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Quiz Session - Attempts With Random Questions

NREMT Paramedic 1.4.12 Exam Questions

Page 10 of 60

181.

Using Simple Triage and Rapid Transport (START) triage criteria, which of the following patients would be categorized as immediate or red?

Select the 2 answer options which are correct.

  • Patient is confused and lethargic with RR 20 and cap refill of <2 seconds 

  • Patient follows commands and has a minor laceration to forehead with RR of 36 and cap refill of 3 seconds

  • Patient is unresponsive, apneic, and has no pulse 

  • Patient follows commands and has deformity to left arm with RR of 26 and cap refill of <2 seconds

The first component of START triage is to gather patients who can walk to a collection area on their own. They are categorized as minor (green). Those who are unable to walk but have normal respirations (breathing between 10 and 30 breaths per minute) and show no signs of circulatory compromise (capillary refill <2 seconds or pulse <100) and can follow simple commands are categorized as delayed (yellow). 

If any patient falls outside these parameters, they are tagged immediate (red). Patients who have no pulse, are not breathing, and are unresponsive are tagged unsalvageable/deceased (black).

182.

You suspect an unconscious adult patient may be intoxicated or a chronic alcoholic. They are found to have a blood glucose level of 60 milligrams per deciliter. Which of the following interventions would be indicated first?

  • Thiamine

  • Dextrose 50 (D50)

  • Narcan

  • Glucagon

Correct answer: Thiamine

Thiamine should be administered before Dextrose 50 (D50) percent in unconscious patients of unknown origin suspected of consuming alcohol or thought to be chronic alcoholics. Thiamine should be administered first to prevent the glucose (D50) from preventing the vitamin B from entering the cells. Thiamine may help with neurological syndromes that are alcohol-related.

D50 is the second medication administered if hypoglycemia is present. Narcan is the medication of choice for patients who have consumed narcotics or unconscious patients who are believed to be on narcotics. If alcohol abuse is suspected and hypoglycemia is present, Narcan should be administered after thiamine and D50. 

Glucagon would be administered if IV access was not available for the administration of D50.

183.

Which of the following are SSRI medications? 

Select the three correct answer options.

  • Fluoxetine (Prozac)

  • Paroxetine (Paxil)

  • Sertraline (Zoloft) 

  • Amitriptyline (Elavil)

Selective serotonin reuptake inhibitors (SSRI) are widely prescribed for depression-related conditions. The most common SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and citalopram (Celexa).

Amitriptyline (Elavil) is a tricyclic antidepressant, not an SSRI. 

184.

Which of the following would be considered a major burn?

  • Partial-thickness burn that involves the full circumference of an appendage or body part

  • Full-thickness burns that are less than 10 percent of the total body surface area in adults

  • Partial-thickness burns less than 25 percent of the total body surface area in an adult

  • Partial-thickness burns that are less than 20 percent of the total body surface area in children

Correct answer: Partial-thickness burn that involves the full circumference of an appendage or body part 

A major burn is any partial-thickness burn that involves the full circumference of an appendage or body part. This is because of compartment syndrome and the dangers associated with the condition. 

Full-thickness burns less than 10 percent of the total body surface area are considered moderate burns and do not require the immediate attention of a major burn. 

Partial-thickness burns less than 25 percent of the total body surface area in an adult are considered moderate, while partial-thickness burns greater than 25 percent of the total body surface area in an adult are considered major burns. 

Partial-thickness burns less than 20 percent of the total body surface area in children are considered moderate burns, while partial-thickness burns greater than 20 percent of the total body surface area in children are considered major burns. 

185.

What is the most crucial criterion to identify rhythms started by the sinus node?

  • Matching upright P waves in lead II

  • Matching inverted P waves in lead I

  • Matching QRS complexes in lead II

  • Matching T waves in V1

Correct answer: Matching upright P waves in lead II

Because P waves originate in the sinus node, upright, matching P waves are crucial to identifying sinus rhythm. You look at lead II to examine to P waves. 

186.

Post-Scene 

You are transporting the patient in the given scenario. Your interventions so far include oxygen via an NRB mask, ECG monitoring, 2 large-bore IVs, normal saline fluid bolus, and spinal motion restriction. The patient is supine on the EMS stretcher. Which of the following interventions was most likely requested during transport to the landing zone?

  • Place a nasogastric tube to decompress the stomach

  • Place the patient in a High Fowler's position

  • Obtain intraosseous (IO) access

  • Perform intubation

Correct answer: Place a nasogastric tube to decompress the stomach

This patient is exhibiting signs and symptoms of diaphragmatic rupture. This is a rare condition that can occur with blunt or penetrating trauma. EMS management of diaphragmatic rupture includes:

  • Provide supplemental oxygen to maintain oxygen saturation
  • Ventilatory support as needed (positive pressure may worsen the injury)
  • Volume-expanding IV fluids
  • Transport supine to a facility capable of surgical intervention
  • Decompression of the stomach 
  • Close hemodynamic monitoring 
  • Manage pain with appropriate analgesics while avoiding agents that may depress respiratory drive

Decompression of the stomach may ease pressure on the abdominal organs and improve his condition. This patient should remain supine. IV access has been obtained, so IO access is not indicated. The patient is maintaining his own airway and breathing, so there is no indication intubation is needed at this point.

187.

Your 50-year-old patient is confused and unable to tell you much about their extensive cardiac history but hands you a list of their medications. Which of the following medications is prescribed to control hypertension?

  • Lisinopril

  • Zocor

  • Nitroglycerin

  • Ipratropium

Correct answer: Lisinopril

Lisinopril is used alone or with other medicines to treat high blood pressure. Lowering blood pressure reduces the risk of stroke and heart attack.

Zocor lowers high cholesterol and triglyceride levels and may reduce the risk of heart attack, stroke, and blood vessel problems. However, it does not directly affect blood pressure.

Nitroglycerin is a powerful vasodilator prescribed for chest pain. It does decrease blood pressure during chest pain but is not often prescribed for hypertension alone.

Ipratropium is an anticholinergic useful for patients with congestion or breathing problems. It is not a medication used to treat hypertension.

188.

Post-Scene

Based on the information given in this scenario, which of the following would be important items to include in the radio report to the hospital?

Select the 3 answer options which are correct.

  • History of the present illness

  • You have started IV fluid bolus

  • Patient's 12 lead ECG results

  • Patient's allergies

  • The patient's name

Patient information is usually reported to the hospital by radio or telephone. Although the order of information delivery may vary by EMS system and the patient-specific scenario, the radio report should be brief and concise and contain the following information:

  • unit personnel identification
  • description of the incident or history of present illness
  • patient's age, sex, and approximate weight
  • chief complaint and associated symptoms
  • level of consciousness / GCS
  • diagnostics and vital signs, ECG results
  • any pertinent information and observations
  • estimated time of arrival
  • request for orders or further questions

Allergies are not important information to include in patient radio report unless they are specific to the present illness (such as in an allergic reaction). Do not give out patient identifying information such as name over the radio unless it is encrypted and secure.

189.

Which of the following is not a criterion for an arrhythmia?

  • Narrow QRS complexes

  • Abnormally long PR intervals

  • Abnormally short PR intervals

  • Irregular rhythm with pauses or premature beats

Correct answer: Narrow QRS complexes 

Signs of irregular rhythms include rhythms with pauses, premature beats, abnormally short or long PR intervals, inconsistent PR intervals, and wide (not narrow) QRS complexes.

190.

Which of the following statements is true regarding sinus bradycardia?

  • It is a slower than normal sinus rhythm

  • It is an irregular rhythm

  • It has consistent PR intervals between 0.2-0.24 seconds

  • It has irregular P waves

Correct answer: It is slower than normal sinus rhythm

A bradycardic rhythm is still a sinus rhythm, containing regular and consistent P waves, and PR intervals between 0.12-0.2 seconds. The difference is the rate of 60 or fewer beats per minute.

191.

Which of the following oxygen delivery devices and the concentration of oxygen provided by that device are listed accurately?

Select the 3 answer options which are correct.

  • Nasal cannula 24%–44% 

  • Non-rebreather 80%–90% 

  • Bag valve with oxygen reservoir 90%–100%

  • Venturi mask 100% 

Oxygen concentrations may vary based on the flow rate selected. The higher the flow rate, the greater the O2 concentration delivered. Generally, a nasal cannula delivers 24-44% O2. A non-rebreather delivers up to 90% O2. A bag valve mask with oxygen reservoir can deliver nearly 100% O2.

Depending on the adapter used, a venturi mask can deliver 24, 28, 35, or 40% O2. However, no adapter allows a venturi mask to deliver 100% O2.

192.

Which of the following correctly identifies the appropriate target oxygen saturation levels during specific conditions, as recommended by the AHA?

Select the 2 answer options which are correct.

  • Stroke: 95% to 98%

  • ACS: 90% to 94%

  • ACS: 100% 

  • Post–cardiac arrest care: 100%

Adjust the oxygen administration to achieve an oxygen saturation in the following ranges:

  • ACS: 90% to 94%
  • Stroke: 95% to 98%
  • Post–cardiac arrest care: 92% to 98%

193.

You are intubating a 26-year-old who is apneic. Once the endotracheal tube passes through the vocal cords, how much farther should the endotracheal tube be advanced before inflating the cuff and confirming proper placement?

  • 1-2.5 cm (0.5 to 1 inch)

  • 2.5-6.4 cm (1 to 2.5 inches)

  • 3 cm

  • Less than 1 cm

Correct answer: 1-2.5 cm (0.5 to 1 inch)

After viewing the tip of the endotracheal tube passing through the vocal cords, the tube itself should be carefully advanced another 1 to 2.5 cm or 0.5 to 1 inch. This places the tip of the tube about halfway between the cords and the carina. This positioning allows for a little more movement without dislodging the tube.

1 to 1.25 inches or 2 to 3 centimeters would most likely place the tip of the tube either against the carina or in the right mainstem bronchus. This is evident by decreased breath sounds with difficulty ventilating or left-sided diminished breath sounds.

Advancing the tube only 1 cm past the cords would not be acceptable. This would place the intubation and ventilation at risk.

194.

You are assessing a 22-year-old patient with difficulty breathing. She has itching, urticaria, and hives after a bee sting. During the possible allergic reaction, what is occurring at the cellular level?

  • The mast cells have degranulated, releasing serotonin and histamines into the general circulation

  • The mast cells are retaining the vasoactive amines, resulting in a localized response to the sting

  • The cells begin a hypermetabolic state associated with the patient's increased activity level after the sting

  • An anaerobic metabolism has begun at the local level and is now moving into the vasculature

Correct answer: The mast cells have degranulated, releasing serotonin and histamines into the general circulation

When the tissue is injured, as in a sting from a bee or hornet, the mast cells discharge their granules (degranulation) as part of the inflammatory response. This response results in a hypersensitivity reaction (commonly referred to as an allergic reaction).

During an allergic reaction, the mast cells are not responsible for retaining the vasoactive amines resulting in an allergic reaction. It causes a histamine/serotonin release. 

The increased activity of the sympathetic nervous system is not associated with the release of histamine and serotonin at the cellular level in response to the antigen. 

Anaerobic metabolism is not a factor in the initial stages of an allergic reaction. The cells are responding to the release of histamine and serotonin.

195.

Which of the following effectively measures the amount of carbon dioxide in a patient's exhaled air?

  • EtCO2

  • CPAP

  • PEEP

  • BiPAP

Correct answer: EtCO2

Capnography, known as EtCO2 or PetCO2, measures carbon dioxide concentrations in a patient's exhaled air. It is often used as a secondary means of endotracheal tube placement confirmation.

Continuous Positive Airway Pressure (CPAP) is an adjunct to airway support that transmits positive pressure into the lower airways of spontaneously breathing patients throughout the respiratory cycle. It does not measure carbon dioxide levels in the exhaled air. 

PEEP is Positive End-Expiratory Pressure. It is an airway support adjunct that maintains a degree of positive pressure at the end of exhalation, not throughout the respiratory cycle like with CPAP. 

BiPAP is Biphasic Positive Airway Pressure. It is an airway support adjunct that combines partial ventilatory support and continuous positive airway pressure; it allows the pressure to vary during each breath cycle.

196.

Other than establishing and maintaining an open airway and supporting ventilatory function, what should be the paramedic's priority when treating patients who have possibly been exposed to an agent such as sarin?

  • Blocking the effects of acetylcholine on the nervous system

  • Enhancing the effects of acetylcholine on the nervous system

  • Enhancing the effects of norepinephrine on the cardiovascular system

  • Blocking the effects of norepinephrine on the cardiovascular system

Correct answer: Blocking the effects of acetylcholine on the nervous system 

Pre-hospital treatment of patients suspected of contacting a nerve agent consists of quickly removing the agent from the body and supporting their vital functions. This is best accomplished by ensuring a patent airway, administering high-flow oxygen therapy or ventilatory support if needed, and blocking the effects of the nerve agents at the nervous system level. Acetylcholine release caused by the nerve agent causes parasympathetic stimulation. This, in turn, causes bradycardia, hypotension, and excessive mucus production. The best way to block the adverse effects of acetylcholine is to administer atropine and pralidoxime chloride.

Nerve agents cause an excessive release of acetylcholine. This neurotransmitter release causes overstimulation of the parasympathetic nervous system and, in turn, bradycardia, hypotension, and excessive mucus production ensue. Enhancing the effects of the neurotransmitter acetylcholine would worsen bradycardia, hypotension, and excess mucus production. 

When a patient has been possibly exposed to a nerve agent of any type, the paramedic must be concerned with ensuring adequate airway, oxygenation, and the removal of the agent from the patient's body as quickly as possible. This is best accomplished by blocking the effects of acetylcholine, not by blocking or enhancing the neurotransmitter norepinephrine.

197.

The National Highway Transportation and Safety Act (NHTSA) created a document that provides guidelines as to what skills each level of EMS provider should be able to accomplish. What is the name of this document?

  • National EMS Scope of Practice Model

  • National EMS Education Standards

  • The White Paper

  • Emergency Care and Transportation of the Sick and Injured

Correct answer: National EMS Scope of Practice Model

The National Highway Transportation and Safety Act (NHTSA), in consultation with a large group of experts, developed the National EMS Scope of Practice Model that provides overarching guidelines for all levels of EMS providers and the skills that each level of provider can practice. 

The National EMS Education Standards were developed in 2009. The federal administrative source for this document is the NHTSA. It provides the minimum education standards for each level of EMS provider. 

The White Paper birthed EMS. Its official name is Accidental Death and Disability: The Neglected Disease of Modern Society. 

Emergency Care and Transportation of the Sick and Injured was the first EMT textbook, which was published in 1971.

198.

Identify the artifact.

  • Undersensing and loss of capture

  • Oversensing and failure to fire

  • Loss of capture only

  • No artifact is present

Correct answer: Undersensing and loss of capture

The pictured rhythm has pacemaker spikes in inappropriate locations, such as in the first QRS complex, a sign of undersensing. There is also loss of capture occurring, as evidenced by the pacemaker spikes with no QRS rhythms following them.

199.

Which of the following is true about normal sinus rhythm?

  • All P waves have the same shape

  • The P waves are inverted in most leads except lead V1

  • Rate is between 40-100

  • QRS intervals are greater than 0.12 seconds

Correct answer: All P waves have the same shape 

In a normal sinus rhythm, the rate is between 60-100, the rhythm is regular, the QRS intervals are less than 0.12 seconds, and the P waves are upright in most leads, except for V1 where they may be inverted. All P waves in a normal sinus rhythm must be matching.

200.

While treating a patient with a closed head injury and a major bleeding wound to the inner thigh, you suspect the presence of hypovolemia due to the patient's blood pressure of 66 systolic and a heart rate of 120. However, your evaluation also reveals signs and symptoms of increased intracranial pressure.

Which of the following would medical command most likely recommend in this case?

  • Crystalloid fluid boluses in an attempt to maintain the blood pressure at 90 systolic

  • Hypertonic saline administration to reduce ICP

  • Colloid solution boluses in an attempt to increase the blood pressure to 100 systolic

  • The administration of vasopressors to raise the blood pressure to greater than 100 systolic

Correct answer: Crystalloid fluid boluses in an attempt to maintain the blood pressure at 90 systolic

In this case, the hypovolemia is usually more immediately life-threatening than the head injury. As a rule, hypotension in the presence of a closed head injury should initially be managed with crystalloid fluid boluses to maintain a blood pressure of at least 90 systolic.

Hypertonic saline would be contraindicated because the patient is in hypovolemic shock. It is also generally not available in the prehospital setting. 

Colloid solutions are not generally used in the pre-hospital setting and would not be indicated for the treatment of a closed head injury patient with possible increased intracranial pressure. 

Vasopressors are not indicated when attempting to correct hypovolemia from an open injury in the pre-hospital setting, especially when the patient may have an increased intracranial pressure from another injury.

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