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Quiz Session - Attempts With Random Questions

NREMT Paramedic 1.4.12 Exam Questions

Page 3 of 60

41.

Your adult patient has a history of sickle cell anemia and called for assistance today with a complaint of severe all-over body pain and shortness of breath. The patient reports the episode began three days ago but today, worsened to the point that they could not handle it any longer without help. The patient is breathing at 26 times per minute with an oxygen saturation of 88 percent on room air. Heart rate is 128 beats per minute, and blood pressure is 90 systolic.

Which of the following interventions would be most appropriate after initiating high-flow oxygen therapy?

  • IV fluid replacement with normal saline at 30 milliliters per kilogram of body weight

  • IV fluid replacement with a glucose-containing fluid such as Dextrose 50 with half-normal saline run at 5 liters per hour

  • IV fluid replacement with Lactated Ringer's solution at 1 liter per hour

  • IV fluid bolus with a Dextrose-containing solution at 100 milliliters per kilogram of body weight

Correct answer: IV fluid replacement with normal saline at 30 milliliters per kilogram of body weight

Patients experiencing a sickle cell crisis have extreme pain caused by the sickle-shaped, crystallized red blood cells irritating the blood vessels as they flow through them. It causes a secondary dehydration to occur. The goal is to increase the blood pressure and reduce friction within the blood vessels. A fluid should be used that contains no solutes, such as normal saline. The standard fluid bolus should be administered due to relatively short treatment time and to prevent fluid overload.

D5W is a glucose-containing fluid normally indicated to help correct a hypoglycemic condition. It is not normally indicated for the patient with a sickle cell crisis. Five liters of any fluid per hour is more than likely to cause a serious case of fluid overload.

Lactated Ringer's (LR) solution contains electrolytes that are normally good for patients with dehydration, but LR is not typically indicated in the case of patients experiencing a sickle cell crisis.

It would never be appropriate to administer a fluid bolus of 100 milliliters per kilogram of body weight. That amount could result in a fluid bolus of over 7,000 milliliters or 7 liters, which is more than the average adult's blood volume.

42.

You are unable to control an upper arm hemorrhage from a laceration that is located just above the patient's antecubital fossa on the inner aspect of the patient's upper arm. After all bleeding control measures fail, you decide to apply a tourniquet to control the hemorrhage. 

After the tourniquet is properly applied, the bleeding is controlled, and the tourniquet is secured, what should you do after reassessing the injury site?

  • Note the time the tourniquet was applied

  • Place a second tourniquet below the injury site

  • Tighten the tourniquet one half a turn, and resecure it every fifteen minutes until the hemorrhage is controlled

  • Loosen the tourniquet one turn every fifteen minutes until the bleeding is controlled

Correct answer: Note the time the tourniquet was applied

After applying the tourniquet and controlling the associated hemorrhage, it is important to reassess the patient's injury after securing the tourniquet. Immediately after reassessment, it is important to note the time the tourniquet was applied.

If a tourniquet fails to control bleeding, a second one can be placed above (proximal to) the first tourniquet and injury. There is no indication this is needed for this patient.

There is no reason to write the patient's name, date, and allergies on the tourniquet. Never retighten or loosen a tourniquet that has proven effective in stopping a hemorrhage after it has been secured unless the hemorrhage begins again in the prehospital setting.

43.

Which of the following is true regarding premature junctional complexes?

  • Inverted P waves may be hidden inside the QRS complex

  • It is an irregular rhythm

  • It can only occur in tachycardia

  • It is one of the most common arrhythmias

Correct answer: Inverted P waves may be hidden inside the QRS complex 

Premature junctional complexes are a regular but interrupted rhythm; this can occur at any rate and contain inverted P waves that can occur before or after, or hidden in, a QRS complex. Junctional rhythms are seen less often than atrial rhythms, and usually, do not cause adverse effects.

44.

Which of the following would be established by the first units that arrive at a mass casualty incident (MCI)? 

Select the three correct answer options.

  • Triage

  • Treatment area

  • Incident command 

  • Transportation group leader 

  • Transportation officer 

The first units to arrive at an MCI will need to establish an incident commander, begin triage, and establish treatment areas for the wounded. As mutual aid and more units arrive, staging and transportation groups with respective leaders will be established. 

Transportation would not be an immediate concern because, in an MCI, transport would not be immediate; time would be needed for more resources to arrive and to alert receiving hospitals. 

45.

Which of the following are contraindications for attempting endotracheal intubation? 

Select the three correct answer options.

  • Intact gag reflex 

  • Inability to open the patient's mouth

  • Inability to see the glottic opening

  • Traumatic brain injury 

  • Respiratory compromise

General contraindications for attempting endotracheal intubation include an intact gag reflex, the inability to open the patient's mouth because of trauma or pathological condition, the inability to see the glottic opening, or substances such as blood or vomit in the airway. 

Traumatic brain injury often results in airway and respiratory compromise and is an indication of endotracheal intubation. 

46.

You and your partner are on scene with a patient who needs to be transported to the hospital for chest pain. You have established an IV, placed the patient on the monitor, administered oxygen, one dose of nitroglycerin, and aspirin. The patient's vitals are stable, and the patient reports pain relief. However, the patient wishes to be transported for evaluation. Your partner checks his watch and notes that his shift is over. You remove the monitor and politely tell the patient the oncoming crew will come and transport them to the hospital. The patient's daughter is on the scene and is a trained first responder. She tells you she will stay until another crew arrives to transport the patient.

Leaving the patient in the daughter's care, in this case, is an example of which of the following?

  • Abandonment

  • Misfeasance

  • Libel

  • Appropriate transfer of care

Correct answer: Abandonment

Abandonment occurs when an emergency medical technician and/or paramedic initiates care of a patient in the pre-hospital environment and then either terminates care or leaves the patient in the care of a less trained person. The only time a paramedic can leave the patient after initiating care is when they turn them over to the higher trained staff at the ER or the competent patient no longer needs assistance and signs a legal refusal of care.

Misfeasance occurs when a paramedic lawfully treats a patient but does so in an inappropriate manner that causes harm. Libel is making false statements about a patient with malicious intent; it does not refer to ending care inappropriately. Even though the patient's daughter is on the scene and a trained first responder, it is not appropriate to leave a patient in the care of a less trained individual. Therefore, abandonment occurred.

47.

While evaluating the electrocardiogram tracing of a 60-year-old patient, you note the presence of deep, symmetrically inverted T waves. The tracing also reveals normal QRS complex and P-R interval durations. The patient states he has a history of hypertension, heart disease, and high cholesterol but denies a past heart attack or stroke. What is the most likely cause of the electrocardiogram findings?

  • An acute CNS event

  • Electrolyte imbalance

  • Sepsis

  • Hypotension

Correct answer: An acute CNS event

The T wave presents ventricular repolarization of the ventricles. It is identified as the first deviation from the ST segment (usually positively deflected) and ends when the T wave returns to the isoelectric line. T waves found to be deeply inverted may indicate an acute central nervous system event, such as a massive stroke or intracranial hemorrhage.

Electrolyte imbalance can cause cardiac rhythm abnormalities such as tall, tented T waves, which appear when a patient is hyperkalemic. However, electrolyte imbalance is not likely to produce deeply symmetrical-inverted T waves. Sepsis is not likely to cause T-wave inversion in an adult cardiac patient. Although sepsis can cause cardiac dysrhythmias in late stages, it is not as likely to cause a T-wave inversion that is considered deep and symmetrical.  Hypotension is more likely to cause an initial increase in the heart rate, rather than a decrease, as the low blood pressure continues to fall due to decreased preload, afterload, and cardiac output. It is not as likely to cause T-wave inversion unless the hypotension leads to cardiac ischemia.

48.

Your adult patient was possibly exposed to an unknown toxic agent at work in a chemical plant that specializes in agricultural insect control. The patient presents with confusion, CNS depression, bradycardia, bronchoconstriction with wheezing, and diaphoresis.

Exposure to which of the following agents is most likely to cause the patient's current signs and symptoms?

  • Organophosphate and/or carbamate agents

  • Jimson weed and mescaline agents

  • Ethylene glycol and mercury-containing agents

  • Isopropanol and acetone agents

Correct answer: Organophosphate and/or carbamate agents

Patients possibly exposed to organophosphate and/or carbamate insecticide agents are likely to present with signs and symptoms consistent with a cholinergic (wet) presentation. These include confusion, CNS depression, weakness, salivation, watery eyes, and diaphoresis. They also commonly present with bradycardia, bronchoconstriction, and wheezing. In the worst exposure cases, coma and death occur. Insecticide exposure normally involves organophosphates and/or carbamate agents. The findings should further alert the paramedic to the possibility of exposure to one or both of these agents.

Patients who have experienced an accidental exposure to toxic amounts of Jimson weed and/or a mescaline agent are more likely to present with an anti-cholinergic presentation. They often present with tachycardia, dry skin, and oral mucosa. They often present with dilated pupils and seizures.

Patients exposed to Ethylene Glycol (EG) would likely have to swallow 5-8 ounces in liquid form to induce a poisoning response. They would present with CNS depression, nausea, vomiting, slurred speech, dizziness, unsteady gait, and abdominal pain. A person who is poisoned with EG may appear drunk. They may also have a sweet aromatic odor to their breath.Mercury-containing agents cause symptoms similar to nerve agents

Isopropanol and acetone agent poisoning patients would present much like ethylene glycol patients. These agents are normally consumed orally in an attempt to become intoxicated. It is not likely they would be involved in an accidental exposure at an agricultural insecticide facility.

49.

Which of the following statements are true regarding a neonate? 

Select the 2 answer options which are correct.

  • Hypothermia is a common cause of bradycardia in the neonate

  • Newborns less than 30 weeks of gestation are at higher risk for complications

  • Complications occur more frequently in newborns aged 38–40 weeks of gestation

  • The risk of complications is not increased in multiple gestation

Hypothermia is a common cause of bradycardia in neonates. Prematurity is the most common cause of respiratory distress and cyanosis in neonates. The risk of complications is higher in newborns younger than 30 weeks of gestation or weighing less than 2.5 pounds. 

A newborn aged 38–40 weeks would be considered normal gestation, and complications would not occur more frequently. Multiple gestation can create a higher risk for complications in newborns. 

50.

For EMS professionals to determine death in the pre-hospital environment, which of the following criteria must be met by the paramedic?

  • No electrical activity in the heart as confirmed by an EKG tracing indicating asystole

  • Apnea with a gag reflex as indicated by an attempt to intubate or establish another means of advanced airway

  • Independent lividity noted to the low points of the patient's body with skin that is cold and clammy

  • Pupils that are pinpoint, fixed, and non-reactive to light along with decreased muscle tone

Correct answer: No electrical activity in the heart as confirmed by an EKG tracing indicating asystole

Policies for determining death in the pre-hospital setting should be established by medical control in accordance with state and local protocols. Determination of death is confirmed by the paramedic by ensuring the patient is asystolic in separate leads (leads I, II, III are commonly used for death determination). It is also confirmed by the addition of breathlessness, no cough or gag reflex, no spontaneous movements, no response to painful stimuli as well as fixed and dilated pupils.

It is not acceptable for the paramedic to determine a patient died because they may be apneic with an active gag reflex. If the patient has an intact gag reflex, they are not likely deceased. 

Obvious independent lividity is not needed to determine death. Independent lividity can be mistaken with bruising. 

Death is determined by the presence of fixed and dilated pupils, not fixed, pinpoint pupils. When a patient is deceased, the eyes do not have the ability or nerve impulses required to initiate pupil constriction.

51.

You are called to the scene of an attempted suicide by local law enforcement. It is determined the juvenile was attempting to commit suicide in his car by mixing several household cleaners. Once on the scene, there is a strong odor of rotten eggs and a barely breathing teenager. 

Which of the following agents is most likely to cause the findings in this case?

  • Hydrogen sulfide

  • Carbon monoxide

  • Cyanide

  • Formaldehyde

Correct answer: Hydrogen sulfide

Hydrogen sulfide is a highly toxic poison believed to affect many body systems once exposure has occurred. It is a product of mixing chemical cleaning agents commonly found in homes in the US and mainly causes nervous system complications. It is colorless, flammable, and extremely hazardous. It is similar to cyanide except it has the telltale rotten-egg smell that distinguishes it from other nerve poisons. It is a common agent for teenagers attempting suicide in confined spaces.

Carbon monoxide is a gas created by burning fossil fuels such as gasoline. It is colorless, odorless, and binds to red blood cells many times stronger than oxygen. Exposure to hydrogen sulfide is five to six times stronger than carbon monoxide. Small doses can be quickly lethal. 

Cyanide is a similar nerve poison that is highly toxic. The classic rotten-egg smell with hydrogen sulfide is not present with cyanide. Cyanide has its own distinct smell that is noticeable to 60 percent of all people who have been exposed to it; it smells like burnt almonds. 

Formaldehyde is an agent used in food preservation and has other uses as well. It can be toxic if a person is exposed to larger than normal amounts of the agent. It is said that formaldehyde in toxic amounts smells like sour pickles. It is not a common agent used for attempting suicide in teens and young adults.

52.

Which of the following is true regarding idioventricular rhythms?

  • There are no P waves

  • It is an irregular rhythm

  • The rate is usually between 40 and 100

  • It is not a lethal rhythm

Correct answer: There are no P waves 

An idioventricular rhythm originates in the ventricles when the higher pacemakers have failed to generate an impulse. It is a regular rhythm, and the rate is between 20 and 40. It has no P waves and wide, bizarre QRS complexes. It is caused by prolonged hypoxia resulting in cardiac damage and is a lethal rhythm that needs cardiopulmonary resuscitation.

53.

Which specialized cells of the conduction system innervate the ventricular walls, sending electrical impulses to the ventricle itself?

  • Purkinje fibers

  • Bundle of His

  • Internodal tracts

  • Interatrial tracts

Correct answer: Purkinje fibers

The interatrial tracts are specialized cardiac cells that serve as a highway between the SA node through the atria.The internodal tracts are specialized cardiac cells that serve as a highway between the atrial tissue to the AV node. From the AV node, the impulse then travels through the bundle of His, then through bundle branches to the Purkinje fibers, which innervate the ventricular walls.

54.

A 36-year-old patient with multiple gunshot wounds demonstrates an altered mental status, and their vital signs are BP 88/66, HR 136, RR 24, and SpO2 90%. Which of the following are appropriate treatments for this patient? 

Select the 3 answer options which are correct.

  • Keep the patient warm

  • Administer fluid bolus 

  • Immediate transport to a trauma center

  • Administer an opioid analgesic

  • Slow breathing rate with a BVM to 12 breaths per minute

This patient is exhibiting signs and symptoms of decompensated shock. Appropriate management of a trauma patient with signs of hypovolemic shock from bleeding include:

  • Oxygen administration
  • Keeping the patient warm
  • Giving crystalloid fluid boluses as needed
  • Immediate transport to a trauma center
  • Administration of tranexamic acid (TXA) if protocols allow

Patients in decompensated shock should not receive opioid pain medications because of possible interference with compensatory mechanisms. Do not try to slow the breathing in shock patients, as they are compensating for the associated metabolic acidosis. 

55.

Which of the following are phases of a rescue operation? 

Select the 3 answer options which are correct.

  • Arrival and scene size-up

  • Disentanglement

  • Gaining access 

  • Decontamination

Rescue situations may take many forms, but the rescue will generally follow these phases: 

  1. Arrival and scene size-up
  2. Hazard control
  3. Gain access to the patient
  4. Medical Treatment
  5. Disentanglement
  6. Patient packaging
  7. Transportation

Decontamination would be a phase of a HAZMAT operation.  

56.

Identify the following rhythm.

  • Third-degree AV block

  • First-degree AV block

  • Paroxysmal supraventricular tachycardia

  • Type 2 Mobitz block

Correct answer: Third-degree AV block

A third-degree heart block is a complete block, not a delay, and will show a dropped QRS beat. The R-R intervals are equal distance apart and the p-waves are equal distance apart. There is no association between the QRS complex and the P waves.

A first-degree AV block is a prolonged PR interval caused by a delay in the impulse being sent to the ventricles. A type 2 Mobitz block is a second-degree block, where the AV node becomes weaker over time, showing PR intervals that become longer, followed by a dropped P wave. An SVT is a regular tachycardic rate, typically caused by firing of several foci in the atrial tissue.

57.

An adult asthma patient is experiencing severe respiratory distress with laryngospasm, making orotracheal intubation impossible. What is the most appropriate immediate action to manage this patient’s airway?

  • Initiate bag-valve-mask (BVM) ventilation with positive pressure

  • Attempt nasotracheal intubation

  • Administer nebulized bronchodilators

  • Perform immediate cricothyrotomy

Correct answer: Initiate bag-valve-mask (BVM) ventilation with positive pressure

In a patient with laryngospasm and severe respiratory distress, initiating bag-valve-mask (BVM) ventilation with positive pressure is the most appropriate immediate action. Positive pressure ventilation can help force air past the obstruction caused by laryngospasm, potentially relieving the spasm and providing critical oxygenation. BVM ventilation is non-invasive and can be rapidly applied in an emergency setting.

Attempting nasotracheal intubation is contraindicated because laryngospasm involves closure of the vocal cords, making this approach highly unlikely to succeed and potentially exacerbating the situation.

Administering nebulized bronchodilators may be useful in treating asthma, but it is not the most immediate action needed for airway management when laryngospasm is present. Airway patency must be addressed first.

Cricothyrotomy is an invasive procedure typically reserved for situations where all other less invasive airway management techniques have failed. Since BVM ventilation is a viable option, cricothyrotomy is not the first-line intervention in this scenario.

58.

Your patient is suffering cardiac arrest with adequate CPR and ACLS interventions initiated, including intubation by your crew. Once capnography is introduced to monitor the effectiveness of the resuscitation effort, what can the paramedic expect to see on the monitor if the patient has a return of spontaneous circulation (ROSC)?

  • A waveform that suddenly rises from around 10–20 mmHg with high-quality CPR to above 40 mmHg

  • A waveform that gradually decreases from 45 mmHg to less than 10 mmHg

  • A waveform that looks like a shark's fin and is above 45 mmHg

  • A sudden, complete loss of waveform from around 10 mmHg to 0 mmHg

Correct answer: A waveform that suddenly rises from around 10–20 mmHg with high-quality CPR to above 40 mmHg

Capnography can be used to monitor the effectiveness of cardiopulmonary resuscitation and ventilation delivered to intubated patients during the arrest. If adequate cardiopulmonary circulation is being properly provided by the rescuers, a waveform of above 10 mmHg is the goal. If the waveform suddenly surges within one waveform from 10 mmHg to well above 40 mmHg, it is most likely the patient has a Return Of Spontaneous Circulation (ROSC). CPR should be stopped, and the patient assessed for a pulse.

A waveform that gradually decreases from 45 mmHg is most likely on a ventilator. If the waveform gradually decreases in intensity until it is under 10 mmHg, it is most likely caused by an ET tube cuff problem or tube obstruction. This is not a finding indicative of patients with ROSC. 

Waveforms that appear as if they are shark fins are most likely caused by bronchospasm, not ROSC. 

A sudden, complete loss of waveform during continued adequate chest compressions and ventilations is most likely caused by a disconnected or kinked ET tube.

59.

You are assisting a full-term pregnant patient in the delivery of her newborn at home. However, once the baby's head delivers and turns to accommodate the shoulders, the next few contractions fail to produce the newborn's shoulder. In this case, what should you do next?

  • Using gentle pressure, guide the infant's head downward to facilitate the anterior shoulder and then upward to release the posterior shoulder

  • Using gentle pressure, guide the infant's head upward to facilitate the anterior shoulder, and then downward to release the posterior shoulder

  • Using gentle pressure, guide the infant's head back into the birth canal and rotate the infant's head in the opposite direction and see if the next contraction allows the shoulder passage

  • Using gentle pressure on the infant's head with the palm of your gloved hand, expedite transport because delivery will require cesarean section at the hospital

Correct answer: Using gentle pressure, guide the infant's head downward to facilitate the anterior shoulder and then upward to release the posterior shoulder

If the newborn's shoulders fail to deliver spontaneously on the next regular contraction, the paramedic should use gentle pressure on the infant's head to guide it downward to assist the clearance of the anterior shoulder and then upward again to help the posterior shoulder clear the pubic bone. After the shoulders deliver, the baby should completely deliver with the next regular contraction.

Guiding the infant's head upward should follow the downward movement to allow the anterior shoulder to pass the pubic bone. Guiding the infant's head upward is used to assist the posterior shoulder passage after the anterior shoulder clears the pubic bone.

It is never appropriate to push a newborn's head back into the birth canal to rotate the head in the opposite direction. This could and would likely cause serious injury to occur to the newborn. This inappropriate maneuver would not help the natural delivery of the shoulders. 

Just because the infant's shoulders are having a difficult time passing the pubic bone does not make it an automatic cesarean section. It would not be appropriate to attempt to stop the progression of labor due to a shoulder not lining up properly for delivery.

60.

Your fifty-year-old COPD patient presents with a productive cough, pleuritic chest pain, and a fever with chills. Which of the following should you suspect due to the patient's signs, symptoms, and history?

  • Bacterial pneumonia

  • COPD exacerbation

  • Congestive heart failure

  • Chronic bronchitis

Correct answer: Bacterial pneumonia

Pneumonia can be classified as viral, bacterial, mycoplasmal, or aspiration. Bacterial pneumonia normally manifests with the classic signs and symptoms of a productive cough, pleuritic chest pain, and a fever with chills. Bacterial pneumonia is often referred to as typical pneumonia.

The classic signs associated with a COPD exacerbation include a cough and chest tightness. The patient may even have a productive cough and wheezing; however, the fever with chills is a tell-tale sign of an infectious disease such as pneumonia. 

Patients with congestive heart failure will likely present with a cough, orthopnea, and nocturnal dyspnea. However, there is no fever associated with congestive heart failure. 

Patients with chronic bronchitis present with a productive cough but not with fever and chills.

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