

Ans: D Page: 912-913 Type: General Knowledge

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What phase of the capnographic waveform is called the expiratory upslope? A) A-B B) B-C C) C-D D) D-E

B) B-C

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Which of the following conditions, if it remains undetected until puberty, can result in acute pain, severe constipation, and low back pain at the onset of menses?A) Ovarian cyst
B) Endometriosis
C) Ectopic pregnancy
D) Imperforate hymen

Ans: D
Page: 1185-1186
Type: General Knowledge

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A patient with a dysconjugate gaze following an ocular injury:
A) most likely has a concomitant basilar skull fracture.
B) should have ice applied to the eyes to prevent blindness.
C) has discoordination between the movements of both eyes.
D) should be treated by irrigating both eyes for 20 minutes.

Ans: C
Page: 1093
Type: General Knowledge

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Signs of clinical improvement during CPAP therapy include: A) a decrease in systolic BP. B) an increase in the heart rate. C) increased ETCO2. D) increased ease of speaking

increased ease of speaking

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A man who was using an arc welder without eye protection presents with bilateral eye pain and diminished vision. He is conscious and alert, has a patent airway, and has stable vital signs. Treatment should include:
A) covering his eyes with sterile, moist dressings; applying cool compresses lightly over his eyes; and placing him in a supine position.
B) immediately irrigating his eyes with sterile saline or water; covering both eyes with dry, sterile dressings; and allowing him to sit up.
C) placing him in a lateral recumbent position, keeping his eyelids closed with tape, and applying chemical warm compresses to his eyes.
D) mixing baking powder with sterile water or saline and irrigating his eyes to prevent further damage caused by the ultraviolet light.

Ans: A
Page: 1094-1095
Type: Critical Thinking

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Which of the following statements regarding ectopic pregnancy is MOST correct?
A) Ectopic pregnancy occurs when a fertilized egg implants in a fallopian tube.
B) Most ectopic pregnancies present with symptoms during the second trimester.
C) Use of an intrauterine device is the most common cause of an ectopic pregnancy.
D) In ectopic pregnancy, a fertilized egg implants somewhere other than the uterus.

Ans: D
Page: 1193
Type: General Knowledge

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83. The preferred initial pharmacologic agent for pediatric bradycardia is:
A) atropine.
B) epinephrine.
C) dobutamine.
D) amiodarone.

Ans: B
Page: 2041
Type: General Knowledge

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41. Irritation or injury to abdominal tissue, causing activation of peripheral nerve tracts, would MOST likely result in \_\_\_\_\_\_\_\_\_\_\_ pain.
A) visceral
B) somatic
C) rebound
D) parietal

Ans: B
Page: 1134
Type: General Knowledge

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Which of the following statements regarding the Apgar score is correct?
A) If resuscitation is necessary, the Apgar score is completed to determine the result of the resuscitation.
B) The Apgar score is determined on the basis of the newborn’s condition at 2 and 10 minutes after birth.
C) If resuscitation is needed, it should commence immediately after you obtain the 1-minute Apgar score.
D) A newborn with a heart rate of greater than 80 beats/min would be assigned a score of 2 on the Apgar score.

Ans: A
Page: 1967-1968
Type: General Knowledge

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Changes in the rate and depth of breathing are regulated primarily by the: A) pH of venous blood. B) pH of the CSF. C) saturation of oxygen and hemoglobin. D) amount of oxygen in the blood plasma.

pH of the CSF.

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46. You are dispatched to a residence for a 34-year-old woman who is “sick.” Upon your arrival, the patient greets you at the door. She tells you that she began experiencing a dull aching pain in the left lower quadrant of her abdomen. She further states that she recently had her menstrual period, which was accompanied by more pain than usual. Her vital signs are stable, she is conscious and alert, and she denies vaginal bleeding or fever. This patient MOST likely has:
A) an ectopic pregnancy.
B) a ruptured ovarian cyst.
C) a tubo-ovarian abscess.
D) pelvic inflammatory disease.

Ans: B
Page: 1197
Type: Critical Thinking

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It is MOST important to exercise caution when administering isotonic solutions to patients with:
A) hypotension and severe hypovolemia.
B) hypertension and congestive heart failure.
C) dehydration secondary to excessive diarrhea.
D) a history of insulin-dependent diabetes mellitus.

B) hypertension and congestive heart failure.

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A construction worker was hammering when he experienced a sudden severe pain to his right eye. Assessment of his eye reveals that it is irritated and you can see a small sliver of metal imbedded in the globe. He is also wearing contact lenses. You should:
A) remove his contact lenses and irrigate his eye with copious amounts of water.
B) leave his contact lenses in place and cover both eyes with a sterile dressing.
C) attempt to remove the foreign object only if he has any visual disturbances.
D) remove his contact lenses and administer a narcotic analgesic for pain.

Ans: B
Page: 1093-1097
Type: Critical Thinking

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49. A patient with Cushing syndrome would MOST likely present with:
A) ketoacidosis.
B) hypoglycemia.
C) decreased urination.
D) acute hyperactivity.

Ans: B
Page: 1233
Type: General Knowledge

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You should be MOST suspicious for cardiogenic shock in an infant or child if:
A) he or she appears listless or lethargic.
B) his or her heart rate varies with activity.
C) his or her heart rate is greater than 150 beats/min.
D) perfusion decreases following a fluid bolus.

Ans: D
Page: 2040
Type: General Knowledge

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The flow-restricted, oxygen-powered ventilation device: A) has a demand valve that is triggered by the negative pressure generated during inhalation. B) is the preferred initial device for ventilating an apneic or inadequately breathing patient. C) delivers 100% oxygen to apneic patients at a fixed flow rate of 50 to 60 L/min. D) should be used in patients with thoracic trauma because it is less likely to cause barotrauma

has a demand valve that is triggered by the negative pressure generated during inhalation

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Which of the following statements regarding the IM route of medication administration is correct?
A) Medications have a bioavailability of 75% to 100% following IM administration.
B) Any medication given by the IV route can be given by the IM route.
C) IM-administered medications are subject to first-pass metabolism in the liver.
D) Muscle perfusion has minimal effect on the absorption of IM-administered drugs.

A) Medications have a bioavailability of 75% to 100% following IM administration

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In which of the following conditions would you be LEAST likely to encounter pulsus paradoxus? A) Moderate asthma attack B) Pericardial tamponade C) Tension pneumothorax D) Decompensating COPD

Moderate asthma attack

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82. Bradydysrhythmias in children MOST often occur secondary to:
A) severe hypoxia.
B) drug ingestion.
C) AV heart block.
D) cardiac irritability.

Ans: A
Page: 2041
Type: General Knowledge

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7. While preparing equipment for newborn resuscitation, which of the following items is/are NOT considered optional?
A) Pulse oximeter
B) Cardiac monitor
C) Endotracheal tubes
D) Laryngeal mask airway

Ans: C
Page: 1966
Type: General Knowledge

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28. Movement of both of the eyes in unison is called:
A) dysconjugate gaze.
B) sympathetic eye movement.
C) extraocular movement.
D) physiologic anisocoria.

Ans: B
Page: 1098, 1120
Type: General Knowledge

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When reviewing a cardiac patient’s medication list, you note that she is taking bisoprolol. You recognize that this drug is also called _____________ and is classified as a(n) _____________. A) Zebeta, beta blocker B) Betapace, antiarrhythmic C) Ticlid, antiplatelet agent D) Norvasc, calcium channel blocker

Ans: A Page: 931 Type: General Knowledge

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193. Which of the following statements regarding second-degree heart block is correct? A) Most second-degree heart blocks are transient in nature and resolve in the prehospital setting without the need for intervention in the emergency department. B) Second-degree heart block occurs when an impulse reaching the AV node is occasionally prevented from proceeding to the ventricles and causing a QRS complex. C) More than half of all second-degree heart blocks cause hemodynamic compromise and require transcutaneous cardiac pacing in the prehospital or hospital setting. D) Second-degree heart block is characterized by inconsistent PR intervals, a QRS complex greater than 0.12 seconds, and a ventricular rate less than 40 beats/min.

Ans: B Page: 957 Type: General Knowledge

36. If a paramedic is on duty and receives a 9-1-1 call in his or her jurisdiction: A) he or she is not covered by the Good Samaritan law. B) the Good Samaritan law will provide limited immunity. C) state law requires that he or she respond within 5 minutes. D) he or she cannot be held liable if a fee is not charged to the patient

A) he or she is not covered by the Good Samaritan law. Ans: A Page: 108 Type: General Knowledge

``` 13. Knowledge of anatomy, physiology, and pathophysiology is MOST important during the ________________ stage of critical thinking. A) data interpretation B) concept formation C) reflection in action D) application of principle ```

Ans: A Page: 699 Type: General Knowledge

38. Lactated Ringer's (LR) solution may be beneficial to patients who have lost large amounts of blood because: A) it takes less LR to effectively expand the intravascular compartment than any other isotonic solution. B) LR has the ability to carry oxygen and can maintain cellular perfusion until the patient receives definitive care. C) the lactate contained within LR is converted to bicarbonate in the liver and can help combat intracellular acidosis. D) the likelihood of causing acute circulatory overload is minimal relative to other hypertonic solutions.

C) the lactate contained within LR is converted to bicarbonate in the liver and can help combat intracellular acidosis.

3. A medication is used “off-label.” This means that it: A) is used for a purpose not approved by the FDA, at doses different from the recommended doses, or by a route of administration not approved by the FDA. B) has been determined to be safe by a physician, and is used to treat a patient's illness before the medication has been approved by the FDA for any purpose. C) is administered in clinical trials while the manufacturer conducts further research and before the FDA has approved the medication for use. D) is administered in an extreme emergency situation, but only if initial clinical trials have determined that the medication will not cause harm to the patient.

A) is used for a purpose not approved by the FDA, at doses different from the recommended doses, or by a route of administration not approved by the FDA.

``` 97. The MOST common type of exogenous hypovolemic shock is: A) severe diarrhea. B) internal hemorrhage. C) excess plasma loss. D) external bleeding. ```

D) external bleeding. Ans: D Page: 368 Type: General Knowledge

71. The hypoxic drive is a phenomenon in which: A) a chronically hypoxic patient's primary respiratory drive is stimulated by increased levels of carbon dioxide in the arterial blood. B) a relatively large percentage of patients with COPD become acutely apneic after receiving high-flow oxygen. C) high levels of oxygen rapidly depress a COPD patient's respiratory rate and depth, leading to worsened hypoxia and severe acidosis. D) bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance.

Ans: D Page: 892 Type: General Knowledge

32. Common signs and symptoms of preeclampsia include: A) edema, hypertension, and headache. B) weight loss, blurred vision, and diarrhea. C) ketones in the urine and rapid weight gain. D) facial swelling, dysuria, and chest pain.

Ans: A Page: 1931 Type: General Knowledge

``` 39. Conveying calm, unmistakable, genuine concern for someone you have never met before is the MOST essential challenge as a(n): A) sympathetic listener. B) competent paramedic. C) effective history taker. D) therapeutic communicator. ```

Ans: D Page: 133 Type: General Knowledge

67. Because stimulation of the parasympathetic nervous system and bradycardia can occur during intubation of a child, you should: A) closely monitor the child's cardiac rhythm. B) premedicate with 0.04 mg/kg of atropine. C) limit your intubation attempt to 10 seconds. D) use a curved blade instead of a straight blade.

Ans: A Page: 2032 Type: General Knowledge

``` 100. A loss of normal sympathetic nervous system tone causes: A) neurogenic shock. B) obstructive shock. C) profound vasoconstriction. D) a reduced absolute blood volume. ```

A) neurogenic shock. Ans: A Page: 369 Type: General Knowledge

48. Which of the following statements regarding the rule of palms is correct? A) The patient's palm, excluding the fingers, represents 1% of his or her total body surface area. B) The rule of palms is not an accurate estimator of total body surface area burned in pediatric patients. C) The patient's palm, including the fingers, represents 1% of his or her total body surface area. D) The rule of palms is most accurate when a patient has experienced burns to less than 20% of his or her total body surface area.

Ans: A Page: 1584

``` 1. Which of the following is a subjective finding? A) Pale, cool, clammy skin B) Obvious respiratory distress C) A complaint of chest pressure D) Blood pressure of 110/60 mm Hg ```

Ans: C Page: 149 Type: General Knowledge

57. In contrast to gravida 3 mothers, gravida 1 mothers: A) have delivered at least one baby. B) are at a lower risk for complications. C) will typically take more time to deliver. D) often experience a precipitous delivery.

Ans: C Page: 1930 Type: General Knowledge

``` 8. Which of the following is one of the 10 system elements developed by the National Highway Traffic Safety Administration (NHTSA) in an effort to sustain EMS systems? A) Medical direction B) Fully enhanced 9-1-1 C) Paramedic supervisors D) Continued federal funding ```

A) Medical direction Ans: A Page: 7 Type: General Knowledge

75. A child in decompensated shock with hypotension should: A) be intubated to protect his or her airway. B) receive initial fluid resuscitation at the scene. C) be given 25% dextrose to prevent hypoglycemia. D) receive volume expansion with 5% dextrose in water.

Ans: B Page: 2038 Type: General Knowledge

101. In decompensated shock, systolic blood pressure is: A) less than 90 mm Hg in adult males. B) less than 80 mm Hg in adult females. C) less than the fifth percentile for the age. D) usually undetectable due to vasodilation.

C) less than the fifth percentile for the age. Ans: C Page: 369 Type: General Knowledge

``` 18. Which of the following is a potential complication of pelvic inflammatory disease? A) Uterine rupture B) Ectopic pregnancy C) Respiratory failure D) Urinary tract infection ```

Ans: B Page: 1195 Type: General Knowledge

49. You are one of the paramedics staffing the rehabilitation section at a hazardous materials incident when a hazardous materials technician brings you one of his coworkers, whose mental status is altered. According to the technician, his coworker was appropriately decontaminated in the warm zone. The patient's skin is hot and moist, and he is confused and nauseated. You should: A) administer oxygen via nasal cannula, take his blood pressure, and offer him cold water to drink. B) administer oxygen, start an IV line, administer 2 L of cold normal saline rapidly, and prepare for transport. C) first contact the incident commander and confirm that the patient has indeed been decontaminated. D) suspect that he is suffering from heatstroke, administer high-flow oxygen, and begin rapid cooling measures.

Ans: D Page: 2279-2280 Type: Critical Thinking

``` 9. According to the Apgar score, a newborn with a heart rate of 80 beats/min and slow, irregular breathing should receive a combined score of: A) 2. B) 3. C) 4. D) 5. ```

Ans: A Page: 1968 Type: General Knowledge

79. A patient with an elevated cholesterol level would MOST likely take: A) Inderal. B) Altacor. C) Isordil. D) Diovan.

Ans: B Page: 933 Type: General Knowledge

``` 52. A primagravida woman: A) has had one abortion. B) has delivered one baby. C) will deliver her second baby. D) is pregnant for the first time. ```

Ans: D Page: 1927 Type: General Knowledge

118. In contrast to a patient with asthma, a patient with left-sided heart failure: A) presents with a dry, nonproductive cough and diffuse wheezing in all lung fields. B) experiences acute weight gain and takes medications such as digoxin and a diuretic. C) presents with a hyperinflated chest, use of accessory muscles, and expiratory wheezing. D) is typically a younger patient with a history of a recent upper respiratory infection.

Ans: B Page: 1019 Type: General Knowledge

In contrast to negative-pressure ventilation, positive-pressure ventilation occurs when: A) the diaphragm contracts. B) air is drawn into the lungs. C) intrathoracic pressure falls. D) air is forced into the lungs.

air is forced into the lungs

``` 30. Common signs of gestational diabetes include: A) confusion. B) diaphoresis. C) polydipsia. D) tachycardia. ```

Ans: C Page: 1932 Type: General Knowledge

259. The recommended first-line treatment for third-degree heart block associated with bradycardia and hemodynamic compromise is: A) atropine sulfate. B) a dopamine infusion. C) an epinephrine infusion. D) transcutaneous pacing.

Ans: D Page: 1001 Type: General Knowledge

``` 33. In which of the following situations is the Morgan lens NOT appropriate to use? A) Eye burn from a strong alkali B) An object impaled in the eye C) Eye burn from a strong acid D) Any foreign body in the eye ```

Ans: B Page: 1095 Type: General Knowledge

A patient with a suppressed cough mechanism: A) should be intubated at once. B) is at serious risk for aspiration. C) often requires ventilation support. D) will have a positive eyelash reflex

is at serious risk for aspiration.

``` 170. A 6-year-old child has burns to his head, face, neck, and anterior chest. What percentage of his body surface area has been burned? A) 21% B) 27% C) 30% D) 36% ```

Ans: A Page: 2068 Type: Critical Thinking

64. When the paramedic administers a medication via the IV route: A) bioavailability of the medication is reduced by 50% as soon as it enters the systemic circulation. B) he or she has the ability to titrate the medication carefully in a rapidly evolving clinical situation. C) it is important for him or her to remember that the medication's onset of action is relatively slow. D) first-pass metabolism significantly alters the medication's effects, thereby requiring frequent dosing.

B) he or she has the ability to titrate the medication carefully in a rapidly evolving clinical situation.

26. Cardiac arrest following an electrical shock: A) typically presents as pulseless atrial fibrillation or atrial flutter. B) is most often caused by an electrical current stronger than 1 ampere. C) may occur secondarily from hypoxia or as a direct result of the shock. D) is typically of short duration and is often reversed with 2 minutes of CPR.

Ans: C Page: 1596

191. A first-degree heart block has a PR interval greater than 0.20 seconds because: A) depolarization of the atria occurs at a slightly slower rate than one would expect. B) each impulse that reaches the AV node is delayed slightly longer than expected. C) impulses generated by the SA node traverse the AV node at an accelerated rate. D) the primary pacemaker is not the SA node, but rather an ectopic atrial pacemaker.

Ans: B Page: 957 Type: General Knowledge

43. A positive Murphy sign is characterized by: A) slow, shallow breathing in an attempt to reduce the severe pain associated with cholecystitis. B) a sudden stop in inspiration due to sharp pain when pressure is applied to the right upper quadrant. C) ecchymosis to the flank area, indicative of free blood in the retroperitoneal compartment. D) periumbilical ecchymosis and is a late, but highly suggestive sign of blood in the peritoneum.

Ans: B Page: 1135 Type: General Knowledge

37. Lactated Ringer's (LR) solution should not be given to patients with liver problems because: A) LR is a hypertonic solution and cannot be metabolized by the liver. B) the lactate contained within LR can cause necrosis of the liver tissue. C) patients with liver disease commonly experience renal insufficiency. D) the liver cannot metabolize the lactate in the solution.

D) the liver cannot metabolize the lactate in the solution.

60. Because minors have no legal status: A) they can neither consent to nor refuse medical care. B) you must obtain consent from both parents before treating. C) they must always be treated under the law of implied consent. D) you must obtain a court order before you can legally treat them.

A) they can neither consent to nor refuse medical care. Ans: A Page: 99 Type: General Knowledge

Hyperventilating an apneic patient: A) is appropriate if the patient is an adult. B) may decrease venous return to the heart. C) is beneficial if the pulse rate is too slow. D) reduces the incidence of gastric distention

may decrease venous return to the heart.

181. Patients with a heart rate greater than 150 beats/min usually become unstable because of: A) reduced ventricular filling. B) an increase in the atrial kick. C) increased right atrial preload. D) a significantly reduced afterload.

Ans: A Page: 952 Type: General Knowledge

71. A 33-year-old man was burned when the hot water heater he was working on exploded. The patient has superficial and partial-thickness burns to his face, neck, and arms. Your primary assessment reveals that he is restless and tachypneic. His BP is 80/54 mm Hg and his heart rate is 120 beats/min and weak. You should: A) conclude that he is experiencing burn shock, start two large-bore IV lines of normal saline, and administer fluids based on the Parkland formula. B) assist his ventilations with a bag-mask device, cover him with a blanket, and start a large-bore IV of normal saline set at a keep vein open rate. C) apply oxygen via nonrebreathing mask, cover his burns with cold moist dressings, start an IV with normal saline, and give up to 4 mg of morphine for pain. D) administer high-flow oxygen, keep him warm, start at least one large-bore IV of normal saline, and administer fluid boluses to maintain adequate perfusion.

Ans: D Page: 1584

``` 42. The number one killer of fire fighters at the scene of a fire is/are: A) heatstroke. B) thermal burns. C) inhalation injury. D) cardiac events. ```

Ans: D Page: 2326, 2335 Type: General Knowledge

11. If a newborn does not respond to the initial steps of resuscitation, the need for further intervention is based upon: A) pulse rate, activity, and appearance. B) respiratory effort, pulse rate, and color. C) appearance, skin color, and muscle tone. D) respirations, appearance, and muscle tone.

Ans: B Page: 1968-1969 Type: General Knowledge

71. The rectal route is preferred over the oral route for certain emergency medications because: A) rectal medications are altered significantly by first-pass metabolism. B) bioavailability of rectal medications does not exceed 50 percent. C) the vasculature of the rectal mucosa allows for slow drug absorption. D) rectal medications are usually not subject to first-pass metabolism.

D) rectal medications are usually not subject to first-pass metabolism.

162. The QT interval would MOST likely be prolonged in patients: A) who take digitalis. B) who are hypocalcemic. C) with a rapid heart rate. D) who are hypercalcemic.

Ans: B Page: 987 Type: General Knowledge

123. Pericardial tamponade can be differentiated from a tension pneumothorax by the presence of: A) jugular venous distention. B) a narrowing pulse pressure. C) clear and equal breath sounds. D) alterations in the QRS amplitude.

Ans: C Page: 1021 Type: General Knowledge

``` 10. The ability of multiple agencies or systems to share the same radio frequency is called: A) a duplex. B) trunking. C) patching. D) telemetry. ```

Ans: B Page: 123 Type: General Knowledge

``` 58. A patient who rolls up his or her sleeve so that you can take his or her blood pressure has given you __________ consent. A) implied B) informed C) rational D) expressed ```

D) expressed Ans: D Page: 96 Type: General Knowledge

``` 40. In contrast to somatic pain, visceral pain: A) is well localized. B) indicates peritonitis. C) is difficult to localize. D) increases with movement. ```

Ans: C Page: 1134 Type: General Knowledge

187. Which of the following prescribed medications would a patient with chronic atrial fibrillation MOST likely take? A) Plavix and Vasotec B) Lisinopril and aspirin C) Digitalis and Coumadin D) Cordarone and furosemide

Ans: C Page: 952 Type: General Knowledge

33. If a young female with a known history of gonorrhea presents with abdominal pain, nausea and vomiting, and bleeding between periods: A) you should suspect disseminated gonococcemia. B) one of her ovaries is probably grossly enlarged. C) it is likely that she has an ectopic pregnancy. D) she most likely has pelvic inflammatory disease.

Ans: D Page: 1199 Type: General Knowledge

``` 1. Which of the following is NOT an antepartum risk factor that increases the potential that a newborn may require resuscitation? A) Preeclampsia B) Prolapsed cord C) Polyhydramnios D) Multiple gestations ```

Ans: B Page: 1964 Type: General Knowledge

99. Anaphylactic shock is characterized by: A) labored breathing and hypertension. B) wheezing and widespread vasodilation. C) intracellular hypovolemia and hives. D) a deficiency of circulating histamines.

B) wheezing and widespread vasodilation. Ans: B Page: 368-369 Type: General Knowledge

46. A commercial truck was involved in a wreck and is spilling anhydrous ammonia on the roadway. The incident commander has already established the hot, warm, and cold zones as dictated by the chemical involved. As one of the paramedics at the scene, you should anticipate that your role will MOST likely involve: A) performing triage and treatment in the cold zone. B) assisting with decontamination in the warm zone. C) removing only critical patients from the hot zone. D) evacuating residents who live near the incident.

Ans: A Page: 2268 Type: Critical Thinking

134. Which of the following statements regarding burns in the pediatric patient is correct? A) A child's larger skin surface–to–body mass ratio increases his or her susceptibility to heat and fluid loss. B) A burn that is characterized by clear demarcation lines is generally suggestive of an unintentional burn. C) Unlike adults, the rule of palm is an inaccurate tool to determine the extent of burns in pediatric patients. D) A child with burns to both lower extremities has burns to approximately 36% of his or her body surface area.

Ans: A Page: 2068 Type: General Knowledge

69. You and your partner are transferring a severely burned patient from a community hospital to a burn specialty center. The patient, a 110-pound woman, has partial- and full-thickness burns that cover approximately 55% of her body. She has two large-bore IV lines in place, is intubated, and is on a cardiac monitor. According to the Parkland formula, how much normal saline should she receive in 30 minutes? A) 340 mL B) 355 mL C) 370 mL D) 395 mL

Ans: A Page: 1588-1589

78. A child in anaphylactic shock: A) should receive 0.1 mg/kg of epinephrine IM. B) is treated primarily with saline fluid boluses. C) may require a low-dose epinephrine infusion. D) should receive epinephrine 1:1,000 via the IV route.

Ans: C Page: 2040 Type: General Knowledge

29. Gestational diabetes is caused by: A) a decreased production of insulin secondary to excess estrogen levels. B) increased insulin production and decreased cellular sensitivity to insulin. C) decreased cellular utilization of insulin secondary to increased estrogen. D) ketones that are excreted in the urine during the course of the pregnancy.

Ans: B Page: 1932 Type: General Knowledge

29. Periumbilical ecchymosis is: A) commonly observed in the prehospital setting following blunt force trauma to the abdomen. B) referred to as Cullen sign and may take hours or days to develop following abdominal trauma. C) usually seen in conjunction with flank bruising and is highly suggestive of injury to the liver or spleen. D) also called Grey Turner sign and manifests almost immediately following blunt abdominal trauma.

Ans: B Page: 1740, 1743

``` 71. Signs of compensated shock in the infant or child include all of the following, EXCEPT: A) abnormal mentation. B) tachycardia and pallor. C) prolonged capillary refill. D) decreased peripheral perfusion. ```

Ans: A Page: 2035-2036 Type: General Knowledge

Typically, ETCO2 is approximately: A) 2 to 5 mm Hg higher than the arterial PaCO2. B) 2 to 5 mm Hg lower than the arterial PaCO2. C) 5 to 10 mm Hg higher than the arterial PaCO2. D) 5 to 10 mm Hg lower than the arterial PaCO2

2 to 5 mm Hg lower than the arterial PaCO2

25. Which of the following statements contains objective and subjective information? A) “The patient's behavior was consistent with alcohol intoxication.” B) “The patient's pulse was rapid and weak and he was diaphoretic.” C) “The patient's wife stated that he began feeling ill a few hours ago.” D) “The patient appeared confused and stated that he had a headache.”

Ans: D Page: 150-151 Type: General Knowledge

72. Patients with decompensated asthma or COPD who require positive-pressure ventilation: A) should be ventilated routinely at a rate that is slightly faster than the rate for a patient without an underlying pulmonary disease. B) may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly. C) should be intubated promptly and ventilated at a rate of 20 to 24 breaths/min to eliminate excess carbon dioxide. D) should be given forceful positive-pressure breaths because their primary problem is difficulty with inhalation.

Ans: B Page: 892 Type: General Knowledge

34. Which of the following statements regarding isotonic solutions is correct? A) Isotonic solutions have almost the same osmolarity as bodily fluids. B) D5W becomes an isotonic solution once it is introduced into the body. C) Normal saline is the only isotonic solution used in the prehospital setting. D) Isotonic solutions expand the vascular space by shifting fluid from other compartments.

A) Isotonic solutions have almost the same osmolarity as bodily fluids.

In contrast to negative-pressure ventilation, positive-pressure ventilation: A) may impair blood return to the heart. B) moves air into the esophagus and trachea. C) causes decreased intrathoracic pressure. D) is the act of normal, unassisted breathing.

may impair blood return to the heart

``` 33. The onset of eclampsia is marked by the presence of: A) hypertension. B) protein in the urine. C) thrombocytopenia. D) generalized seizures. ```

Ans: D Page: 1931 Type: General Knowledge

Supplemental oxygen given to a patient with an acute myocardial infarction: A) will prevent the patient from developing a lethal cardiac dysrhythmia. B) should not exceed 3 L/min in order to prevent oxidative injury. C) oxygenates the myocardium that is distal to the occluded coronary artery. D) enhances the body's compensatory mechanisms during the cardiac event

enhances the body's compensatory mechanisms during the cardiac event.

``` 29. Early hypoxia in a child would MOST likely present with: A) tachycardia. B) bradypnea. C) mottled skin. D) bradycardia. ```

Ans: A Page: 2015 Type: General Knowledge

10. If an acutely burned patient is in shock in the prehospital setting: A) it is likely that he or she is experiencing burn shock. B) you should look for another injury as the source of shock. C) administer a 250-mL bolus of normal saline and reassess. D) avoid IV fluids unless the systolic BP is below 80 mm Hg.

Ans: B Page: 1589

``` 72. In which of the following situations would the paramedic MOST likely administer a drug via the rectal route? A) Seizure termination B) Acute renal failure C) Respiratory failure D) Anaphylactic shock ```

A) Seizure termination

62. The BEST way for the paramedic to evaluate a patient's decision-making capacity is to: A) determine if the patient knows what care is appropriate for the situation. B) talk to the patient to determine if he or she understands what is happening. C) confirm that the patient is at least 18 years of age or otherwise emancipated. D) ensure that pulse oximetry and blood glucose readings are within normal limits.

B) talk to the patient to determine if he or she understands what is happening. Ans: B Page: 97 Type: General Knowledge

35. A solution of water with 0.9% sodium chloride is: A) hypotonic until it is introduced into the body. B) capable of carrying oxygen when it is infused. C) of minimal value in expanding the vascular space. D) also called normal saline and is an isotonic solution.

D) also called normal saline and is an isotonic solution.

``` 12. The initial steps of newborn resuscitation include: A) free-flow oxygen. B) proper positioning. C) assessment of pulse rate. D) positive-pressure ventilation. ```

Ans: B Page: 1968-1969 Type: General Knowledge

268. A 70-year-old man called 9-1-1 because of generalized weakness. When you arrive at the scene, you find the patient seated in his recliner. He is conscious and alert and is breathing without difficulty. Your physical exam reveals tenderness to his right upper abdominal quadrant, edema to his ankles, and distended jugular veins. The patient tells you that he takes Vasotec for hypertension and Maxide for his swollen ankles. His vital signs are stable. The MOST appropriate treatment for this patient includes: A) an IV of D5W, 0.4 mg of sublingual nitroglycerin, ECG, and transport. B) high-flow oxygen, vascular access, 1 mg/kg of furosemide, and transport. C) oxygen, cardiac monitoring, an IV line at a keep-open rate, and transport. D) 12-lead ECG acquisition, vascular access, 4 mg of morphine, and transport.

Ans: C Page: 1020-1021 Type: Critical Thinking

286. A 68-year-old woman presents with an acute onset of confusion, shortness of breath, and diaphoresis. Her blood pressure is 72/50 mm Hg, her heart rate is slow and weak, and her respirations are increased and shallow. The ECG reveals a third-degree heart block at a rate of 38 beats/min. After placing the patient on high-flow oxygen, you should: A) start an IV and administer 0.5 mg atropine. B) obtain a 12-lead ECG to detect an acute myocardial infarction. C) obtain vascular access and give a fluid bolus. D) immediately attempt transcutaneous pacing.

Ans: D Page: 1001 Type: Critical Thinking

41. If a burn patient presents with a hoarse voice and states, "I'm cold," your MOST immediate concern should be: A) hypothermia. B) burn shock. C) inhalation injury. D) cyanide toxicity.

Ans: C Page: 1583

28. Grey Turner sign is defined as ecchymosis to the _________ and is indicative of _________. A) umbilicus, peritoneal bleeding B) epigastrium, stomach rupture C) flank, retroperitoneal bleeding D) back, traumatic aortic dissection

Ans: C Page: 1740, 1743

``` 25. Which of the following conditions is characterized by a lack of progesterone and increased androgen levels, and can lead to gestational diabetes and cardiac problems? A) Polycystic ovaries B) Ectopic pregnancy C) Corpus luteum cyst D) Tubo-ovarian abscess ```

Ans: A Page: 1197 Type: General Knowledge

You would NOT expect to encounter decreased breath sounds in a patient with: A) opiate intoxication. B) cardiac tamponade. C) status asthmaticus. D) pulmonary edema.

The hypoxic drive stimulates breathing in patients with: A) chronically decreased PaO2 levels. B) emphysema or chronic bronchitis. C) chronically decreased PaCO2 levels. D) mild bronchospasm caused by asthma

chronically decreased PaO2 levels

61. Which of the following patients is NOT an emancipated minor? A) 17-year-old man who is a member of the U.S. armed forces B) 16-year-old woman who is pregnant and lives with her boyfriend C) 17-year-old woman who goes to college and lives with her parents D) 18-year-old woman who is pregnant and lives with her grandmother

C) 17-year-old woman who goes to college and lives with her parents Ans: C Page: 99 Type: General Knowledge

266. You are dispatched to a residence at 2:00 AM for an elderly man with shortness of breath. The patient tells you that he was suddenly awakened with the feeling that he was smothering. You note dried blood on his lips. The patient tells you that he has some type of “breathing problem,” for which he uses a prescribed inhaler and takes a “heart pill.” You should suspect: A) right ventricular failure. B) reactive airway disease. C) acute COPD exacerbation. D) left-sided heart failure.

Ans: D Page: 1018-1019 Type: Critical Thinking

24. Signs and symptoms of retinal detachment include: A) flashing lights, specks, or floaters in the field of vision. B) double vision and partial or complete loss of peripheral vision. C) immediate pain and total loss of vision following blunt eye trauma. D) paralysis of upward gaze and greater than 50% loss of central vision.

Ans: A Page: 1101 Type: General Knowledge

70. Patients with COPD typically experience an acute exacerbation of their condition because of: A) a secondary condition such as congestive heart failure or a pneumothorax. B) progressively worsening pneumonia that results in a diminished cough reflex. C) chronic noncompliance with their prescribed medications and home oxygen. D) environmental changes such as weather or the inhalation of trigger substances.

Ans: D Page: 891 Type: General Knowledge

20. Which of the following statements regarding the warm zone at a hazardous materials incident is correct? A) Patients who are brought to the warm zone by trained rescuers should already have been decontaminated. B) A standard-size warm zone is generally 50 feet in all directions, but may be smaller depending on the incident. C) The warm zone is also known as the contamination zone and is only accessible by properly trained rescuers. D) It may be necessary to perform urgent lifesaving care in the warm zone before a patient is fully decontaminated.

Ans: D Page: 2268, 2275-2276 Type: General Knowledge

``` 21. Triage and emergency medical treatment should be performed: A) in the hot zone. B) in the cold zone. C) in the warm zone. D) at least 100 feet from the incident. ```

Ans: B Page: 2268 Type: General Knowledge

194. A second-degree heart block, Mobitz type I, occurs when: A) every other impulse generated by the SA node is blocked at the AV node and does not depolarize the ventricles. B) each successive impulse is progressively delayed, until one impulse is blocked from entering the ventricles. C) the PR interval progressively grows narrower, until there is a P wave that is not followed by a QRS complex. D) more than one successive impulse from the SA node is blocked at the AV node and is not allowed to enter the ventricles.

Ans: B Page: 957 Type: General Knowledge

60. COPD is characterized by: A) narrowing of the smaller airways that is often reversible with prompt treatment. B) changes in pulmonary structure and function that are progressive and irreversible. C) small airway spasms during the inhalation phase, resulting in progressive hypoxia. D) widespread alveolar collapse due to increased pressure during the exhalation phase.

Ans: B Page: 888 Type: General Knowledge

``` 26. The MOST common underlying cause of a tubo-ovarian abscess is: A) vaginitis. B) gonorrhea. C) an ectopic pregnancy. D) a ruptured ovarian cyst. ```

Ans: B Page: 1197 Type: General Knowledge

``` 29. Alkali or strong acid burns to the eye should be irrigated for at least ____ minutes. A) 10 B) 15 C) 20 D) 30 ```

Ans: C Page: 1095 Type: General Knowledge

``` 2. All of the following are subjective findings, EXCEPT: A) visible blood in the ear canal. B) a feeling of impending doom. C) a persistent dull headache. D) acute and severe nausea. ```

Ans: A Page: 149 Type: General Knowledge

192. Which of the following statements regarding treatment for a first-degree heart block is correct? A) Treatment is generally not indicated unless the rate is slow and cardiac output is impaired. B) Most first-degree heart blocks are associated with significant bradycardia and require atropine. C) First-degree heart block is often accompanied by a compensatory tachycardia that requires treatment. D) Transcutaneous cardiac pacing should be initiated without delay for patients with a first-degree heart block.

Ans: A Page: 957 Type: General Knowledge

37. The Good Samaritan law was originally passed in order to: A) encourage paramedics to respond while on duty. B) discourage EMS systems from billing the patient. C) encourage the public to help at emergency scenes. D) provide immunity from liability to the paramedic.

C) encourage the public to help at emergency scenes. Ans: C Page: 108 Type: General Knowledge

196. Which of the following occurs at the AV node during a third-degree heart block? A) There is an abnormal delay in conducting impulses. B) Every third impulse is allowed to enter the ventricles. C) Impulses bypass the AV node and enter the ventricles. D) All impulses are blocked from entering the ventricles.

Ans: D Page: 958 Type: General Knowledge

2. An individual trained at the hazardous materials technician level is trained to: A) provide medical support for hazardous materials teams. B) perform patient care activities in an incident's warm zone. C) care for patients contaminated with a hazardous material. D) perform patient care activities in an incident's cold zone.

Ans: D Page: 2258 Type: General Knowledge

What point(s) on the capnographic waveform represent(s) a mixture of alveolar gas and dead space gas? A) A-B B) B C) B-C D) D

B) B

``` 53. If a woman is gravida 3 and para 2: A) she has been pregnant two times. B) she has delivered three babies. C) she has been pregnant five times. D) she has delivered two babies. ```

Ans: D Page: 1927 Type: General Knowledge

42. If an off-duty paramedic stops at the scene of a motor vehicle crash, the paramedic: A) does not have a legal duty to provide care. B) must accompany the patient to the hospital. C) has a legal obligation to provide patient care. D) is legally protected by the Good Samaritan law.

C) has a legal obligation to provide patient care. Ans: C Page: 101 Type: General Knowledge

``` 76. Distributive shock in children is MOST often the result of: A) sepsis. B) spinal injury. C) heart failure. D) anaphylaxis. ```

Ans: A Page: 2040 Type: General Knowledge

142. Damage to the cardiac electrical conduction system caused by an acute myocardial infarction MOST commonly results in: A) severe tachycardia. B) ventricular dysrhythmias. C) acute bundle branch block. D) bradycardia or heart block.

Ans: D Page: 936-937 Type: General Knowledge

67. You are caring for a 41-year-old man who was trapped in his burning house before being rescued by fire fighters. He has full-thickness burns to his head and anterior trunk, and mixed partial- and full-thickness burns to both anterior upper extremities. What percentage of his total body surface area has been burned? A) 18% B) 27% C) 36% D) 45%

Ans: C Page: 1585

``` 63. Which of the following medications can be administered via the intranasal route? A) Atropine B) Diazepam C) Morphine D) Naloxone ```

D) Naloxone

100. An elderly woman with COPD presents with peripheral edema. The patient is conscious but agitated. She is breathing with slight difficulty but has adequate tidal volume. During your assessment, you note that her jugular veins engorge when you apply pressure to her right upper abdominal quadrant. She tells you that she takes a “water pill” and Vasotec for high blood pressure. You should: A) expect to hear crackles when you auscultate her lungs. B) suspect acute right heart failure and administer oxygen. C) start an IV of normal saline and give her a 250-mL bolus. D) conclude that she has been noncompliant with her diuretic.

Ans: B Page: 891 Type: Critical Thinking

``` 85. Which of the following is the first-line treatment for a hemodynamically unstable child with bradycardia? A) Epinephrine IV or IO B) Chest compressions C) Ventilatory support D) Transcutaneous pacing ```

Ans: C Page: 2041 Type: General Knowledge

Negative-pressure ventilation occurs when: A) the diaphragm ascends and the intercostal muscles retract. B) air is drawn into the lungs when intrathoracic pressure decreases. C) pressure within the chest decreases and air is forced from the lungs. D) the phrenic nerves stop sending messages to the diaphragm

air is drawn into the lungs when intrathoracic pressure decreases.

77. Spironolactone is a(n): A) beta blocker. B) vasodilator. C) diuretic. D) antiarrhythmic.

Ans: C Page: 932 Type: General Knowledge

28. Which of the following statements regarding Grey Turner sign is correct? A) Grey Turner sign is characterized by bruising around the umbilicus. B) The presence of Grey Turner sign should make you suspicious for hepatitis. C) Grey Turner sign is the cessation of inspiration during abdominal palpation. D) Grey Turner sign is characterized by flank bruising and indicates retroperitoneal hemorrhage.

Ans: D Page: 1145 Type: General Knowledge

If a patient is able to sense smell, his or her __________ nerve is intact. A) abducens B) olfactory C) trigeminal D) trochlear

59. Implied consent is based on the premise that a patient: A) would consent to care because of the seriousness of his or her injury. B) will die unless emergency medical treatment is provided immediately. C) is of legal age and is able to make rational decisions regarding his or her care. D) would refuse any emergency medical care if he or she were unconscious.

A) would consent to care because of the seriousness of his or her injury. Ans: A Page: 96 Type: General Knowledge

92. Stable angina: A) typically subsides within 10 to 15 minutes. B) occurs after a predictable amount of exertion. C) usually requires both rest and nitroglycerin to subside. D) is characterized by sharp chest pain rather than pressure.

Ans: B Page: 1012 Type: General Knowledge

``` 5. The combination of two or more signals, which allows the paramedic to talk and transmit an ECG simultaneously on one frequency, is called a: A) simplex system. B) trunking system. C) multiplex system. D) half-duplex system. ```

Ans: C Page: 123 Type: General Knowledge

``` 30. The ONLY indication for removing contact lenses in the prehospital setting is: A) chemical eye burns. B) acute conjunctivitis. C) cardiopulmonary arrest. D) a foreign body in the eye. ```

Ans: A Page: 1097 Type: General Knowledge

93. In contrast to stable angina, unstable angina: A) occurs following periods of strenuous exertion. B) often awakens the patient from his or her sleep. C) indicates that myocardial necrosis has occurred. D) is less frequent but is associated with more pain

Ans: B Page: 1013 Type: General Knowledge

62. Which of the following statements regarding the endotracheal route of medication administration is correct? A) If a medication must be given via the endotracheal route, five times the standard IV dose should be given. B) Evidence has shown that medications given via the endotracheal route quickly achieve a peak plasma level. C) Medications given via the endotracheal route should be flushed with 20 to 30 mL of sterile water. D) The endotracheal route is no longer considered a reliable method of medication administration.

D) The endotracheal route is no longer considered a reliable method of medication administration.

``` 94. You are dispatched to a residence for a 59-year-old man with difficulty breathing. The patient, who has a history of COPD, is conscious and alert. During your assessment, he tells you that he developed chills, fever, and a productive cough 2 days ago. Auscultation of his lungs reveals rhonchi to the left lower lobe. This patient is MOST likely experiencing: A) bronchitis. B) pneumonia. C) end-stage COPD. D) COPD exacerbation. ```

Ans: B Page: 891 Type: Critical Thinking

``` 25. What part of the eye is MOST commonly injured following a thermal burn? A) Globe B) Retina C) Cornea D) Eyelids ```

Ans: D Page: 1094 Type: General Knowledge

119. In addition to supplemental oxygen, treatment of a patient with left-sided heart failure includes: A) a saline lock, a selective beta-2 adrenergic medication, and bicarbonate. B) an IV of normal saline, a 20-mL/kg fluid bolus, and a diuretic medication. C) a saline lock, fentanyl, and intubation facilitated by pharmacologic agents. D) an IV of normal saline to keep the vein open, nitroglycerin, and morphine.

Ans: D Page: 1019-1020 Type: General Knowledge

47. According to the rule of nines, an adult man with partial- and full-thickness burns to his head, face, and anterior chest has burns to ____% of his total body surface area. A) 18 B) 27 C) 36 D) 45

Ans: A Page: 1584

9. Burn shock is caused by: A) a massive infection that occurs when microorganisms breach burned skin. B) renal failure secondary to excess myoglobin production from burned muscle. C) fluid loss across damaged skin and volume shifts within the rest of the body. D) acute dehydration, and it commonly manifests within 30 minutes after the burn.

Ans: C Page: 1577-1578

``` 7. Which of the following was NOT a required component identified by the Emergency Medical Services System Act of 1973? A) EMS research B) Mutual aid agreements C) National EMS certification D) Integration of health services ```

C) National EMS certification Ans: C Page: 7 Type: General Knowledge

23. When assessing a child's circulation by looking at his or her skin, pallor is MOST indicative of: A) vasomotor instability and decompensated shock. B) peripheral vasoconstriction and compensated shock. C) poor oxygenation and a state of circulatory collapse. D) systemic vasodilation with resulting low blood pressure.

Ans: B Page: 2014 Type: General Knowledge

71. Crowning is MOST accurately defined as: A) bulging of the baby's head from the vaginal opening. B) passage of the baby through the fully dilated cervix. C) the presenting of the baby at the vaginal opening. D) the thinning and shortening of the cervix during labor.

Ans: C Page: 1939 Type: General Knowledge

``` 95. The MOST common cause of cardiogenic shock is: A) untreated hypertension. B) blunt force chest trauma. C) acute myocardial infarction. D) sustained pulmonary hypertension. ``` Ans: C Page: 367 Type: General Knowledge

C) acute myocardial infarction. Ans: C Page: 367 Type: General Knowledge

``` 96. What type of shock occurs when blood flow becomes blocked in the heart or great vessels? A) Cardiogenic B) Peripheral C) Distributive D) Obstructive ```

D) Obstructive Ans: D Page: 367 Type: General Knowledge

4. The patient care report: A) provides for a continuum of patient care upon arrival at the hospital. B) is a legal document and should provide a brief description of the patient. C) should include the paramedic's subjective findings or personal thoughts. D) is only held for a period of 24 months, after which it legally can be destroyed.

Ans: A Page: 149, 151 Type: General Knowledge

105. You respond to the residence of an elderly man with severe COPD. You recognize the address because you have responded there numerous times in the recent past. You find the patient, who is clearly emaciated, seated in his recliner. He is on oxygen via nasal cannula, is semiconscious, and is breathing inadequately. The patient's daughter tells you that her father has an out-of-hospital DNR order, for which she is frantically looking. You should: A) apply a nonrebreathing mask, assess his oxygen saturation level, and prepare for immediate transport. B) provide aggressive airway management unless the daughter can produce a valid DNR order. C) intubate him at once, begin transport, and advise the daughter to notify the hospital when she finds the DNR order. D) recognize that he is experiencing end-stage COPD, begin assisting his ventilations, and contact medical control as needed.

Ans: D Page: 891-892 Type: Critical Thinking

71. A 34-year-old female states that she feels like she has a grain of sand in her eye. Assessment reveals that her eye and the surrounding area are red. Treatment for her should include: A) carefully assessing her eye for an object imbedded in the globe and removing it if one is present. B) instructing her to continue rapid eye blinking and administering analgesia as indicated. C) gently rubbing the surface of the eye with a cotton-tipped applicator to remove the foreign body. D) gently irrigating her eye and taping the affected eye closed to prevent it from drying out.

Ans: D Page: 1098 Type: Critical Thinking

12. In EMS, the process of concept formation involves: A) determining the validity of obtained data. B) gathering information about your patient. C) knowing which treatment algorithm to use. D) interpreting a patient's signs and symptoms.

Ans: B Page: 698 Type: General Knowledge

98. Distributive shock occurs when: A) central vasoconstriction forces blood from the core of the body. B) blood pools in expanded vascular beds and tissue perfusion decreases. C) microorganisms attack the blood vessels, resulting in vasodilation. D) a significant decrease in cardiac contractility causes decreased perfusion.

B) blood pools in expanded vascular beds and tissue perfusion decreases. Ans: B Page: 368 Type: General Knowledge

170. Common causes of bradycardia include: A) exercise. B) hyperthermia. C) amphetamines. D) beta blocker use.

Ans: D Page: 947 Type: General Knowledge

``` 98. Etomidate should be avoided as an induction agent in pediatric intubation in the presence of: A) hypovolemia. B) tachycardia. C) hypotension. D) septic shock. ```

Ans: D Page: 2046 Type: General Knowledge

32. Retinal injuries that are caused by exposure to extremely bright light: A) are generally not painful but may result in permanent damage. B) cause immediate intense pain and result in permanent blindness. C) are painless and almost always heal without permanent damage. D) cause severe pain but heal quickly and without permanent damage.

Ans: A Page: 1094 Type: General Knowledge

``` 77. Early distributive shock in children is characterized by: A) warm, flushed skin. B) weak peripheral pulses. C) pallor and diaphoresis. D) gross neurologic deficits. ```

Ans: A Page: 2040 Type: General Knowledge

69. Which of the following statements regarding the sublingual administration of nitroglycerin is correct? A) Large doses of IV nitroglycerin are required to achieve the same effect as a single sublingual nitroglycerin dose B) Sublingual nitroglycerin administration involves placing a tablet in between the patient's cheek and gum C) Sublingual nitroglycerin has a delayed onset of action, but nearly a 100% bioavailability D) Nitroglycerin given by the sublingual route has a rapid onset of action, but a low bioavailability

D) Nitroglycerin given by the sublingual route has a rapid onset of action, but a low bioavailability

65. The use of a straight blade during pediatric intubation: A) is generally reserved for neonates only. B) makes it easier to manipulate the epiglottis. C) is associated with a higher risk of bradycardia. D) facilitates laryngoscopy by lifting the vallecula.

Ans: B Page: 2031 Type: General Knowledge

23. Hyphema is defined as: A) severe ecchymosis to the orbital region. B) blood in the anterior chamber of the eye. C) marked swelling of the globe of the eye. D) double vision following blunt eye trauma.

Ans: B Page: 1100 Type: General Knowledge

``` 69. Which of the following clinical findings is MOST suggestive of pneumonia in a patient with COPD? A) Nonproductive cough B) White sputum and rales C) Fever and localized crackles D) Dyspnea and diffuse wheezing ```

Ans: C Page: 891 Type: General Knowledge

32. It is important to remember that blood pressure is only one component in the overall assessment of a child because: A) it is an unreliable measurement of perfusion in all children. B) hypotension is seen much earlier in children than in adults. C) blood pressure may remain adequate in compensated shock. D) it generally yields a falsely low reading in agitated children.

Ans: C Page: 2018 Type: General Knowledge

``` 10. An infant born with a pink body and blue extremities, a pulse rate of 90 beats/min, a strong cry, and active movement should be assigned an initial Apgar score of: A) 5. B) 6. C) 7. D) 8. ```

Ans: D Page: 1968 Type: General Knowledge

288. A 41-year-old man complains of chest heaviness and mild shortness of breath that began about 2 hours ago. He is conscious and alert. As you are assessing him, he tells you that he has high blood pressure for which he takes Clonidine. His blood pressure is 160/90 mm Hg, heart rate is 140 beats/min and regular, and respirations are 22 breaths/min and somewhat labored. The cardiac monitor displays a narrow complex tachycardia in lead II. Which of the following interventions is NOT indicated for this patient? A) Aspirin B) Adenosine C) IV access D) 12-Lead ECG

Ans: B Page: 1001, 1005, 1015 Type: Critical Thinking

``` 79. Unlike other types of shock, a child in cardiogenic shock would MOST likely present with: A) an enlarged spleen. B) unlabored tachypnea. C) increased work of breathing. D) a primary cardiac dysrhythmia. ```

Ans: C Page: 2040 Type: General Knowledge

65. After performing the initial steps of resuscitation, you assess a newborn and note that its respirations are poor and its pulse rate is 50 beats/min. You should: A) immediately begin positive-pressure ventilations and chest compressions and then reassess the newborn's pulse rate in 30 seconds. B) begin chest compressions if the heart rate remains below 60 beats/min after 30 seconds of effective positive-pressure ventilation. C) begin chest compressions, insert an endotracheal tube, and administer 0.1 to 0.3 mL/kg of epinephrine 1:10,000 down the endotracheal tube. D) perform tactile stimulation for 30 seconds, reassess the infant's respirations and pulse rate, and begin positive-pressure ventilations if there is no improvement.

Ans: B Page: 1968-1969, 1975 Type: Critical Thinking

``` 56. Medications administered by the ___________ route, by definition, have 100% bioavailability. A) sublingual B) intramuscular C) endotracheal D) intravenous ```

D) intravenous

84. While on duty, a paramedic unit stops at the scene of a traffic accident to which it has not been dispatched. During the course of providing patient care, one of the paramedics purposely manipulates the patient's neck to elicit a painful response. This paramedic: A) is protected by the Good Samaritan law because he was not officially dispatched to the scene of the accident. B) is not a Good Samaritan and did not perform as any other paramedic with similar training would have performed. C) is not protected by the Good Samaritan law but provided treatment that is consistent with the accepted standard of care. D) cared for the patient in a manner consistent with his scope of practice and is not liable for the patient's injury or injuries.

Ans: B Page: 100-103, 108-109 Type: Critical Thinking

``` 31. Gestational hypertension: A) often requires an antihypertensive. B) is common in underweight women. C) may be an early sign of preeclampsia. D) is benign in the vast majority of cases. ```

Ans: C Page: 1931 Type: General Knowledge

48. Which of the following would MOST likely cause Cushing syndrome? A) Abrupt termination of steroids such as prednisone and hydrocortisone B) Administration of large amounts of methylprednisolone to an asthma patient C) An acute decrease in cortisol secretion secondary to an infection or malignancy D) Underuse of corticosteroids for illnesses such as rheumatoid arthritis and asthma

Ans: B Page: 1233 Type: General Knowledge

Chemoreceptors located in the carotid bodies and aortic arch sense minute changes in the ______ and send signals to the respiratory centers via the _______________ nerves. A) PaO2, vagus and intercostal B) PaCO2, glossopharyngeal and vagus C) PaCO2, phrenic and glossopharyngeal D) PaO2, hypoglossal, vagus, and intercostal

PaCO2, glossopharyngeal and vagus

195. A key to interpreting a Mobitz type II second-degree heart block is to remember that: A) unlike a Mobitz type I second-degree heart block, a type II heart block is always regular. B) in this type of heart block, the PR interval gets progressively longer until a P wave is not conducted. C) the PR interval of all of the conducted P waves and their corresponding QRS complexes is constant. D) most type II second degree AV blocks have more than two nonconducted P waves that occur in succession.

Ans: C Page: 958 Type: General Knowledge

On a capnographic waveform, point ___ is the maximal ETCO2 and is the best reflection of the alveolar CO2 level. A) B B) C C) D D) E

C) D

253. In which of the following situations would you likely NOT be able to palpate a pulse despite effective chest compressions? A) Profound hypoxia B) Severe acidosis C) Hyperkalemia D) Tension pneumothorax

Ans: D Page: 1008 Type: General Knowledge

66. General criteria for determining a patient's mental competence include all of the following, EXCEPT: A) the absence of cardiac dysrhythmias. B) an appropriate response to questions. C) blood glucose levels within normal limits. D) the absence of a head injury or other trauma.

A) the absence of cardiac dysrhythmias. Ans: A Page: 98 Type: General Knowledge

The Hering-Breuer reflex is a protective mechanism that: A) terminates inhalation and prevents lung overexpansion. B) decreases pneumotaxic function during severe hypoxia. C) sends messages to the diaphragm via the phrenic nerves. D) allows the apneustic center to influence the respiratory rate.

terminates inhalation and prevents lung overexpansion

24. Left shoulder pain following injury to the spleen: A) typically precedes hypotension and other signs of shock. B) usually does not occur until 1 to 2 hours after the injury. C) is a sign of associated injury to a hollow abdominal organ. D) is called Cullen sign and indicates intraabdominal bleeding.

Ans: B Page: 1742

``` 23. What level of personal protective equipment is typically worn by the hazardous materials decontamination team in the warm zone? A) Level A B) Level B C) Level C D) Level D ```

Ans: B Page: 2269, 2272 Type: General Knowledge

32. Epinephrine is indicated during newborn resuscitation if: A) the heart rate does not increase above 80 beats/min after 30 to 60 seconds of effective positive-pressure ventilation. B) the newborn is bradycardic and thick secretions are hindering your ability to provide effective positive-pressure ventilations. C) the heart rate remains below 60 beats/min after 30 seconds of effective ventilation and an additional 30 seconds of chest compressions. D) profound central cyanosis persists despite 30 seconds of effective positive-pressure ventilation with 100% supplemental oxygen.

Ans: C Page: 1977 Type: General Knowledge

74. When caring for an infant or child who is in compensated shock, you should: A) intubate at the earliest sign of altered mentation. B) administer a 10-mL/kg normal saline fluid bolus. C) assist ventilations to improve tissue oxygenation. D) establish IV or IO access en route to the hospital.

Ans: D Page: 2037 Type: General Knowledge

Under normal conditions, the central chemoreceptors in the brain increase the rate and depth of breathing when the: A) PaO2 level falls quickly. B) pH of the CSF decreases. C) PaCO2 decreases slowly. D) pH of the CSF increases

pH of the CSF decreases

``` 73. Which of the following events occur during the third stage of labor? A) Crowning B) Placental delivery C) Delivery of the baby D) Mucous plug expulsion ```

Ans: B Page: 1939 Type: General Knowledge

43. If a volunteer paramedic has signed up to work a shift for an EMS system: A) he or she does not have a legal obligation to act. B) the Good Samaritan law provides limited immunity. C) he or she must be a third responder on the ambulance. D) he or she is obligated to respond to calls during the shift.

D) he or she is obligated to respond to calls during the shift. Ans: D Page: 101 Type: General Knowledge

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