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Quiz Session - Attempts With Random Questions

IBSC CCP-C Exam Questions

Page 9 of 20

161.

You are treating a 69-year-old female who recently had a craniotomy performed 3 days prior. The patient presented to the ED with complaints of dehydration, extreme thirst, and an increase in urination. You should suspect:

  • Diabetes insipidus

  • Pneumonia

  • Subdural hematoma

  • Cerebrospinal fluid (CSF) leak

Correct answer: Diabetes insipidus

Diabetes insipidus can occur following head trauma or surgery. This is the result of the lack of or decrease in ADH secretion. This can cause large amounts of urination and fluid loss, which leads to a loss of electrolytes. Diabetes insipidus is treated with vasopressin. 

Pneumonia is a common complication of surgery but does not present in this manner. Pneumonia presents with fever, fatigue, and shortness of breath. 

A subdural hematoma presents with confusion, dizziness, headache, nausea, vomiting, and possible syncopal episodes. 

A CerebroSpinal Fluid (CSF) leak presents with a stiff neck, nausea, vomiting, and positional headaches. 

162.

You are caring for a patient with an arterial line. You note there is no dicrotic notch in their arterial waveform. Which of the following is this a normal finding?

  • Aortic valvular insufficiency

  • Cardiogenic shock

  • Mitral valve prolapse

  • Atrial fibrillation

Correct answer: Aortic valvular insufficiency

The dicrotic notch occurs due to closure of the aortic valve temporarily increasing aortic pressure at the end of systole. A patient with aortic valvular insufficiency will not have effective closure of the aortic valve, obscuring the dicrotic notch. 

Patients who are in cardiogenic shock, have mitral valve prolapse, or atrial fibrillation will all still have closure of the aortic valve, maintaining a dicrotic notch

163.

You are transporting a 20-year-old female who is 28 weeks pregnant and in pre-term labor. The patient is on a magnesium sulfate infusion to cease contractions. Which of the following is a sign of magnesium toxicity?

  • Loss of deep tendon reflexes

  • Red rash on the chest and abdomen

  • Severe headache

  • Bilateral hand tremors

Correct answer: Loss of deep tendon reflexes

Magnesium sulfate is a smooth muscle relaxant indicated in pre-term labor. It is also used in patients suffering from eclampsia to stop seizure activity. When magnesium levels reach toxic levels, deep tendon reflexes are absent, and respiratory depression occurs due to the diaphragm being relaxed. Deep tendon reflexes can be reduced or hypoactive while magnesium is in the therapeutic range. Hourly checks of deep tendon reflexes are necessary during the administration of magnesium to ensure toxicity is avoided and promptly treated.

A red rash, severe headache, and bilateral hand tremors are not signs of magnesium toxicity. 

164.

You are treating a 16-year-old cross-country runner who fractured his leg while running through a wooded area. You are transporting the patient from the incident site to the ambulance via UTV, which takes approximately two and a half hours. Approximately two hours into the transport, the patient states the pain has greatly increased and describes it as a very sharp pain. He states he can't feel his toes and complains of a pins and needles sensation throughout his leg. 

What should you suspect?

  • Compartment syndrome

  • Crush syndrome

  • Typical fracture pain

  • Deep vein thrombosis

Correct answer: Compartment syndrome

The patient is exhibiting typical signs and symptoms of compartment syndrome, such as pins and needles sensation, increasing pain, and losing feeling distal to the injury.  

Crush syndrome occurs with entrapment of four hours or more, but there is no mention of entrapment with this patient. 

A fracture typically has pain, but not like the increasing pain as described, and deep vein thrombosis is a blood clot in the leg that develops over time, not within two hours of a fracture. 

165.

You are treating a 64-year-old female patient who is post thrombolytic treatment for an ischemic stroke. The patient's blood pressure is 232/124 mmHg. Which of the following treatments is appropriate for this patient?

  • Labetalol 10 mg IVP over 2 mins.

  • Labetalol infusion 2-8 mg/min

  • Labetalol 20 mg IVP over 2 mins.

  • Sodium nitroprusside 0.5 mcg/kg/min

Correct answer: Labetalol 10 mg IVP over 2 mins.

Since the patient is post thrombolytic treatment, her dose of labetalol is 10 mg IVP over one to two minutes. The dose can be repeated every 10 minutes with a maximum of 300 mg. 

Following the IV bolus, the patient may receive a labetalol infusion of 2-8 mg/min. The bolus must be given prior to the infusion. 

Labetalol 20 mg IVP is indicated in a patient with a blood pressure of SBP > 200 and DBP 120-140, who is not a candidate for thrombolytic therapy. 

Sodium nitroprusside is recommended if the patient is unresponsive to the labetalol. 

166.

Extraglottic airways provide an excellent option for emergency airway management in pre-hospital care. These types of airways provide a universal feature that enables the extraglottic airway to serve as a means of indirect intubation. What is this feature?

  • A glottic opening

  • Blind insertion ability

  • Double-lumen

  • A Murphy Eye

Correct answer: A glottic opening

The universal feature of extraglottic airways is a glottic opening, which allows for a stylet or a bougie to be placed through the airway. The stylet or bougie is placed into the trachea and the extraglottic airway is removed. An EndoTracheal Tube (ETT) is now placed over the stylet or bougie for intubation. 

All extraglottic airways allow for blind insertion, but this does not serve as a means of indirect intubation. 

Most extraglottic airways are single lumen with only a few being double lumen. 

A Murphy Eye is the small opening on the side of the tip of an ETT that allows for ventilation even if the ETT is clogged at the end. 

167.

You respond to a home birth where the mother is experiencing postpartum hemorrhage. Upon assessment, you have a high suspicion the patient is experiencing uterine inversion. The mother is hemodynamically unstable. Your attempt at manual replacement was unsuccessful. What is the next appropriate management strategy?

  • Initiate rapid transport to the nearest appropriate facility

  • Administer uterotonic medications intravenously

  • Elevate the mother's legs to promote venous return

  • Lay the mother supine and transport rapidly

Correct answer: Initiate rapid transport to the nearest appropriate facility

Uterine inversion is a rare but life-threatening obstetric emergency characterized by the inversion of the uterus into the uterine cavity or through the cervix. Initiating rapid transport to the nearest appropriate facility is the most appropriate immediate management strategy for a hemodynamically unstable patient with suspected uterine inversion. Time is precious. 

Administering uterotonic medications intravenously is an appropriate initial management strategy for postpartum hemorrhage, including cases associated with uterine inversion. Uterotonic agents such as oxytocin or carboprost (prostaglandin F2-alpha) help stimulate uterine contraction and control bleeding. However, in the case of uterine inversion, other interventions to stabilize the patient may be necessary before administering uterotonic medications. 

Elevating the mother's legs to promote venous return may be beneficial in cases of hypotension or shock to improve cardiac preload and perfusion but is not the initial management of uterine inversion. 

Laying the mother supine is not recommended, as this can cause Inferior Vena Cava Syndrome. 

168.

Your patient has an epidural hematoma. You note pupillary changes. These changes are most likely due to which of the following?

  • Increased pressure against CN III

  • Increased pressure against CN XII

  • Increased pressure against CN IV

  • Increased pressure against CN IX

Correct answer: Increased pressure against CN III

Most epidural hematomas are caused by a rupture of the middle meningeal artery. Tentorial herniation causes increased pressure against CN III, the oculomotor cranial nerve. 

Increased pressure against CN XII (Hypoglossal), CN IV (Trochlear), and CN IX (Glossopharyngeal) do not cause pupillary changes.

169.

You are treating an adult male with respiratory distress due to COPD. Which form of NIPPV is most appropriate?

  • BiPap

  • CPAP

  • High-flow nasal cannula (HFNC)

  • Intubation

Correct answer: BiPAP

Non-Invasive Positive Pressure Ventilation, or NIPPV, is a form of ventilation without the use of an artificial airway. Techniques for NIPPV include Bilevel Positive Airway Pressure (BiPAP), Continuous Positive Airway Pressure (CPAP), and High-Flow Nasal Cannula (HFNC). BiPAP is most appropriate for patients with hypercarbic respiratory failure, such as those suffering from COPD or asthma exacerbation. 

CPAP provides the same pressure during both inspiration and expiration and is more suited for patients with hypoxia due to increased work of breathing. 

High-Flow Nasal Cannula (HFNC) provides humidified, oxygenated air through a nasal cannula and is most appropriate for patients with purely hypoxic respiratory failure. 

Intubation and mechanical ventilation is a form of invasive ventilation, not NIPPV.

170.

You and your partner are treating an adult female in severe respiratory distress. Your partner is the team leader, and you are concerned that he is about to administer the incorrect dose of epinephrine. You should do which of the following?

  • Call your partner by name and express your concern

  • Use a phrase such as "Maybe we should try something else"

  • Don't say a word now, but bring it up to your partner after the call

  • Tell your partner he is wrong, and demand you take over patient care

Correct answer: Call your partner by name and express your concern

Situational awareness must be maintained by all members of the healthcare team. TeamSTEPPS allows for a health team member to challenge an order or speak up when they believe an error is about to occur. Closed-loop communication is effective in expressing appreciative inquiry in stressful situations.

Using phrases such as "maybe" or "perhaps" are mitigating statements and should not be used. 

You cannot sit in silence while your partner administers the wrong medication or the wrong dosage. This will put the patient in danger. 

Telling your partner he is wrong on scene and demanding to take over can instigate a fight and make matters worse. 

171.

Your 27-year-old female patient is being transferred to a Level I burn center after being trapped in a house fire. During transport, your patient becomes anxious and short of breath. She has a respiratory rate of 32 and rapid, with cyanosis noted to the lips. Her airway is patent and auscultation reveals wheezing and stridor. Although your patient is in respiratory distress, her pulse oximetry reading is 98%. 

Why does the patient have a high SpO2 reading?

  • Increased carboxyhemoglobin level

  • Increased partial pressure of oxygen

  • Increased skin perfusion

  • Increased core temperature

Correct answer: Increased carboxyhemoglobin level

Carboxyhemoglobin is a hemoglobin derivative and a small amount is always in the vasculature system and is harmless at normal levels. Carbon monoxide poisoning causes an increase in carboxyhemoglobin, which will provide a falsely high SpO2 reading. A high SpO2 reading in a patient with carbon monoxide poisoning is not a true representation of the patient's respiratory status. 

The partial pressure of oxygen may or may not be initially affected by CO poisoning, as the partial pressure of oxygen in plasma is generally not affected at low levels of CO. CO poisoning does not require a high amount of carbon monoxide to be dangerous. 

Increased skin perfusion and increased core temperature do not affect SpO2 readings. 

172.

You are caring for a newborn baby boy who was born at 30 weeks, prematurely. The patient is grunting, cyanotic, and tachypneic. You intubated the patient due to respiratory distress syndrome. Which of the following should you administer?

  • Surfactant

  • Terbutaline

  • Epinephrine

  • Magnesium

Correct answer: Surfactant

Respiratory Distress Syndrome (RDS) is the leading cause of respiratory distress. The main cause of RDS is surfactant insufficiency. Surfactant acts in the alveoli by reducing the surface tension between the air/fluid barrier. Giving exogenous surfactant greatly improves the outcomes of neonates suffering from RDS. 

Terbutaline is given as a tocolytic and as a beta 2 agonist. Epinephrine can be given for anaphylaxis and severe asthma; however, asthma is not the cause of RDS. Magnesium is given for preeclampsia, eclampsia, and seizures in pregnancy. 

173.

A 75-year-old female with a history of congestive heart failure and atrial fibrillation presents to the ED with nausea, vomiting, confusion, and visual disturbances. Her medications include digoxin, furosemide, and enalapril. An ECG shows bradycardia with frequent Premature Ventricular Contractions (PVCs). 

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

  • Administer digoxin-specific antibody fragments (Digibind)

  • Administer intravenous calcium

  • Administer activated charcoal

  • Initiate hemodialysis

Correct answer: Administer digoxin-specific antibody fragments (Digibind)

Digitalis toxicity, commonly due to digoxin overdose, can result in a wide range of symptoms and potentially life-threatening cardiac arrhythmias. Signs and symptoms of digitalis toxicity are nausea, vomiting, abdominal pain, confusion, dizziness, visual disturbances, bradycardia, and various arrhythmias, including Premature Ventricular Contractions (PVCs), ventricular tachycardia, and AtrioVentricular (AV) block. The most effective treatment for severe digitalis toxicity is Digibind. 

Intravenous calcium is contraindicated in digitalis toxicity, as it can worsen cardiac arrhythmias. 

Activated charcoal may be useful if the ingestion was recent (within a few hours), but it is not the primary treatment in symptomatic toxicity. 

Hemodialysis is not effective for digoxin removal due to its large volume of distribution and protein binding.

174.

You are treating a 16-year-old male who was ejected during a high-speed motor vehicle crash. He is confused and complaining of difficulty breathing. You note paradoxical motion to his left anterior chest. 

What should you do first?

  • Provide oxygen via non-rebreather mask

  • Stabilize the flail segment with 5-inch tape.

  • Perform a pleural decompression to left side

  • Place a bulk dressing to left chest

Correct answer: Provide oxygen via non-rebreather mask

The patient is exhibiting signs and symptoms of a flail chest. This is caused by multiple fractures to multiple ribs. The pain is severe, which causes the paradoxical movement. The first step is to provide oxygen via non-rebreather mask. Pain medications are recommended, which will improve the patient's breathing secondary to pain relief. 

It is important not to restrict chest wall movement, which includes stabilizing the flail segment with five-inch tape and placing a bulky dressing on the left chest. 

There is no indication of a tension pneumothorax, so a pleural decompression is not recommended. 

175.

You are transporting a 57-year-old male to a higher-level of care. The patient was brought to the ED after a large, heavy piece of farm equipment fell and pinned him underneath. The patient was trapped from the waist down for several hours before FD was able to extricate the patient. 

Which of the following conditions should you be concerned the patient may have?

  • Rhabdomyolysis 

  • Traumatic asphyxia

  • Disseminated intravascular coagulopathy

  • Compartment syndrome

Correct answer: Rhabdomyolysis 

After suffering entrapment, you should be aware of the possibility of patients developing rhabdomyolysis. This condition is caused when muscle tissue is crushed and damaged, releasing myoglobin, which can cause acute renal failure. Damaged muscle cells also release potassium, leading to hyperkalemia which, at high levels, can cause fatal arrhythmias. 

Traumatic asphyxia is more common in compression of the thoracic cavity. Disseminated Intravascular Coagulopathy (DIC) is a condition in which the patient forms many micro clots, resulting in the depletion of clotting factors. Compartment syndrome is isolated to one muscle compartment. 

176.

Kussmaul respirations are directly related to diabetic ketoacidosis. What is the physiology of Kussmaul respirations?

  • Eliminating carbon dioxide to increase the body's pH

  • Eliminating carbon dioxide to decrease the body's pH

  • Retaining carbon dioxide to increase the body's pH

  • To increase oxygen carried on the red blood cells

Correct answer: Eliminating carbon dioxide to increase the body's pH

Decreasing CO2 to combine with water causes the body's production to decrease in carbonic acid. The decrease in carbonic acid will increase the body's pH. So, Kussmal respirations are the body's mechanism to decrease CO2 to increase the pH. 

Eliminating carbon dioxide or retaining carbon dioxide will not decrease the body's pH. 

Kussmaul respirations do not increase oxygen carried by the red blood cells. 

177.

Which of the following types of skull fractures are most often seen in infants?

  • Diastatic

  • Linear

  • Depressed

  • Orbital

Correct answer: Diastatic

Diastatic skull fractures occur along the same line as the skull sutures. They create a widening or a complete separation. These are most often seen in infants and other pediatrics. 

Linear skull fractures are a single fracture line. These can occur in all age types. They are associated with hematomas and soft tissue swelling. 

Depressed skull fractures occur due to direct trauma to the skull and are classified as open and closed. 

Orbital skull fractures are eye socket fractures and cause the entrapment of the inferior rectus eye muscle. 

178.

You are transporting a 58-year-old female eight hours post hepatectomy. During the transfer flight, the patient becomes lethargic and confused. Vital signs are BP 94/62, P 122, R 12, SpO2 88%, BGL 118 mg/dl. The patient's abdomen appears distended, and the patient's IAP is 23 mmHg. You should suspect:

  • Abdominal compartment syndrome

  • Septic shock

  • Abdominal aortic aneurysm

  • Hepatic failure

Correct answer: Abdominal compartment syndrome

The patient is suffering from abdominal compartment syndrome. Complications from abdominal surgery are a common cause of the syndrome. Common signs and symptoms are early signs of shock, such as altered mental status, hypoxia, decreased urinary output, and CO2 retention. Normal IAP is 0-5 mmHg, and with abdominal compartment syndrome, the IAP can exceed 20 mmHg. 

Septic shock can occur after surgery, but the patient is not exhibiting signs and symptoms of septic shock. The patient is only slightly hypotensive and no mention of fever. Also, this was a sudden onset, and septic shock happens over a longer period of time. 

An abdominal aortic aneurysm presents with severe, tearing abdominal pain radiating to the back, hypotension, and tachycardia. This patient is not complaining of abdominal pain. 

Hepatic failure is not a sudden onset and does not present in this manner. 

179.

You are on the scene of a mass casualty accident at a pesticide factory. Multiple patients are presenting with confusion, excessive sweating, tearing of the eyes, breathing difficulty, nausea, and vomiting. What should you administer?

  • Pralidoxime

  • Sodium bicarbonate

  • Epinephrine

  • Diphenhydramine

Correct answer: Pralidoxime

The patients are exhibiting signs and symptoms of organophosphate poisoning. The patients are experiencing widespread cholinergic effects. The treatment of choice is an anticholinergic. Pralidoxime, also known as 2-Pam, is an antidote auto-injector for organophosphate poisoning and nerve agent poisoning. Atropine is also used in the treatment of anticholinergic poisoning. 

Sodium bicarbonate is not indicated for these patients. It is the antidote for TCA overdose. 

Epinephrine is not indicated, as it is useful in anaphylaxis, status asthmaticus, and cardiac arrest. 

Diphenhydramine is an antihistamine used in the treatment of allergic reactions, anaphylaxis, and dystonic reactions. 

180.

Your 68-year-old male patient complains of shortness of breath. He advises he's had a cold for the past week and is coughing up green phlegm.  Auscultation reveals rhonchi in his left lower chest. Vital signs are P 108, R 14, BP 132/72, and SpO2 is 96%. What should you suspect?

  • Pseudomonas aeruginosa

  • Pleural effusion

  • COPD exacerbation

  • Staphylococcus aureus

Correct answer: Pseudomonas aeruginosa

The patient is exhibiting signs and symptoms of Pseudomonas aeruginosa. It is the second most common nosocomial. Common signs and symptoms are dyspnea, chest pain, fever, fatigue, green sputum, productive cough, and rhonchi. 

A pleural effusion presents with sudden, sharp chest pains and a non-productive cough. COPD exacerbation does not cause a productive cough. Staphylococcus aureus occurs from aspiration during a upper respiratory infection and presents with fever, chills, dyspnea, and a cough with yellow sputum. 

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