×

Quiz Session - Attempts With Random Questions

IBSC CCP-C Exam Questions

Page 8 of 20

141.

Evidence-based medicine involves the categorization of clinical practices according to the strength of the evidence. Levels of evidence are referred to as the hierarchy of evidence. 

Which level has well-designed case-control and cohort studies and single correlational/observational studies?

  • Level IV

  • Level I

  • Level VII

  • Level V

Correct answer: Level IV

Level IV is the systematic reviews of descriptive and qualitative studies

Levels of Evidence include the following:

  1. Level I: The strongest systematic reviews, meta-analyses of RCTs, and evidence-based clinical practice guidelines based on systematic reviews of RCTs.
  2. Level II: Well-designed RCTs and single nonrandomized trials.
  3. Level III: Noncontrolled trials without randomization and systematic reviews of correlational/observational studies.
  4. Level IV: Systematic reviews of descriptive and qualitative studies.
  5.  Level V: Systematic reviews of descriptive and qualitative studies. 
  6. Level VI: Single descriptive or qualitative studies.
  7. Level VII: Opinions of authorities or reports of expert committees. 

142.

You have just administered the combination of sedative and paralytic medications to your 38-year-old female patient and are preparing to place your laryngoscope blade. You have asked your partner to provide cricothyroid pressure. Approximately how many pounds of pressure are recommended to bring the vocal cords within sight? 

  • 10 pounds of pressure

  • 5 pounds of pressure

  • 8 pounds of pressure

  • 2 pounds of pressure

Correct answer: 10 pounds of pressure

Cricothyroid pressure is an effective method to facilitate successful intubation. You should direct your partner to provide approximately 10 pounds of pressure straight downward. The next step is the BURP technique. This technique is used to facilitate a central view of the vocal cords. Your assistant should apply Backward, Upward, and the Right Pressure on the cricothyroid membrane. 

The other anwer options are incorrect.

143.

Your adult patient presents to the ED with hypoglycemia. IV attempts are unsuccessful, which means you are unable to administer dextrose. You administer glucagon 1 mg IM to treat the hypoglycemia. How does glucagon reverse the hypoglycemia? 

  • Signals the liver to release its stores of glycogen

  • Causes an increase of glucose in the bloodstream

  • Signals the pancreas to release glucose

  • Converts angiotensin I to angiotensin II

Correct answer: Signals the liver to release its stores of glycogen

Glucagon is a synthetic hormone. It can mirror the sympathetic nervous system by signaling the liver to release its glycogen stores. This causes the reversal of hypoglycemia. 

Glucagon is unable to release more glucose into the bloodstream. Glucagon does not communicate with the pancreas. Glucagon does not covert angiotensin, as that is the job of Renin.

144.

You are assessing a 23-year-old female found unconscious in her car by her friends. Her friends state that the patient is pregnant, but they are unsure of how far along she is. During your physical assessment, you palpate her fundus at the level of her xiphoid process. Which trimester do you suspect the patient is? 

  • Third trimester

  • First trimester

  • Second trimester

  • Not pregnant

Correct answer: Third trimester

Palpating the fundus of a uterus can be a good indication of the trimester the patient is in. Fundal height can be the first indication of growth problems with the fetus. The fundus is palpable beginning at 20 weeks. A fundus palpated at the xiphoid process would indicate the third trimester. 

A fundus at the level of the umbilicus would indicate the second trimester. In the first trimester, fundal height is at the pubic bone. 

145.

Transport ventilators are classified as automatic resuscitators and sophisticated ventilators. What is the most common mode of ventilation used on transport ventilators? 

  • Volume-controlled pressure-variable ventilation

  • Continuous mandatory ventilation

  • Pressure-regulated volume-controlled ventilation

  • Synchronized intermittent mandatory ventilation

Correct answer: Volume-controlled pressure-variable ventilation

The most common mode of ventilation used on transport ventilators is volume-controlled pressure-variable ventilation. The tidal volume and minute volumes are preset and require the clinician to set the inspiratory flow, flow time, and inspiratory time. They are volume-targeted, pressure-limited, and time-cycled. 

Continuous mandatory ventilation has a preset tidal volume and preset ventilatory rate. This mode of ventilation ignores the spontaneous respirations of the patient, and there is no possibility of patient triggering. 

Pressure-regulated volume-controlled ventilation allows the operator to set the tidal volume and high-pressure limit. The ventilator will then adjust the inspiratory flow wave to deliver the set tidal volume within the set parameter. 

Synchronized intermittent mandatory ventilation provides a set rate and a set tidal volume. 

146.

Your adult patient dove head first into a shallow pool. Which type of spinal cord injury is this patient most likely to experience?

  • Vertical compression

  • Rotation flexion

  • Flexion extension

  • Extension flexion

Correct answer: Vertical compression

Vertical compression injuries are caused by forces transmitted through vertebral bodies inferiorly through the skull or superiorly through the feet. Vertical compression injuries are seen in patients injured from diving head first into a shallow pool. They are also caused by an individual jumping from a great height and landing on both feet. The force generated throughout can cause a burst fracture of the vertebral bodies. 

Rotation-flexion injuries are caused by the twisting and flexing of the spinal column. Flexion-extension injuries result from rapid deceleration. Extension-flexion is a fabricated term. 

147.

You are treating a 23-year-old female complaining of blurriness, dizziness, a racing heart, and palpitations. The patient states she took a large handful of amitriptyline approximately one hour ago. Vital signs are BP 98/64, P 89, R 16, and SpO2 97%. You should:

  • Administer sodium bicarbonate

  • Administer diphenhydramine

  • Administer dopamine infusion

  • Administer glucagon

Correct answer: Administer sodium bicarbonate

TriCyclic Antidepressants (TCAs), and other sodium-channel blocker medications, are responsible for phase 0 of the cardiac action potential. The patient is exhibiting signs and symptoms of a TCA overdose. The medication of choice for TCA toxicity is sodium bicarbonate. 

Diphenhydramine is used in allergic reactions and is not indicated for TCA toxicity. 

A dopamine infusion may be indicated in the event the patient's blood pressure drops any lower, but it is not indicated at this time. 

Glucagon is the antidote for beta blocker and calcium channel blocker overdose. 

148.

A patient experiences life-threatening bradycardia and undergoes a subsequent heart transplant. Which of the following medications is the best to treat this patient's slow heart rate?

  • Isoproterenol

  • Adenosine

  • Dopamine

  • Epinephrine

Correct answer: Isoproterenol

Isoproterenol is a potent pure beta-receptor agonist. It has potent inotropic, chronotropic, and vasodilatory properties, increasing heart rate and contractility and causing vasodilation in mesenteric, renal, and skeletal muscle tissue beds. Its use is typically reserved for temporizing life-threatening bradycardia, as significant tachycardia almost always accompanies it. 

Adenosine depresses sinus node automaticity and atrioventricular nodal conduction. It is indicated for the acute termination of atrioventricular nodal and reentrant tachycardia, and for SVTs, including Wolff-Parkinson-White (WPW) syndrome. Adenosine slows the heart rate down rather than speeding it up. 

Dopamine and epinephrine can be used to treat symptomatic bradycardia. However, in this example, the patient undergoes a heart transplant; therefore, the patient will require treatment with isoproterenol.

149.

Which of the following gas laws demonstrates how increasing altitude causes a proportional decrease in the partial pressure of the gas without altering the percentage concentration of the gas? 

  • Dalton's Law

  • Charles' Law

  • Fick's Law

  • Henry's Law

Correct answer: Dalton's Law

Dalton's Law states that each individual gas present in a mixture exerts a partial pressure that when summed equals the total pressure of the gas. Dalton's Law is expressed as:

P = P1 + P2 + P3 .....Pn

As altitude increases, the partial pressure decreases, which explains why supplemental oxygen is required at higher altitudes.

Charles' Law states when pressure is constant, the volume of a gas is very nearly proportional to its absolute temperature. It describes how aircraft is affected by atmospheric temperatures. 

Fick's Law is a law of diffusion. Fick's Law concludes that the diffusion of a gas is proportional to the difference in partial pressure and a membrane's surface area. 

Henry's Law states the quantity of gas dissolved in a liquid is proportional to the partial pressure of the gas in contact with the liquid. 

150.

You are transporting a 62-year-old male patient with a history of chronic obstructive pulmonary disease (COPD). The patient presents with increased shortness of breath and wheezing. An arterial blood gas (ABG) analysis is performed, revealing the following results: pH 7.32, PaCO2 50 mmHg, HCO3- 24 mEq/L, PaO2 60 mmHg.

Based on these findings, how should the patient's acid-base status be interpreted?

  • Respiratory acidosis with no significant metabolic compensation

  • Metabolic alkalosis with partial respiratory compensation

  • Respiratory alkalosis with no significant metabolic compensation

  • Metabolic acidosis with partial respiratory compensation

Correct answer: Respiratory acidosis with no significant metabolic compensation

The patient's arterial blood gas (ABG) results show a pH of 7.32, which is below the normal range (7.35-7.45), indicating acidemia. The PaCO2 level is elevated at 50 mmHg (normal range: 35-45 mmHg), pointing to respiratory acidosis due to CO2 retention, a common issue in patients with chronic obstructive pulmonary disease (COPD). The bicarbonate (HCO3-) level is within the normal range (22-26 mEq/L), suggesting that there is no significant metabolic compensation for the respiratory acidosis. The PaO2 level is 60 mmHg, which is below the normal range (75-100 mmHg), indicating hypoxemia, a common finding in COPD exacerbations.

Respiratory alkalosis is incorrect because the elevated PaCO2 indicates acidosis, not alkalosis. Metabolic alkalosis with partial respiratory compensation is incorrect because the primary issue is respiratory, not metabolic. Metabolic acidosis with partial respiratory compensation is also incorrect, as the acidosis is due to elevated CO2, not a primary metabolic disturbance.

151.

You have just delivered a full-term infant. The patient is having respiratory difficulty but is relieved with crying. You should suspect which of the following?

  • Choanal atresia

  • Pierre Robin syndrome

  • Omega-shaped epiglottis

  • Laryngomalacia

Correct answer: Choanal atresia

Choanal atresia is one of the most common congenital upper airway anomalies that may be encountered in pediatric airway compromise. In choanal atresia, there is stenosis of the posterior nostrils, which may cause full or partial obstruction of breathing. If not corrected shortly after birth, these children will require emergency placement of an oral airway to maintain their airway. Cases of bilateral choanal atresia are typically discovered at birth when the neonate rapidly develops respiratory distress due to the inability to breathe.

An omega-shaped epiglottis is seen in laryngomalacia and may cause inspiratory stridor. Pierre Robin is a group of developmental abnormalities that can lead to airway obstruction, including a small chin and posterior positioning of the tongue. While all these may be seen in neonates, choanal atresia is the most commonly found.

152.

You are dispatched to transport a ventilated ARDS patient from the local hospital to a higher level of care. During the nurse's hand-off report, you are provided with the newest set of arterial blood gases for the patient. You note the patient's pH is low at 7.14. Current ventilator settings are SIMV, Vt 400 mL, rate 20, PEEP 10, and FiO2 0.7. 

What would be an appropriate step for the management of this patient?

  • Increase respiratory rate to 32

  • Increase tidal volume in 2 ml/kg increments

  • Decrease respiratory rate to 16

  • Increase PEEP to 12

Correct answer: Increase respiratory rate to 32

Patients with ARDS require low tidal volumes paired with high levels of PEEP and FiO2 to stay properly oxygenated. Arterial blood gases will be the most accurate tool used when adjusting ventilator settings. An ARDS patient should have a target pH of 7.30-7.45, during mechanical ventilation. A patient with a pH under 7.15 requires an increase in ventilatory rate to a maximum of 35. If the pH remains under 7.15, tidal volume should be increased step-wise in 1 ml/kg increments. Sodium bicarbonate may also be considered. 

Decreasing the respiratory rate would have the opposite necessary effect on the patient, and increasing PEEP would improve oxygenation but not pH.

153.

When examining the effects of hypoxia, within air transport, there are four stages of hypoxia that are divided by altitude. The compensatory stage, which is the second stage, occurs at which atmospheric height? 

  • 10,000 - 15,000 feet

  • 3,000 - 8,000 feet

  • 15,000 - 20,000 feet

  • 5,000 - 10,000 feet

Correct answer: 10,000 - 15,000 feet

The four stages of hypoxia are divided by altitude. 10,000 - 15,000 feet is the second stage.

The stages are as follows:

  1. The first stage, also known as the indifferent stage, is sea level to 10,000 feet. 
  2. The second stage, the compensatory stage, extends from 10,000 to 15,000 feet. 
  3. The third stage, known as the disturbance stage, measures 15,000 to 20,000 feet.
  4. The fourth stage, the critical stage, extends from 20,000 to 30,000 feet. 

154.

A 19-year-old male has been shot in the back just below C-5. He presents to the ED alert and conscious and states he is unable to move his right side. On examination, you note that he can move his left side, but he is unable to feel sensation on his left side. What should you suspect?

  • Brown-Sequard syndrome

  • Anterior cord syndrome

  • Central cord syndrome

  • Complete cord transection

Correct answer: Brown-Sequard syndrome

Brown-Sequard syndrome is commonly caused by penetrating trauma. The syndrome involves loss of motor function on the ipsilateral side of the injury with sensory impairment to the contralateral side of the injury. 

An anterior cord syndrome involves paraplegia below the level of the injury with loss of pain and temperature sensation. 

Central cord syndrome involves motor impairment with some sensory impairment but is typically worse in the upper extremities than the lower extremities. 

Complete cord transection is a complete loss of sensation and motor function below the level of the injury. 

155.

Which of the following cranial nerves is responsible for lateral eye movement?

  • VI - Abducens

  • XI - Accessory

  • III - Oculomotor

  • V - Trigeminal

Correct answer: VI - Abducens

Cranial nerves are between the midbrain and the pons. Cranial nerves provide essential information on pressure changes within the cranium and its effects on the brainstem. Cranial nerve IV - Abducens is a motor nerve with no sensory properties. It controls the lateral movement of the eye.

The XI - Accessory nerve is responsible for the movement of the head and shoulders. 

III - Oculomotor nerve is responsible for innervation to the pupil and lens, the upper eyelid, and visual tracking of the eye muscles. 

The V- Trigeminal is the largest of all cranial nerves and is the motor to the mastication muscles. 

156.

Your 36-year-old female patient was found by family lying unconscious on the living room floor when they arrived home from shopping. You arrive to find the patient supine, responsive to painful stimuli, and shallow breathing. You note an empty bottle of Chlordiazepoxide next to the patient. 

What should you administer as the antidote?

  • Flumazenil

  • Naloxone

  • Glucagon

  • Atropine

Correct answer: Flumazenil

Chlordiazepoxide is a benzodiazepine used to treat mild depression and anxiety. The patient is exhibiting symptoms of a possible benzodiazepine overdose. Flumazenil is the medication of choice for benzodiazepine overdose. The initial dosage is 0.2 mg IV.

Naloxone is the antidote for narcotics. Glucagon is the antidote for beta blockers, and atropine is the antidote for cholinergics. 

157.

A 65-year-old female with a history of CHF presents to the ED with increasing shortness of breath and pleuritic chest pain over the past week. On physical examination, decreased breath sounds and dullness to percussion are noted on the right lower lung field. A chest X-ray confirms a large right-sided pleural effusion. 

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

  • Perform an urgent thoracentesis

  • Administer diuretics and observe

  • Administer antibiotics and observe

  • Initiate mechanical ventilation

Correct answer: Perform an urgent thoracentesis

Pleural effusion, particularly when large and symptomatic, often requires prompt intervention to relieve symptoms and obtain a diagnosis. The choice of initial management depends on the patient's clinical presentation, the size of the effusion, and the underlying cause. A thoracentesis relieves symptoms by removing the accumulated fluid and allows analysis to determine the cause of the effusion (transudative versus exudative).

While diuretics are important in managing underlying CHF, they do not provide immediate relief from a large symptomatic effusion. 

Antibiotics are appropriate if there is evidence of infection, but this is not the first step without clear signs of infection. 

Mechanical ventilation is reserved for patients with severe respiratory failure, but this is not the first-line treatment for pleural effusion.

158.

You are treating a 58-year-old male who was the victim of an assault with a baseball bat. The patient has a large hematoma on his left forehead and large bruising noted on his right anterior chest. The patient is anxious and non-compliant with hospital staff. Vital signs are BP 138/74, P 119, R 22, and SpO2 97%. You are infusing a fluid bolus of Lactated Ringers. 

What class of hypovolemic shock is the patient exhibiting? 

  • Class II

  • Class III

  • Class I

  • Class IV

Correct answer: Class II

The patient is exhibiting Class II of hypovolemic shock.

There are four classes of hypovolemic shock. 

  • Class I: Blood loss < 750 mL, pulse rate < 100, normal BP, R 14-20, urine output > 30 mL/hr, and normal mental state. Recommended fluid is Lactated Ringers.
  • Class II: Blood loss 750-1000 mL, pulse > 100, normal BP, R 20-30, urine output 20-30 mL/hr, and anxiety. Recommended fluid is Lactated Ringers.
  • Class III: Blood loss 1500-2000 mL, pulse > 120, decreased BP, R 30-40, urine output 5-15 mL/hr, and confusion. Recommended fluid is Lactated Ringers and blood.
  • Class IV: Blood loss > 2000 mL, pulse rate > 140, decreased BP, R > 35, urine output negligible, and lethargy. Recommended fluid is Lactated Ringers and blood.

159.

You are treating an adult female patient for severe abdominal pain. The patient's lab results are the following:

  • Ammonia - 61 mcg/dl
  • Hemoglobin - 7 g/dl
  • Hematocrit - 33%
  • Lactate - 245 units/L
  • PTT - 53 sec.
  • PT - 18.2 sec
  • Gamma - 32 units/L

What should you suspect?

  • Liver disease

  • Heart failure

  • Renal failure

  • Pancreatitis

Correct answer: Liver disease

Liver disease is indicated by increased ammonia, decreased hemoglobin, increased lactate, increased PTT and PT, and increased gamma. These lab tests are typical for patients with gastrointestinal complications.

Heart failure is not measured specifically by these lab tests. The blood test ordered for heart failure patients is a BNP. 

Renal failure would cause a decrease in hemoglobin and an increase in lactate but would also require a serum creatinine blood test, urea, and BUN. 

Pancreatitis can cause increased lactate, but the primary blood test to evaluate pancreatitis is a serum lipase test. 

160.

You are treating a 60-year-old male patient who presents with chest pain, hypotension, and altered mental status. The patient has a history of myocardial infarction and is currently experiencing cardiogenic shock. Upon arrival, you obtain the following laboratory values:

  • Arterial Blood Gas (ABG): pH 7.28, PaO2 70 mmHg, PaCO2 30 mmHg, HCO3 18 mEq/L
  • Complete Blood Count (CBC): HGB 9 g/dL, HCT 27%, WBC 10,000/mm3
  • Basic Metabolic Panel (BMP): Sodium 135 mEq/L, Potassium 5.5 mEq/L, Chloride 98 mEq/L, BUN 30 mg/dL, Creatinine 2.0 mg/dL, Glucose 200 mg/dL
  • Cardiac Enzymes: Elevated troponin levels

Based on these lab values and clinical presentation, which of the following interventions should be prioritized in the care plan for this patient?

  • Administer intra-aortic balloon pump (IABP) counterpulsation therapy to augment cardiac output

  • Administer intravenous fluids to improve preload and cardiac output

  • Initiate mechanical ventilation to correct hypoxemia and respiratory acidosis

  • Initiate vasopressor therapy to decrease systemic vascular resistance

Correct answer: Administer intra-aortic balloon pump (IABP) counterpulsation therapy to augment cardiac output

The patient's lab values and clinical presentation are consistent with cardiogenic shock, characterized by hypotension, hypoxemia, metabolic acidosis, and evidence of end-organ dysfunction. Elevated troponin levels suggest ongoing myocardial damage. In cardiogenic shock, the primary goal is to improve cardiac output and tissue perfusion. Intra-Aortic Balloon Pump (IABP) counterpulsation therapy is a mechanical support device used to augment cardiac output and improve coronary perfusion. 

IV fluid boluses tend to increase preload, and the goal is to decrease preload. Cardiogenic shock increases preload, which places a strain on ischemic cardiac muscle. 

Intubation and mechanical ventilation are not indicated in this patient and will not address the critical issue of cardiogenic shock. 

Systemic vascular resistance is increased with cardiogenic shock. Vasopressors increase systemic vascular resistance. 

×