×

Quiz Session - Attempts With Random Questions

IBSC CCP-C Exam Questions

Page 6 of 20

101.

You are transporting a 68-year-old male patient weighing 98 kg with severe COPD exacerbation and a recent history of upper gastrointestinal bleeding. During transport, your patient experiences a decrease in mental status, and his respirations are slow and shallow. You prepare to perform rapid sequence intubation on this patient. 

Which of the following plans is most appropriate for this patient, considering the need to minimize respiratory depression while ensuring adequate sedation and analgesia?

  • Fentanyl 100 mcg IV and Propofol 196 mg IV for induction and sedation and Rocuronium 98 mg IV for post-intubation

  • Fentanyl 250 mcg IV and Versed 10 mg IV for induction and Succinylcholine 100 mg for post intubation

  • Ketamine 98 mg IV and Versed 4 mg IV, and avoid paralytics due to the patient's COPD exacerbation

  • Morphine 10 mg IV and Ativan 2 mg and avoid paralytics to monitor spontaneous breathing efforts

Correct answer: Fentanyl 100 mcg IV and Propofol 196 mg IV for induction and sedation and Rocuronium 98 mg IV for post-intubation

The dose of fentanyl is 50-250 mcg (1-2.5 mcg/kg) and the dose of propofol is 2-2.5 mg/kg for induction and sedation. After the patient is intubated, it is recommended to administer a longer-acting paralytic, such as rocuronium. The dose of rocuronium is 0.5-1 mg.kg, making 98 mg an appropriate dose for this patient. 

The dose of versed is 0.5-2 mg, which makes 10 mg too large of a dose for this patient. Also, succinylcholine is not recommended for post-intubation because of its short duration of effect. 

The dosage of ketamine is 1-2 mg/kg, which makes 98 mg the correct dose for this patient, but it is not indicated to withhold paralytics due to COPD exacerbation. Paralytics should still be administered. 

The correct dose of morphine is 1-2 mg/kg, but fentanyl is preferred over morphine. Fentanyl has greater lipid solubility and less histamine release, which creates a faster onset. Paralytics should not be withheld in this patient. 

102.

You are treating a 22-year-old female for palpitations and dizziness. On the patient's ECG, there is no ST elevation, but you note a delta wave in lead V1. When transferring the patient to the ambulance, the patient has a sudden mental status change, becomes lethargic, and has a respiratory rate of 28. ECG shows a regular tachyarrhythmia at a rate of 198. 

You should do which of the following?

  • Perform synchronized cardioversion at 100 J

  • Have the patient perform vagal maneuvers

  • Perform synchronized cardioversion at 200 J

  • Administer adenosine 6 mg RIVP

Correct answer: Perform synchronized cardioversion at 100 J

The delta wave seen on the ECG is indicative of Wolff Parkinson White (WPW), which is a pre-excitation syndrome. Because the patient is unstable, the immediate treatment is synchronized cardioversion at 100 J. Electrical therapy is considered a safe treatment for WPW, as pharmacological therapy may sometimes illicit unpredictable results. 

Vagal maneuvers are only indicated in the stable patient, and this patient is unstable secondary to the decrease in mental status and increased respiratory rate. 

200 J is too high a dose of synchronized cardioversion. 

Adenosine is not a first-line treatment for WPW. Adenosine may cause additional complications in the presence of WPW.

103.

A 32-year-old female with a known history of Myasthenia Gravis (MG) presents to the ED with a sudden onset of respiratory distress. She is tachypneic and fatigued. Her vital signs are stable. 

Which of the following interventions is most appropriate as initial management for this patient?

  • Mechanical ventilation

  • Intravenous immunoglobulin (IVIG)

  • Pyridostigmine (Mestinon)

  • High-dose corticosteroids

Correct answer: Mechanical ventilation

Myasthenia Gravis (MG) is an autoimmune disorder characterized by muscle weakness and fatigue, typically worsening with exertion. Respiratory muscle weakness can lead to respiratory distress and failure. In a myasthenic crisis, mechanical ventilation is often required to support respiratory function and prevent respiratory arrest.

IntraVenous ImmunoGlobulin (IVIG) is used to modulate the immune response in MG but is not the initial intervention in acute respiratory distress. 

Pyridostigmine is an acetylcholinesterase inhibitor that improves muscle strength in MG, but it does not address acute respiratory failure. 

Corticosteroids may be used to manage MG long-term and in some exacerbations but do not provide immediate relief of respiratory distress.

104.

You are treating a 65-year-old male with a history of chronic bronchitis. Which of the following pathological changes in these patients causes the most debilitating effect?

  • Cor pulmonale

  • Chronic coughing

  • Constant mucus blockages

  • Airway inflammation

Correct answer: Cor pulmonale

Right-sided heart failure can occur in patients with chronic bronchitis. Cor pulmonale leads to pulmonary hypertension. 

Chronic coughing, constant mucus blockages, and airway inflammation are debilitating effects of chronic bronchitis, but the most devastating is cor pulmonale. 

105.

Your patient is a 76-year-old female who needs a gastric lavage due to an accidental overdose of her prescription medications. Intermittent suction through the gastric tube is required because continuous suctioning can lead to hypokalemia and also cause:

  • Metabolic alkalosis

  • Respiratory alkalosis

  • Metabolic acidosis

  • Hypercalcemia

Correct answer: Metabolic alkalosis

Continuous suctioning of a gastric tube, for lavage, can cause metabolic alkalosis. This can occur because of the removal of hydrochloric acid. Other complications are hypokalemia, gastric lining irritation, and hypoxia. 

Respiratory alkalosis will not occur, as this is primarily caused by hyperventilation. Metabolic acidosis and hypercalcemia are not adverse effects of gastric lavage. 

106.

Which of the following is not part of ethical decision-making in transport?

  • Competition

  • Patient autonomy

  • Justice

  • Veracity

Correct answer: Competition

Factors that may influence the transport decision but are not a part of an ethical decision-making process are local competition, experience level, and concern about employment. Many decisions need to be made with ethical consideration in patient transport. Who to transport and how, when not to transport, when to discontinue resuscitative efforts, and requests to transport positions under unsafe conditions are just a few situations where ethics will come into play. 

Several values may be used to make ethical decisions regarding patient transport:

  • Patient autonomy is the patient's right to make decisions about their own healthcare. This includes Do No Resuscitate orders and verbal requests by the patient. 
  • Justice is the idea that the patient and community served must be treated with fairness at all times. 
  • Veracity is honest, truthful communication with the patient. 
  • Beneficence versus malfeasance is ensuring that the benefit of transport outweighs the risks.

107.

You are first on the scene of a passenger bus crash with multiple patients. Your agency utilizes SALT Triage for multi-casualty accidents. You have completed global sorting and are now assessing an 8-year-old female who is not breathing. 

What should you do?

  • Provide 2 rescue breaths then recheck breathing

  • Intubate the patient and prepare her for transport

  • Place a black tag, as the patient is decreased

  • Check for a carotid pulse no longer than 10 seconds

Correct answer: Provide 2 rescue breaths then recheck breathing.

SALT Triage is a worldwide, standardized method of disaster triage. The first step is Global Sorting, which groups the patients into Walking, Waves/Purposeful Movement, and Obvious Life Threats. If a pediatric patient is not breathing, the next step is to provide two rescue breaths and then recheck breathing. If an adult patient is not breathing, they are tagged black (decreased) and remain where they are. 

Intubation is not indicated because that would tie up resources. 

There is no need to check for a carotid pulse because if the patient is not breathing after two rescue breaths, then the patient is marked black for decreased. 

108.

You are preparing to complete an inter-facility transfer of a 72-year-old male cardiac patient. According to EMTALA, which of the following must be transferred with the patient from the sending facility to the receiving facility?

  • Patient assessment findings

  • A printed copy of the medical chart

  • The patient's belongings

  • Payment agreement statement

Correct answer: Patient assessment findings

The Emergency Medical Treatment and Active Labor Act (EMTALA) was passed by Congress in 1986. The federal law ensures patients receive emergency medical care at an Emergency Department (ED) and prevents hospitals from transferring patients regardless of insurance status or ability to pay for services. EMTALA provides transfer obligations for healthcare teams providing inter-facility transfers. Patient assessment findings are a requirement for the sending facility to send to the receiving facility. 

The patient's medical chart is required to be sent, but it does not have to be a printed copy. An electronic patient chart is acceptable. 

The patient's belongings should be sent with the patient, but it is not an EMTALA requirement. 

A payment agreement statement is not a required document under EMTALA regulations. 

109.

You are treating a 70-year-old male complaining of chest pressure and shortness of breath. Vital signs are P 182, R 28, and BP 76/54. ECG reveals a regular wide complex tachycardia. Rhythm conversion was unsuccessful with cardioversion at 100 J. You should do which of the following?

  • Increase joules and cardiovert

  • Administer adenosine 6 mg

  • defibrillate at 200 J

  • Administer amiodarone 150 mg

Correct answer: Increase joules and cardiovert

Synchronized cardioversion is the recommended treatment for unstable Wide Complex Tachycardia (WCT). The patient is unstable due to ischemic chest pain and hypotension. If the initial cardioversion does not convert the WCT, it is recommended to increase the joules and cardiovert again. 

Adenosine and amiodarone are indicated in the stable patient with regular wide complex tachycardia. 

Defibrillation is only indicated in patients without a pulse. 

110.

You are transporting a 68-year-old male suffering from esophageal varices. The patient has a history of chronic alcoholism and hypertension. Vital signs are BP 178/98, P 102, R 16, and SpO2 97%. During transport, the patient becomes confused and anxious. While re-assessing, the patient becomes lethargic and begins vomiting blood. 

Which of the following medications would be indicated in this patient?

  • Octreotide

  • Droperidol

  • Ondansteron

  • Metoclopramide

Correct answer: Octreotide

The patient is exhibiting signs of ruptured esophageal varices. Octreotide is a synthetic somatostatin used in the treatment of esophageal varices. Octreotide is a potent vasoconstrictor and decreases the inflow of blood to the portal system by constricting the splanchnic arterioles. 

Droperidol is a dopamine-blocking agent used in the treatment of nausea and vomiting. It is contraindicated in patients with long-QT syndrome. 

Ondansteron is an antiemetic used to treat nausea and vomiting and does not cause drowsiness. 

Metoclopramide is a dopamine receptor antagonist used in the treatment of nausea and GERD. 

111.

What important airway structure anchors the vocal cords in the larynx?

  • Arytenoids

  • Epiglottis

  • Cuneiform

  • Corniculate

Correct answer: Arytenoids

The most important paired cartilages of the larynx are the arytenoids. These structures anchor the vocal cords in the larynx. They are a unique pyramid shape. 

The epiglottis is a single cartilage that lies directly over the glottic opening. It is spoon-shaped and prevents anything but air from entering the trachea. 

The cuneiform are small cartilages that support the epiglottis and vocal cords. 

The corniculate sit on top of the arytenoid cartilage.

112.

A 50-year-old with a history of dilated cardiomyopathy presents with acute decompensated heart failure and cardiogenic shock unresponsive to conventional therapies, including inotropes and vasopressors. The decision is made to initiate veno-arterial extracorporeal membrane oxygenation (VA-ECMO). 

Which of the following is the most critical consideration when managing this patient on VA-ECMO?

  • Monitoring for limb ischemia and ensuring adequate perfusion

  • Using high-dose anticoagulation to prevent clot formation

  • Increasing pump flow rates to maximize oxygen delivery

  • Minimizing sedation to allow for neurological assessment

Correct answer: Monitoring for limb ischemia and ensuring adequate perfusion

Veno-arterial ECMO (VA-ECMO) is specifically used for patients with severe cardiac failure to provide both cardiac and respiratory support. Proper management of a patient on VA-ECMO involves several critical considerations to avoid complications and ensure optimal outcomes. One of the most serious complications of VA-ECMO is limb ischemia due to the cannulation of major arteries. Continuous monitoring for signs of ischemia (e.g., decreased pulses, pallor, pain, and coldness in the limb) and ensuring adequate distal perfusion are essential.

While anticoagulation is necessary to prevent clot formation in the ECMO circuit, high-dose anticoagulation increases the risk of bleeding complications. Anticoagulation should be carefully balanced and monitored using protocols and frequent blood tests. 

Excessively high flow rates can cause hemolysis and other complications. Flow rates should be optimized based on the patient's needs and monitored continuously. 

Adequate sedation and analgesia are necessary to prevent agitation, which can lead to complications. Sedation should be balanced to allow for comfort and safety.

113.

You are preparing to assist in the childbirth of your 26-year-old patient. Upon examination, you notice the patient is experiencing the turtle sign. Which of the following is most significant about this sign?

  • The fetus is experiencing shoulder dystocia

  • The fetus is presenting in a frank breech presentation

  • The mother is experiencing uterine tetany

  • The mother is experiencing abruptio placenta

Correct answer: The fetus is experiencing shoulder dystocia

Shoulder dystocia is an obstetrical emergency. You may observe the presence of the turtle sign: After the baby's head has successfully passed under the pelvis and presented on the perineum, it is retracted or sucked back into the vagina, giving an appearance similar to that of a turtle retracting its head into its shell, due to the shoulder being caught up on the pelvis. 

Frank breech presentation would present with the baby's buttocks appearing first during delivery. Abruptio placenta causes pain and bleeding with the palpation of fetal parts under the skin. Uterine tetany occurs when contractions are longer than 90 seconds and result in fetal distress.

114.

Which of the following statements regarding the management of a patient on pulmonary artery monitoring is correct?

  • Continuous monitoring of pulmonary artery pressure can help guide fluid management in critically ill patients.

  • Pulmonary artery catheterization is primarily used for the measurement of left atrial pressure.

  • The main indication for pulmonary artery catheterization is to monitor systemic blood pressure.

  • Pulmonary artery monitoring is contraindicated in patients with respiratory distress syndrome.

Correct answer: Continuous monitoring of pulmonary artery pressure can help guide fluid management in critically ill patients.

Pulmonary artery monitoring allows for direct measurement of right atrium pressure, pulmonary artery pressure, pulmonary artery wedge pressure, cardiac output, and systemic and pulmonary vascular resistance. Pulmonary artery monitoring is used to assess volume status and administer fluids. 

Pulmonary artery monitoring does not measure left atrial pressure, as it measures right atrium pressure, nor does it measure systemic blood pressure. 

Patients with respiratory distress syndrome can benefit from pulmonary artery monitoring. 

115.

All the following are elements of a malpractice case except for which one?

  • Limitation

  • Breach of duty

  • Foreseeability

  • Presence of duty

Correct answer: Limitation

Limitation is not an element of malpractice. 

The elements of malpractice are listed in order of priority: presence of duty, breach of duty, foreseeability, casusation, injury, and damages. The elements that must be proven are causation, injury, and damages. 

116.

You are treating a two-month-old infant in cardiac arrest. The infant weighs 3.64 kg. You are preparing to administer epinephrine. Calculate the correct dosage, and state the standard concentration of the epinephrine for the highest dose of epinephrine allowed for this patient.

  • 1.092 mL dose; concentration is 0.1 mg/mL

  • 0.364 mL dose; concentration is  1 mg/mL

  • 1.82 mL dose; concentration is 0.1 mg/mL

  • 3.64 mL dose; concentration is 1 mg/mL

Correct answer: 1.092 mL dose; concentration is 0.1 mg/mL

The pediatric dosage of epinephrine is a solution of 0.1 mg/mL (1 mg in 10 mL vial/syringe). Emergency epinephrine for the neonate is dosed in a range of 0.01 mg/kg to 0.03 mg/kg. The patient weighed 3.64 kg. Using the following formula, we can calculate the dosage required for this patient in milligrams. 0.03 mg x 3.64 kg = 0.1092 mg dose is needed. The calculation for the correct dose and concentration is 0.1092 mg/0.1 mg/ml = 1.092 mL.

0.364 mL dose reflects the correct dosage if you were asked to administer the lowest acceptable dosage (0.01 mg/kg) via IV route. 

1.82 mL dose reflects the correct dosage if you were asked to administer the lowest acceptable dosage (0.05 mg/kg) via ET route. 

3.64 mL dose reflects the correct dosage if you were asked to administer the highest acceptable dosage (0.1 mg/kg) via ET route.

117.

All the following are contraindications for nasotracheal intubation, except which one?

  • Fractured mandible

  • Basilar skull fracture

  • Acute epiglottitis

  • Anticoagulation therapy

Correct answer: Fractured mandible

A fractured mandible may be a contraindication in orotracheal intubation, depending on degree of fracture. It is an indication of nasotracheal intubation. 

Contraindications for nasotracheal intubation are the following:

  • Suspected basilar skull fracture
  • Acute epiglottitis
  • Anticoagulation therapy or other coagulopathies
  • Severe nasal or maxillofacial fractures
  • Upper airway foreign body, abscess, or tumor

118.

Your adult patient has a balloon tamponade tube placed for the treatment of esophageal varices. Which statement below is true about a balloon tamponade tube? 

  • Balloon tamponade tubes may be used for 24-48 hours

  • The esophageal balloon is inflated first after insertion

  • Balloon tamponade tubes may be used for up to five days

  • The balloon tamponade tubes have either four or five lumens

Correct answer: Balloon tamponade tubes may be used for 24-48 hours

Balloon tamponade tubes are indicated in the treatment of esophageal varices when medication treatments have failed. The two most common types of tubes are the Sengstaken-Blakemore tube and the Minnesota tube. Balloon tamponade tubes may only be used up to 24-48 hours. 

Immediately following the insertion of the balloon tamponade tube, the gastric balloon is inflated first and then the esophageal balloon. Balloon tamponade tubes have either three or four lumens. 

119.

You are treating a 37-year-old female who took an unknown amount of Tylenol. The patient refuses to disclose how long ago she took the Tylenol. The patient is experiencing right upper quadrant pain, which is related to liver enlargement. 

What stage of acute acetaminophen poisoning is the patient experiencing?

  • Second stage

  • First state

  • Third stage

  • Fourth stage

Correct answer: Second stage

The clinical course of acute acetaminophen occurs in four stages. The patient is currently in the second stage. The second stage occurs 24-72 hours after ingestion. The patient may experience right upper quadrant pain due to liver enlargement. Liver enzymes begin to increase at 36 hours following ingestion. 

The first stage occurs within the first 24 hours. The patient experiences nausea, vomiting, malaise, pallor, and diaphoresis. 

The third stage occurs 72-96 hours following ingestion. This is the time of peak liver function abnormalities. The nausea, vomiting, and malaise return, and the patient also experiences jaundice. 

In the fourth state, patients are asymptomatic and liver function returns to normal. This commonly occurs four days to two weeks after ingestion. 

120.

Fentanyl is often used in the induction phase of rapid sequence intubation (RSI) and delayed sequence intubation (DSI). In doses greater than 5 mcg/kg and more commonly in neonates and pediatrics, what effect can Fentanyl cause that impedes ventilation?

  • Chest wall rigidity

  • Bronchospasms

  • Increase in histamine release

  • Decrease in surfactant

Correct answer: Chest wall rigidity

Although it is more associated with administration rate and higher than normal therapeutic doses, Fentanyl may cause chest wall rigidity, which can make ventilation difficult and possibly impossible. It is more common in neonatal and pediatric patients than in adult patients.

Fentanyl does not cause bronchospasm, a histamine release, or a decrease in surfactant. 

×