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1. Hypoglycemia and acute ischemic stroke can present similarly because:
**- A:both oxygen and glucose are needed for brain function.
- B:the majority of stroke patients have a history of diabetes.
- C:the most common cause of a stroke is hypoglycemia.
- D:they are both caused by low levels of glucose in the blood.:** • A:both oxygen and glucose are needed for brain function. Reason: Although stroke and hypoglycemia are two distinctly different conditions, their signs and symptoms are often similar. This is because the brain requires both oxygen and glucose to function normally. An acute ischemic stroke is caused by a lack of oxygen to a part of the brain due to a blocked cerebral artery, whereas hypoglycemia (low blood glucose level) deprives the entire brain of glucose. In either case, the patient presents with signs of impaired brain function (ie, slurred speech, weakness, altered mental status). Both conditions may lead to permanent brain damage or death if not treated promptly.
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2. When dealing with an emotionally disturbed patient, you should be MOST
concerned with:
**- A:gathering all of the patient's medications.
- B:safely transporting to the hospital.
- C:whether the patient could harm you.
- D:obtaining a complete medical history.:** You selected C; This is correct! Reason: When managing any patient with an emotional or psychiatric crisis, your primary concern is your own safety. Safely transporting the patient to the hospital is your ultimate goal. If possible, you should attempt to obtain a medical history and should take any of the patient's prescribed medications to the hospital. However, this should not supercede your own safety or interfere with safely transporting the patient.
3. You are at the scene where a man panicked while swimming in a small lake.
Your initial attempt to rescue him should include:
**- A:rowing a small raft to the victim.
- B:reaching for the victim with a long stick.
- C:throwing a rope to the victim.
- D:swimming to the victim to rescue him.:** You selected B; This is correct! Reason: General rules to follow when attempting to rescue a patient from the water include "reach, throw, row, and then go." In this case, you should attempt to reach the victim by having him grab hold of a large stick or similar object. If this is unsuccessful,
**- C:Cocaine
- D:Valium:** The correct answer is C; Reason: Of the drugs listed, cocaine would be the least likely cause of the patient's condition. Cocaine is a central nervous system (CNS) stimulant; you would expect her to be hypertensive, tachycardic, tachypneic, and perhaps even violent. Heroin, Valium, and Seconal are all CNS depressants and could explain her condition. Heroin is an illegal narcotic (opiate), Valium is a benzodiazepine sedative-hypnotic drug, and Seconal is a barbiturate. Narcotics, benzodiazepines, and barbiturates are all CNS depressants. When taken in excess, they cause a decreased level of consciousness, respiratory depression, bradycardia, and hypotension.
6. Activated charcoal is contraindicated for a patient who is:
**- A:conscious and alert and has ingested a large amount of Motrin.
- B:emotionally upset and has ingested two bottles of aspirin.
- C:agitated and claims to have ingested a bottle of Tylenol.
- D:awake and alert and has swallowed a commercial drain cleaner.:** You
selected D; This is correct! Reason:Activated charcoal adsorbs (sticks to) many ingested substances, prevent- ing them from being absorbed into the body by the stomach or intestines. In some cases, you may give activated charcoal to patients who have ingested certain substances, if approved by medical control or local protocol. Activated charcoal is contraindicated for patients who have ingested an acid or alkali (ie, drain cleaner) or a petroleum product (ie, gasoline), who have a decreased level of consciousness and cannot protect their own airway, or who are unable to swallow.
7. The MOST obvious way to reduce heat loss from radiation and convection is
to:
**- A:move away from a cold object.
- B:increase metabolism by shivering.
- C:wear a thick wind-proof jacket.
- D:move to a warmer environment.:** you selected D; This is correct! Reason:In a cold environment, the body has two ways of staying warm: generating heat (thermogenesis) and reducing heat loss. Radiation is the transfer of heat by radiant energy. The body can lose heat by radiation, such as when a person stands in a cold room. Convection occurs when heat is transferred to circulating air, as when cool air moves across the body's surface. A person standing in windy cold weather, wearing lightweight clothing, is losing heat to the environment mostly by convection. The quickest and most obvious way to decrease heat loss from radiation and convection is to move out of the cold environment and seek shelter from wind. Shivering increases the body's metabolism and is a mechanism for
injuries. Drowning is defined as death after submersion in a liquid medium, usually water. In a drowning, death is either immediate or occurs within 24 hours following submersion. Near-drowning is defined as survival, at least temporarily (24 hours), af- ter submersion. It should be noted, however, that complications such as pneumonia and pulmonary edema can cause death greater than 24 hours following submersion. For this reason, all patients with a submersion injury should be transported to the hospital, even if they appear fine at the scene.
9. A young woman reports significant weight loss over the last month, per-
sistent fever, and night sweats. When you assess her, you note the presence of dark purple lesions covering her trunk and upper extremities. You should suspect:
**- A:end-stage cancer.
- B:HIV/AIDS.
- C:tuberculosis.
- D:rheumatic fever.:** You selected B; This is correct! Reason:Weight loss, fever, and night sweats could indicate tuberculosis or HIV/AIDS; however, the dark purple lesions on the skin, which are called Kaposi's sarcoma, are malignant skin tumors and are a classic finding in patients in the later stages of AIDS.
10. A 48-year-old male became acutely hypoxic, experienced a seizure, and is
now postictal. The MOST effective way to prevent another seizure is to:
- A:dim the lights in the back of the ambulance.
**- B:place him in the recovery position.
- C:administer high-flow supplemental oxygen.
- D:give him oral glucose if he can swallow.:** You selected C; This is correct! Reason:You should administer high-flow oxygen to all patients who are actively seizing and to patients who experienced a seizure and are postictal. This is es- pecially true if the seizure was caused by hypoxia. Increasing the oxygen content of the blood, which minimizes hypoxia, may prevent another seizure. The recovery position is appropriate for uninjured patients with a decreased level of consciousness and adequate breathing; it will help maintain the airway and facilitate drainage of secretions from the mouth, but will not prevent another seizure. Oral glucose may prevent another seizure if hypoglycemia was the cause of the seizure. You should dim the lights in the back of the ambulance to help prevent any seizure, not just those that are caused by hypoxia.
11. Which of the following conditions would be the LEAST likely to be present
in a patient who was submerged in water?
(: You selected C; This is correct! Reason:Meningitis is an inflammation of the protective coverings of the brain and spinal cord (meninges). Common signs and symptoms of meningitis include fever, headache, neck stiffness (nuchal rigidity), and vomiting. An altered mental status is common in severe cases. Meningococcal meningitis, caused by a bacterium, is the most contagious and potentially fatal type of meningitis. The patient's signs and symptoms are not consistent with acute stroke, tuberculosis (TB), or influenza (the flu). Although fever is common with both TB and the flu, neither causes neck stiffness. Acute stroke may be associated with a headache, especially a hemorrhagic stroke; however, stroke patients typically do not have a fever.
13. All of the following are signs of gastrointestinal bleeding, EXCEPT:
**- A:melena.
- B:hematemesis.
- C:tachycardia.**
- D:hemoptysis.: You selected D; This is correct! Reason:Signs and symptoms of gastrointestinal (GI) bleeding include abdominal pain; vomiting blood (hematemesis); the passage of dark, tarry stools (melena); and bright red rectal bleeding (hematochezia). If blood loss is significant, the patient may have signs of shock (eg, tachycardia, diaphoresis, tachypnea, hypotension). Hemoptysis (coughing up blood) is a sign of a pulmonary injury, not GI bleeding.
14. A 24-year-old female presents with a rash to her left leg and swollen, painful
knee joints. She tells you that she and her friends returned from a hiking trip in the mountains a week ago. She is conscious and alert with a blood pressure of 112/62 mm Hg, a pulse of 84 beats/min, and respirations of 14 breaths/min. Her symptoms are MOST likely the result of:
**- A:Rocky Mountain spotted fever.
- B:tetanus.
- C:Lyme disease.
- D:a localized allergic reaction.:** You selected C; This is correct! Reason:The patient's symptoms and her history of a recent hiking trip are consistent with Lyme disease, which was the result of a tick bite. Ticks can carry two infectious diseases: Lyme disease and Rocky Mountain spotted fever. Both are spread through the tick's saliva, which is injected into the skin when the tick attaches itself. The first symptom of Lyme disease, a rash that may spread to several parts of the body, begins about 3 days after the bite of an infected tick. The rash may eventually resemble a target bull's-eye pattern in one third of patients. After a few more days or weeks, painful swelling of the joints, particularly the knees, occurs. If recognized and treated promptly with antibiotics, many patients recover completely. Rocky Mountain
should be administered as needed. Typically, the patient will prefer to lie supine or on the side
16. A patient who overdosed on heroin would be expected to present with:
**- A:tachycardia.
- B:hyperpnea.
- C:hypotension.
- D:dilated pupils.:** The correct answer is C; Reason:Heroin is a Schedule I (illegal) narcotic that is typically injected. As with all narcotics, legal or illegal, overdose causes depression of the central nervous system (CNS), resulting in a decreased level of consciousness; bradycardia; hy- potension; and slow, shallow (reduced tidal volume) breathing. Hyperpnea (deep breathing) would not be present in a patient who overdosed on a narcotic. In a narcotic overdose, the pupils are typically constricted (miosis). Barbiturates, such as phenobarbital, are also CNS depressants and cause the same symptoms seen with narcotic overdose. The patient's pupils, however, are typically dilated (mydriasis), not constricted.
17. When caring for any patient with a decreased level of consciousness, your
primary concern should be the:
**- A:potential for airway compromise.
- B:patient's blood glucose level.
- C:possibility of a spinal injury.
- D:possibility of a drug overdose.:** You selected A; This is correct! Reason:Altered mental status could be caused by a high or low blood glucose level, drug overdose, or head injury, among other causes. Furthermore, the possibility of a
spinal injury should be considered if the patient was injured. However, your primary concern should be the status of the patient's airway. Patients with a decreased level of consciousness are at risk for aspiration if vomiting occurs. Unless spinal trauma is present or the patient is breathing inadequately (eg, fast or slow rate, shallow breathing [reduced tidal volume]), place him or her in the recovery position to facilitate drainage if vomiting occurs. Remember this: no airway, no patient!
18. A 16-year-old, 125-pound male ingested a bottle of aspirin approximately 20
minutes ago. Medical control orders you to administer activated charcoal in a dose of 1 g/kg. How much activated charcoal should you administer?
**- A:54 g
- B:60 g
- C:51 g
- D:57 g:** You selected D; This is correct!
**- C:avoid using the AED.
- D:hyperventilate the patient.:** The correct answer is B; Reason:Patients with severe hypothermia (core body temperature < 86°F) who are in cardiac arrest should be managed with basic life support (chest compressions and ventilations), passive external rewarming (ie, removal of wet clothing, applying warm blankets) and rapid transport to the hospital where they can be actively rewarmed. Because cold muscle is a poor conductor of electricity, defibrillation, if indicated, should be limited to 1 attempt until the patient's body temperature has been increased. Cardiac arrest patients with severe hypothermia generally do not respond to defibrillation. Hyperventilation should be avoided as this may increase intrathoracic pressure and impair blood flow back to the heart.
21. You should not attempt to actively rewarm a patient with moderate or
severe hypothermia in the field because:
**- A:rewarming too quickly can cause a fatal cardiac dysrhythmia.
- B:the risk of inadvertently inducing hyperthermia is too high.
- C:it is painful for the patient and you cannot give analgesic drugs.
- D:active rewarming has been shown to cause severe hypertension.:** You selected A; This is correct! Reason:When caring for a patient with hypothermia, your goal is to prevent further heat loss; this involves removing wet clothing, applying warm blankets, and allowing the patient's body temperature to rise gradually and naturally (passive rewarming). If the patient is moderately or severely hypothermic, you should not try to rewarm him or her actively (placing heat on or into the body). Rewarming too quickly may cause a fatal cardiac dysrhythmia, such as ventricular fibrillation (V-Fib). Active rewarming may also cause rewarming shock, a condition in which the blood vessels dilate when heat is applied to the body, resulting in significant hypotension. For these reasons, active rewarming should only be performed in the controlled setting of a hospital.
22. You respond to a grocery store where a 39-year-old man reportedly experi-
enced a seizure. When you arrive at the scene, a clerk begins to escort you to the patient. She tells you that the man stopped seizing about 5 minutes ago. If the patient truly experienced a seizure, you will MOST likely find that he:
**- A:has a slow heart rate.
- B:is fully conscious and alert.
- C:is not breathing and is cyanotic.
- D:is confused and disoriented.:** You selected D; This is correct!
**- B:ensure an open airway.
- C:administer high-flow oxygen.
- D:move him to a cool area.:** You selected D; This is correct! Reason:Your first action in a heat-related emergency is to move the patient to a cooler environment. Once you have moved the patient to a cooler place, you should begin your assessment and treat the patient accordingly. Remember, you must FIRST prevent further harm to the patient.
24. A known diabetic female is found unresponsive. Her respirations are rapid
and shallow; her skin is cool, clammy, and pale; and her pulse is rapid and weak. Which of the following would BEST explain the likely cause of her condition?
**- A:Failure to take insulin
- B:Insulin overdose
- C:Excessive eating
- D:High blood sugar:** The correct answer is B; Reason:The patient has classic signs of insulin shock, a condition caused by a low blood glucose level (hypoglycemia). Common causes of insulin shock include insulin overdose (accidental or intentional), failure to eat (or not eating enough), and exces- sive exertion. The patient's symptoms are not consistent with diabetic ketoacidosis (DKA), a condition that results from a high blood glucose level (hyperglycemia). Signs of DKA include deep, rapid breathing with a fruity or acetone breath odor (Kussmaul respirations), and warm, dry skin. Unlike insulin shock, which can result from an insulin overdose, DKA can occur if a patient fails to take his or her insulin or takes too little.
25. You are dispatched to a residence for a 20-year-old male with respiratory
distress. When you arrive, you find that the patient has a tracheostomy tube and is ventilator dependent. His mother tells you that he was doing fine, but then suddenly began experiencing breathing difficulty. You should:
**- A:detach the ventilator, suction the tracheostomy tube, and reassess the patient.
- B:remove the ventilator tubing and place an oxygen mask over the tra- cheostomy tube.
- C:remove him from the mechanical ventilator and ventilate him manually.
- D:check the settings on the ventilator to ensure that it is functioning proper- ly.:** you selected C; This is correct! Reason:If a ventilator-dependent patient experiences a sudden onset of respiratory
