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NREMT MULTIPLE CHOICE
QUESTIONS ,ANSWERS AND RATIONALES
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. - Correct answer • A:both oxygen and glucose are needed for brain function. Reason: Although stroke and hypoglycemia are two distinctly different conditions, their signs and symptoms are often similar. This is because the brain requires both oxygen and glucose to function normally. An acute ischemic stroke is caused by a lack of oxygen to a part of the brain due to a blocked cerebral artery, whereas hypoglycemia (low blood glucose level) deprives the entire brain of glucose. In either case, the patient presents with signs of impaired brain function (ie, slurred speech, weakness, altered mental status). Both conditions may lead to permanent brain damage or death if not treated promptly. When dealing with an emotionally disturbed patient, you should be MOST concerned with:
- A:gathering all of the patient's medications.
- B:safely transporting to the hospital.
- C:whether the patient could harm you.
- D:obtaining a complete medical history. - Correct answer You selected C; This is correct! Reason: When managing any patient with an emotional or psychiatric crisis, your primary concern is your own safety. Safely transporting the patient to the hospital is your ultimate goal. If possible, you should attempt to obtain a medical history and should take any of the patient's prescribed medications to the hospital. However, this should not supercede your own safety or interfere with safely transporting the patient. You are at the scene where a man panicked while swimming in a small lake. Your initial attempt to rescue him should include:
- A:rowing a small raft to the victim.
- B:reaching for the victim with a long stick.
- C:throwing a rope to the victim.
- D:swimming to the victim to rescue him. - Correct answer You selected B; This is correct! Reason: General rules to follow when attempting to rescue a patient from the water include "reach, throw, row, and then go." In this case, you should attempt to reach the victim by having him grab hold of a large stick or similar object. If this is unsuccessful, throw the victim a rope or flotation device (if available). If these are not available, row to the patient in a small raft (if available). Going into the water to retrieve the victim is a last resort. The rescuer must be a strong swimmer because patients who are in danger of drowning are in a state of blind panic and will make every attempt to keep themselves afloat, even if it means forcing the rescuer underwater. How should you classify a patient's nature of illness if he or she has a low blood glucose level, bizarre behavior, and shallow breathing?
- A:Behavioral emergency
- B:Altered mental status
- C:Respiratory emergency
- D:Cardiac compromise - Correct answer The Correct answer is B; Reason: The nature of illness (NOI) is the medical equivalent to mechanism of injury (MOI). Altered mental status should be the suspected NOI in any patient with any fluctuation in level of consciousness, which can range from bizarre behavior to complete unresponsiveness. Causes of an altered mental status include hypo- or hyperglycemia, head trauma, stroke, behavioral crises, drug overdose, and shock, among others. A young female is unresponsive after overdosing on an unknown type of drug. Her respirations are slow and shallow and her pulse is slow and weak. Which of the following drugs is the LEAST likely cause of her condition?
- A:Seconal
- B:Heroin
- C:Cocaine
- D:Valium - Correct answer The Correct answer is C;
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 generating heat, not reducing heat loss. Layers of clothing trap air and provide excellent insulation; thus, layered clothing decreases heat loss better than a single, thick jacket. Conduction is the direct transfer of heat from a part of the body to a colder object by direct contact, as when a warm hand touches cold metal or ice. The most obvious way to decrease heat loss by conduction is to remove your hand from the cold object. A near-drowning is MOST accurately defined as:
- A:complications within 24 hours following submersion in water.
- B:immediate death due to prolonged submersion in water.
- C:survival for at least 24 hours following submersion in water.
- D:death greater than 24 hours following submersion in water. - Correct answer You selected C; This is correct! Reason:Collectively, drowning and near-drowning are referred to as submersion 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), after 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. A young woman reports significant weight loss over the last month, persistent 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. - Correct answer 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. 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. - Correct answer You selected C; This is correct! Reason:You should administer high-flow oxygen to all patients who are actively seizing and to patients who experienced a seizure and are postictal. This is especially true if the seizure was caused by hypoxia. Increasing the oxygen content of the blood, which minimizes hypoxia, may prevent another seizure. The recovery position is appropriate for uninjured patients with a decreased level of consciousness and adequate breathing; it will help maintain the airway and facilitate drainage of secretions from the mouth, but will not prevent another seizure. Oral glucose may prevent another seizure if hypoglycemia was the cause of the seizure. You should dim the lights in the back of the ambulance to help prevent any seizure, not just those that are caused by hypoxia. Which of the following conditions would be the LEAST likely to be present in a patient who was submerged in water?
- A:Spinal injury
- B:Gastric distention
- C:Hyperglycemia
- D:Laryngospasm - Correct answer You selected C; This is correct! Reason: Many factors can contribute to or result from a submersion injury (eg, drowning, near-drowning). It is not uncommon for a person to experience a spinal injury after diving head first into shallow water, especially if he or she is under the influence of alcohol. When a swimmer panics, he or she initially swallows large amounts of water, resulting in gastric distention. Gastric distention can cause aspiration if the patient regurgitates water during rescue breathing; protect the airway! During the panic phase, the victim expends a tremendous amount of energy (and glucose) from flailing around in the water, possibly resulting in hypoglycemia. Inhaling even a small amount of fresh or salt water can
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. - Correct answer You selected C; This is correct! Reason:The patient's symptoms and her history of a recent hiking trip are consistent with Lyme disease, which was the result of a tick bite. Ticks can carry two infectious diseases: Lyme disease and Rocky Mountain spotted fever. Both are spread through the tick's saliva, which is injected into the skin when the tick attaches itself. The first symptom of Lyme disease, a rash that may spread to several parts of the body, begins about 3 days after the bite of an infected tick. The rash may eventually resemble a target bull's-eye pattern in one third of patients. After a few more days or weeks, painful swelling of the joints, particularly the knees, occurs. If recognized and treated promptly with antibiotics, many patients recover completely. Rocky Mountain spotted fever, which is not limited to the Rocky Mountains, occurs within 7 to 10 days after being bitten by an infected tick. Its symptoms include nausea, vomiting, headache, weakness, paralysis, and possibly cardiopulmonary failure. A 50-year-old woman who is conscious and alert complains of a severe migraine headache. When caring for her, you should generally avoid:
- A:transporting her in a supine position.
- B:shining a light into her pupils.
- C:dimming the lights in the ambulance.
- D:applying ice packs to her forehead. - Correct answer You selected B; This is correct! Reason:Patients with migraine or cluster headaches typically have photophobia (light sensitivity). Any type of bright light, especially if shone directly into the eyes, will cause the patient with a headache unnecessary severe pain. Dimming the lights in the ambulance and making the patient as comfortable as possible are the treatments of choice for a patient with a headache. Some patients benefit from ice packs applied to the forehead; just be sure to wrap the ice pack with roller gauze. Oxygen also should be administered as needed. Typically, the patient will prefer to lie supine or on the side
A patient who overdosed on heroin would be expected to present with:
- A:tachycardia.
- B:hyperpnea.
- C:hypotension.
- D:dilated pupils. - Correct answer 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; hypotension; 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. 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. - Correct answer 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! 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?
wet clothing, applying warm blankets) and rapid transport to the hospital where they can be actively rewarmed. Because cold muscle is a poor conductor of electricity, defibrillation, if indicated, should be limited to 1 attempt until the patient's body temperature has been increased. Cardiac arrest patients with severe hypothermia generally do not respond to defibrillation. Hyperventilation should be avoided as this may increase intrathoracic pressure and impair blood flow back to the heart. You should not attempt to actively rewarm a patient with moderate or severe hypothermia in the field because:
- A:rewarming too quickly can cause a fatal cardiac dysrhythmia.
- B:the risk of inadvertently inducing hyperthermia is too high.
- C:it is painful for the patient and you cannot give analgesic drugs.
- D:active rewarming has been shown to cause severe hypertension. - Correct answer You selected A; This is correct! Reason:When caring for a patient with hypothermia, your goal is to prevent further heat loss; this involves removing wet clothing, applying warm blankets, and allowing the patient's body temperature to rise gradually and naturally (passive rewarming). If the patient is moderately or severely hypothermic, you should not try to rewarm him or her actively (placing heat on or into the body). Rewarming too quickly may cause a fatal cardiac dysrhythmia, such as ventricular fibrillation (V-Fib). Active rewarming may also cause rewarming shock, a condition in which the blood vessels dilate when heat is applied to the body, resulting in significant hypotension. For these reasons, active rewarming should only be performed in the controlled setting of a hospital. You respond to a grocery store where a 39-year-old man reportedly experienced a seizure. When you arrive at the scene, a clerk begins to escort you to the patient. She tells you that the man stopped seizing about 5 minutes ago. If the patient truly experienced a seizure, you will MOST likely find that he:
- A:has a slow heart rate.
- B:is fully conscious and alert.
- C:is not breathing and is cyanotic.
- D:is confused and disoriented. - Correct answer You selected D; This is correct!
Reason: Most seizures are followed by a postictal phase, in which the patient is unresponsive at first and then gradually regains consciousness. In most cases, the postictal patient appears dazed, confused, or disoriented; in some cases, he or she is combative. The postictal phase typically lasts from 5 to 30 minutes. During the seizure, the patient is often not breathing or is breathing inadequately; however, when the seizure stops, breathing usually resumes. You will also find that most postictal patients are tachycardic; this is the result of an adrenalin surge that occurs during the tonic-clonic phase of the seizure. You are called to a local park for an ill person. It is a hot day and the humidity is high. When you arrive, a bystander directs you to the patient, a young male who is semiconscious. His skin is flushed, hot, and moist. Your FIRST action in the management of this patient should be to:
- A:begin rapid cooling measures.
- B:ensure an open airway.
- C:administer high-flow oxygen.
- D:move him to a cool area. - Correct answer 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. 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 - Correct answer 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 excessive 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
Reason:After safely reaching a drowning victim, you should first turn him to a supine position by rotating the entire upper half of the body as a single unit; protect the cervical spine as you do this because a spinal injury cannot be ruled out. Open the patient's airway, without manipulating the neck, and begin rescue breathing while still in the water. Float a buoyant backboard under the patient, secure him to it, and remove him from the water. After removing the victim from the water, assess for a pulse. If the victim is pulseless, begin CPR, dry him off, and apply the AED as soon as possible. Which of the following patients with diabetes is the BEST candidate for oral glucose?
- A:A confused patient who has cool, clammy skin
- B:A semiconscious patient with pale, clammy skin
- C:An unresponsive patient who took too much insulin
- D:A confused patient with suspected hyperglycemia - Correct answer You selected A; This is correct! Reason:Oral glucose is indicated for patients with diabetes who are in insulin shock (hypoglycemic crisis), or for any patient with symptomatic hypoglycemia (as documented by glucometer). The patient must be conscious and alert enough to be able to swallow the glucose, which comes in a tube of gel. If the patient is unresponsive or otherwise unable to swallow the glucose, you should provide rapid transport, providing the appropriate airway management en route, and consider an ALS intercept. A 40-year-old woman presents with widespread hives that she noticed about 45 minutes after taking penicillin. She is conscious and alert and denies difficulty breathing. Her breath sounds are clear to auscultation bilaterally, her vital signs are stable, and her oxygen saturation is 94%. She tells you she is allergic to wasps and has an epinephrine auto-injector. You should:
- A:assist her in administering epinephrine via her auto-injector.
- B:give high-flow oxygen and administer 100 mg of Benadryl.
- C:give supplemental oxygen and transport her to the hospital.
- D:advise her that she can probably drive herself to the hospital. - Correct answer You selected C; This is correct! Reason:The patient is experiencing an allergic reaction, but she is not in anaphylactic shock. Urticaria (hives) is common to all allergic reactions, regardless of severity; however, wheezing and hypotension, which she
does not have, are specific to anaphylaxis. Although she carries an epinephrine auto-injector for her allergy to wasps, she was not stung by a wasp. Furthermore, the absence of wheezing and hypotension negates epinephrine administration. Give supplemental oxygen (in a concentration sufficient to maintain an SpO2 of greater than 94%) and transport her to the hospital. Because it can take up to an hour for signs of a severe allergic reaction to manifest, the patient should not drive herself. Diphenhydramine (Benadryl), an antihistamine, is an appropriate drug based on her presentation; however, it is not typically carried on a BLS unit. Furthermore, the correct dose is 25 to 50 mg. Immediately following a generalized motor seizure, most patients are:
- A:hyperactive.
- B:confused.
- C:apneic.
- D:awake and alert. - Correct answer You selected B; This is correct! Reason:After a generalized (grand mal) motor seizure, the patient typically will be confused, sleepy, or in some cases, combative. This is referred to as the postictal phase. The patient's level of consciousness typically improves within 30 minutes. In many cases, the patient's respirations will be fast (tachypnea) following a seizure; this is the body's attempt to eliminate excess carbon dioxide that accumulated in the blood during the seizure. When assessing a conscious patient who overdosed on a drug, you should FIRST determine:
- A:if there is a history of prior overdose.
- B:the patient's weight in kilograms.
- C:the type of medication ingested.
- D:when the medication was ingested. - Correct answer You selected C; This is correct! Reason: When assessing a patient who has overdosed on a drug, you should first determine what was ingested, which will provide you with immediate information about whether or not the substance is toxic. You should then find out when the medication was ingested. This information will provide medical control (or poison control) with the information needed to direct the most appropriate treatment. The patient's weight also should be estimated in kilograms in the event that an antidote is required.
Reason:Most generalized (grand mal) seizures last 3 to 5 minutes and are followed by a lengthy (5 to 30 minutes) period called the postictal phase, in which the patient is unresponsive at first but gradually regains consciousness. During the seizure itself, the nervous system releases excess adrenaline (epinephrine); therefore, tachycardia, even after the seizure has stopped, is common. Apnea is common during a seizure; however, breathing usually resumes after the seizure has stopped. Many patients are tachypneic following a seizure; this is the body's attempt to eliminate excess carbon dioxide that accumulated in the blood during the seizure. Unlike grand mal seizures, petit mal seizures (also called absence seizures) can last for just a fraction of a minute, after which the patient fully recovers immediately with only a brief lapse of memory of the event. Which of the following organs are contained within the right upper quadrant of the abdomen?
- A:Liver and gallbladder
- B:Stomach and gallbladder
- C:Liver and spleen
- D:Liver and stomach - Correct answer You selected A; This is correct! Reason:The liver and gallbladder lie within the right upper quadrant of the abdomen. Most of the stomach is within the left upper quadrant, as is the entire spleen. You respond to a baseball field for a person who was struck by lightning. When you arrive, you see one patient who appears confused and is ambulatory; a second patient who is conscious, sitting on the ground, and holding his arm; and a third patient who is supine and motionless. After requesting additional responders, you should:
- A:assess the motionless victim and perform CPR and defibrillation if necessary.
- B:assess and begin treating the sitting patient first because he is obviously injured.
- C:treat the conscious patients because the motionless patient is likely deceased.
- D:proceed to the ambulatory patient, sit him down, and assess his mental status. - Correct answer You selected D; The Correct answer is A;
Reason:The process of triaging multiple victims of a lightning strike is different than the conventional triage methods used during a mass-casualty incident. When a person is struck by lightning, respiratory or cardiac arrest, if it occurs, usually occurs immediately. Those who are conscious following a lightning strike are much less likely to develop delayed respiratory or cardiac arrest; they usually survive. Therefore, you should focus your efforts on those who are in respiratory or cardiac arrest. This process, called reverse triage, differs from conventional triage, where such patients would ordinarily be classified as deceased. A 32-year-old man who was stung by a bee has diffuse hives, facial swelling, and difficulty breathing. When he breathes, you hear audible stridor. What does this indicate?
- A:Narrowing of the two mainstem bronchi
- B:Swelling of the upper airway structures
- C:Narrowing of the bronchioles in the lungs
- D:Swelling of the lower airway structures - Correct answer You selected B; This is correct! Reason:This patient is experiencing a severe allergic reaction (anaphylaxis). Stridor, which is a high-pitched sound heard on inhalation, indicates swelling of the structures and tissues of the upper airway. If not promptly treated, the patient's airway may close completely, resulting in respiratory arrest. Narrowing of the bronchioles in the lungs causes wheezing, a whistling sound that may be heard during inhalation, exhalation, or both. A behavioral crisis is MOST accurately defined as:
- A:any reaction to an event that interferes with the activities of daily living or has become unacceptable to the patient, family, or community.
- B:an acute psychiatric emergency characterized by violent behavior, mood swings, and a loss of connection to reality.
- C:a persistent feeling of sadness, despair, or hopelessness that incapacitates the patient and prevents him or her from interacting socially.
- D:a chronic mental health problem in which the patient experiences frequent thoughts of suicide or other self-destructive behavior. - Correct answer You selected A; This is correct! Reason:The definition of a behavioral crisis or emergency is any reaction to an event that interferes with the activities of daily living (eg, bathing,
supply. Diabetic coma (hyperglycemic crisis) typically presents with warm, dry skin and a slow onset, sometimes occurring over a period of days. Your FIRST action in managing a patient with an altered mental status should be to:
- A:determine if the patient is breathing adequately.
- B:administer one tube of oral glucose.
- C:administer high-flow supplemental oxygen.
- D:ask a family member how the patient normally acts. - Correct answer You selected A; This is correct! Reason:When treating a patient with an altered mental status, you must first ensure a patent airway and determine if the patient is breathing adequately. If the patient is breathing adequately, administer supplemental oxygen and continue your assessment. If the patient is not breathing adequately (ie, fast or slow rate, shallow breathing [reduced tidal volume]), assist his or her ventilations. It is important to ask a family member, if available, how the patient normally acts; this will help establish a baseline. Before administering oral glucose, you should assess the patient's blood glucose level to determine if hypoglycemia is the cause of his or her problem and then decide if the patient is able to swallow the glucose, if indicated. If the patient is unable to swallow, do not administer oral glucose, even if he or she is hypoglycemic. Request a paramedic ambulance if possible so the patient can receive intravenous glucose. A patient who overdosed on methamphetamine would be expected to have all of the following clinical signs, EXCEPT:
- A:agitation.
- B:hypertension.
- C:dilated pupils.
- D:bradycardia. - Correct answer You selected C; The Correct answer is D; Reason:Methamphetamine, an upper, stimulates the central nervous system, causing it to release excessive amounts of adrenaline (epinephrine). Epinephrine increases heart rate and blood pressure; therefore, the patient would experience tachycardia and hypertension. Other signs of methamphetamine overdose, which also indicate an adrenaline surge, include pupillary dilation, agitation, and hyperthermia.
Bradycardia would be expected in patients who have overdosed on drugs that suppress, not stimulate, the central nervous system (eg, narcotics, benzodiazepines, barbiturates). A 50-year-old woman with a history of epilepsy is actively seizing. Care for this patient should focus primarily on:
- A:protecting her from injury and ensuring adequate ventilation.
- B:administering high-flow oxygen and requesting an ALS ambulance.
- C:frequently suctioning her airway and carefully restraining her.
- D:placing a bite block in between her molars and giving her oxygen. - Correct answer You selected A; This is correct! Reason:Seizure deaths are most frequently the result of hypoxia. When a person is actively seizing, he or she is not breathing adequately. Your primary focus when treating a seizure patient is to protect him or her from injury and to ensure adequate ventilation and oxygenation. Many seizing patients require assisted ventilation. Suction the oropharynx only if the patient has secretions in his or her mouth. Do NOT insert anything into the mouth of a seizing patient; doing so may cause an airway obstruction or damage the soft tissues of the mouth, resulting in bleeding. Do not attempt to restrain an actively seizing patient; doing so may result in musculoskeletal injuries. Request an ALS ambulance per your local protocols. When you arrive at a residence for a man who is "not acting right," you enter the house and find him sitting on his couch. Which of the following findings would be MOST indicative of an altered mental status?
- A:Slurred speech.
- B:Tired appearance.
- C:Odor of alcohol.
- D:Eyes are closed. - Correct answer You selected A; This is correct! Reason:Often, an altered mental status can be difficult to assess, especially if you do not know how the patient normally acts. However, there are key findings that should increase your index of suspicion. An abnormal speech pattern, such as slurring or incoherent words, can be the result of a diabetic problem, alcohol intoxication, or drug ingestion. All of these can cause an altered mental status. The odor of alcohol suggests intoxication as a potential cause of his problem, but cannot be quantified. Just because
