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Quiz Session - Attempts With Random Questions

NREMT Paramedic 1.4.12 Exam Questions

Page 4 of 60

61.

Scene

Based on the information given in this scenario, which of the following treatments should be performed on the scene, before resuming transport to the hospital?

Select the 4 answer options which are correct.

  • Obtain a 12-lead ECG

  • Obtain IV access

  • Administer nitroglycerin

  • Perform medication-assisted intubation

  • Increase CPAP to 12 cm/H2O

  • Switch the CPAP to BiPAP 10/5

  • Administer Albuterol via nebulizer inline with the CPAP

  • Administer Furosemide (Lasix) IV

This patient is exhibiting signs and symptoms of CHF exacerbation. Treatments on the scene for this patient should include IV access, administration of nitroglycerin, a 12-lead ECG (if not obtained and transmitted by BLS crew already), and medication-assisted intubation.

Increasing the CPAP or changing to BiPAP would not be recommended due to the patient's decreasing mental status. Furosemide (Lasix) administration is not a priority and could be administered during transport. Furosemide is no longer widely used in EMS management of CHF exacerbation due to its long onset time and potential for complications. Albuterol is not indicated for this patient, and it may even worsen the patient's condition.

62.

Which of the following is true concerning J point elevation?

  • The J point elevation may be seen in normal hearts

  • The J point is often confused with an extra Q wave in myocardial infarctions

  • J point elevation is only seen in ischemic conditions

  • J point elevation is common in those with chronic heart failure

Correct answer: The J point elevation may be seen in normal hearts

J point elevation is a type of ST-segment elevation that can be seen in normal hearts. It is seen in young, healthy adults and typically returns to baseline with exercise. It can be mistaken for a pathologic ST elevation. However, the key difference is a merging of the ST elevation with the T wave during an infarction. In J point elevation, the T wave is an independent, normal wave.

63.

You are ordered to administer morphine sulfate to an eight-year-old child with an open tib/fib fracture. Which of the following dosage ranges and routes would be most appropriate?

  • 0.1 - 0.2 mg/kg IV

  • 0.5 - 1.0 mg/kg IM

  • 0.7 - 0.9 mg/kg SC

  • 1 - 2 mg/kg IN 

Correct answer: 0.1 - 0.2 mg/kg IV

The correct dosage range for a pediatric patient who has sustained significant trauma is 0.1 to 0.2 mg per kg of the child's body weight. It is best to administer the medication via the IV route in the pre-hospital setting.

It is not appropriate to administer 0.5 to 1 mg per kg of morphine to a child for pain. It is too much at one time; the max dosage of 15 mg would likely be exceeded in an eight-year-old child. 

0.7 to 0.9 mg/kg falls between 0.5 and 1 mg/kg and would be too much to administer to a child. 

Administering 1 to 2 mg per kg would likely overdose a pediatric patient, and morphine is not given IntraNasally (IN).

64.

Which of the following is true regarding Prinzmetal angina?

  • It is characterized by ST-segment elevation

  • It is characterized by the absence of T waves

  • It is characterized by tall, peaked T waves

  • It is brought on by very warm temperatures

Correct answer: It is characterized by ST-segment elevation

Prinzmetal angina is characterized by ST-segment elevation and may include T-wave inversion. This type of angina can occur at any time, and the patient affected may not have any atherosclerotic disease. It is caused by spasms of the coronary artery and is treated with nitroglycerin. It may occur with exertion but most commonly occurs while at rest. It may also occur in some healthy patients if they are outside in very cold temperatures, but it is not associated with warm temperatures.  

Tall, peaked T waves are indicative of hyperkalemia, not Prinzmetal angina.

65.

The way to distinguish Torsade de Pointes from ventricular tachycardia is:

  • The QRS complexes in Torsade de Pointes vary in axis and amplitude

  • The QRS complexes in Torsades de Pointes are more uniform than in ventricular tachycardia

  • In Torsades de Pointes, the QRS complexes maintain their axis and amplitude

  • There is no electrical activity in ventricular tachycardia

Correct answer: The QRS complexes in Torsade de Pointes vary in axis and amplitude

In Torsade de Pointes, the QRS complexes go around the baseline like a spiral, changing in axis and amplitude; this is the key difference between the two rhythms.

66.

You are evaluating a 20-year-old male patient experiencing respiratory problems. You apply an End-Line CO2-equipped nasal cannula to the patient and attach it to your monitor. You notice a shark-fin-shaped graph on the capnography and the patient's EtCO2 at 45 mmHg. 

What is this most likely indicative of?

  • The patient is experiencing asthma exacerbation and needs to be treated accordingly

  • The patient is hyperventilating due to the distress and should be coached to breathe slower

  • The patient is experiencing a foreign body airway obstruction in the upper airway and cannot breathe adequately

  • The patient is experiencing diabetic ketoacidosis (DKA) and needs to be treated accordingly

Correct answer: The patient is experiencing asthma exacerbation and needs to be treated accordingly

A capnography wave that shows a consistent shark-fin appearance is indicative that the patient is having constriction in the lower airways, as air is not passing through them consistently. While the CO2 measurement of 45 mmHg is on the high side of normal (normal is 35–45 mmHg), this shows that the patient is unable to expel CO2 as effectively, which helps hold up the hypothesis of asthma (other possibilities include COPD and possibly pneumonia, depending on the patient).

If the patient is hyperventilating, this would most likely cause low CO2 measurement, as the patient is breathing too fast to properly retain CO2. Also, generally with just hyperventilation, the graph will have a normal box-like appearance. 

While an airway obstruction may cause a higher CO2 reading that is normal due to inadequate ventilation, it would still likely retain a box-like appearance because the air in the patient's respiratory system would all be moving at the same time, just slower than normal. This is opposed to asthma, wherein the bronchioles are having a harder time moving air, and the upper airway is unobstructed.

Diabetic KetoAcidosis (DKA) results in the patient experiencing Kussmaul respirations, which are faster than normal in an attempt to blow off the excess acid in the patient's body. This could result in a possibly lower CO2 measurement, but at the very least, the capnography would not show shark fins.

67.

You are transporting a 20-year-old pregnant female from a local hospital to a medical facility that specializes in high-risk pregnancies when you note the patient is experiencing unexplained hypotension and bradycardia. The patient has a patent IV and is being administered magnesium that was initiated by hospital staff. On the cardiac monitor, the patient presents with a lengthening PR interval and signs of an impending high-degree nodal block.

Which of the following interventions would be most appropriate in this case?

  • Stop the magnesium sulfate infusion immediately, and administer the appropriate dose of calcium chloride to correct the adverse effects of magnesium toxicity

  • Continue the infusion, but administer potassium chloride to counteract the adverse effects of the magnesium chloride administration

  • Reduce the infusion by half, and administer dextrose 50% to counteract the adverse cardiac effects caused by the magnesium chloride infusion

  • Increase the magnesium sulfate infusion rate, and administer a 1,000 mL normal saline bolus to support the patient's blood pressure

Correct answer: Stop the magnesium sulfate infusion immediately, and administer the appropriate dose of calcium chloride to correct the adverse effects of magnesium toxicity

Magnesium sulfate toxicity in pregnant patients may result in prolonged PR intervals, QRS complexes, and QT intervals. It may also cause high-degree infra-nodal blocks, bradycardia, frank hypotension, and if not corrected, cardiac arrest. If mag sulfate toxicity is suspected, the paramedic should immediately discontinue the magnesium sulfate infusion and administer the appropriate dose of calcium chloride to help counteract the cardiac abnormalities.

It is not appropriate to continue a magnesium sulfate infusion at any rate of infusion for a pregnant female patient showing the obvious signs and symptoms of mag sulfate toxicity such as unexplained, new-onset bradycardia, and hypotension. The continued infusion could result in a worsening high-degree nodal block, frank hypotension, and a slowing heart rate that quickly progresses to cardiac arrest. 

It is not acceptable or helpful to administer potassium or dextrose 50% to a patient with the signs and symptoms of magnesium toxicity. Calcium chloride is the appropriate medication to combat mag toxicity.

68.

Which of the following is not a criterion for identifying a junctional rhythm?

  • Regular, consistent P waves

  • Absent  P waves

  • Inverted P waves following a QRS complex

  • Inverted P waves with a short PR interval preceding a QRS complex

Correct answer: Regular, consistent P waves 

The hallmark sign of a junctional rhythm is an inverted, abnormal P wave. This includes P waves that are inverted following the QRS complex, preceding the QRS complex, or completely absent.

69.

Scene 

Which of the following is the most appropriate intervention to perform when the patient in this scenario becomes unresponsive?

  • Administer transcutaneous pacing (TCP)

  • Establish an IV and administer Atropine

  • Establish an IV and administer epinephrine

  • Begin chest compressions

Correct answer: Administer transcutaneous pacing (TCP)

This patient is exhibiting signs of poor perfusion from severe bradycardia, and immediate intervention is required. Starting an IV will delay intervention, so immediate transcutaneous pacing (TCP) is most appropriate. Chest compressions are not indicated, as he still has a pulse.

70.

En-Route

Which of the following is accurate as you respond to the patient in this scenario?

  • You should be prepared to move the patient to a sheltered area as soon as possible

  • The patient most likely has severe, full-thickness burns

  • The patient will most likely not survive

  • You should be prepared to treat this patient the same as every other electrical injury patient

Correct answer: You should be prepared to move the patient to a sheltered area as soon as possible

It would be best if you were prepared to move this patient into a sheltered area as soon as possible. Lightning strikes produce tissue injuries that differ from other types of electrical injury because the pathway of tissue damage is often over rather than through the skin. Lightning duration is brief, so skin burns are usually less severe than those seen of high voltage current. Full-thickness burns are rare in lightning injuries. Although morbidity and mortality from lightning strikes are high, with immediate treatment, almost 90% of patients survive.

71.

Which of the following are used to describe specific parts of a motor vehicle? 

Select the two answer options which are correct.

  • A post 

  • B post 

  • T post 

  • L post 

Using common terminology to describe parts of a motor vehicle helps avoid confusion and can facilitate rescue/extrication. Vehicle anatomy terminology includes A post, B post, C post, engine compartment, trunk, roof, driver side, and passenger side. 

T post and L post are not used in vehicle anatomy terminology.  

72.

The energy that is emitted from a radiological source can be categorized as which of the following?  

Select the 4 answer options which are correct.

  • Alpha radiation 

  • Gamma radiation 

  • Neutron radiation 

  • Beta radiation

  • Delta radiation 

  • Microwave radiation

The energy that is emitted from a radiological source can be categorized as alpha, beta, gamma (X-rays), or neutron radiation. 

Delta radiation and microwave radiation are not forms of energy emitted from a radiological source. 

73.

An adult trauma patient suffered a fall from greater than 15 feet. When predicting the injuries associated with this type injury, the paramedic should evaluate the distance fallen, the position of the body on impact, and which of the following?

  • The type of landing surface involved

  • The ambient temperature at the time of the fall

  • The body parts that were struck with the most force

  • The patient's neurological status

Correct answer: The type of landing surface involved

Falls from greater than three times the patient's height are often associated with significant trauma. In predicting the possibility of injuries sustained, the paramedic should evaluate three factors: the overall distance of the fall, the patient's position on impact, and the type of surface involved in the fall. These factors are useful when trying to determine possible internal and external injury.

Ambient temperature at the time of fall is not usually a consideration when attempting to determine the severity or probability of an injury. 

It is almost impossible and impractical to attempt to determine which body parts received the bluntest force from the fall. 

The neuro status of the patient is a physical exam finding and not a consideration when attempting to determine the possible injuries from a fall.

74.

Post-Scene

Based on the information given in the scenario, which of the following treatments is appropriate for this patient?

Select the 2 answer options which are correct.

  • Administer naloxone (Narcan) IV

  • Assist ventilations with a BVM and oxygen

  • Administer sodium bicarbonate IV

  • Administer atropine (Atropen) IV

  • Endotracheal intubation

This patient is exhibiting signs and symptoms of opioid toxicity. Treatment for this patient should include the administration of naloxone (Narcan) and ventilatory support with a bag-mask until his respiratory drive is restored.

Sodium bicarbonate is indicated in a TCA or SSRI overdose, which is not consistent with the given signs and symptoms for this patient. Atropine (Atropen) is used for cholinergic toxicity, which is not evident in this patient. Intubation is not indicated in this patient at this time. It would only be indicated if there is no response to the administration of Narcan.

75.

You are on-scene with a six-year-old who is unconscious and unable to protect his own airway. He is of average height, and his estimated weight is 23 kg. Which of the following endotracheal tube sizes would be most appropriate for this patient?

  • 5.5-millimeter uncuffed endotracheal tube

  • 5-millimeter cuffed endotracheal tube

  • 7-millimeter cuffed endotracheal tube

  • 4-millimeter uncuffed endotracheal tube

Correct answer: 5.5-millimeter uncuffed endotracheal tube

The EndoTracheal Tube (ETT) size formula, (age/4) + 3.5 is used for cuffed ETT, or the formula (16+age)/4 or (age/4) + 4 to calculate the uncuffed pediatric ETT size.

The appropriate size endotracheal tube for a 23-kg, six-year-old child would be a 5- to 5.5-mm internal diameter tube. However, since the child is six, he has a natural narrowing around the cricoid cartilage and does not require the use of a ballooned or cuffed endotracheal tube. A cuffed endotracheal tube may not correctly seal this patient's airway due to the narrowing or cause mucosal injury. Uncuffed ETT should be used in patients under 8 years of age. 

A 5-mm cuffed ET tube would more appropriate for a very small adult or child who is over the age of eight. At eight years old, the natural narrowing of the cricoid cartilage expands to normal dimensions. Cuffed tubes should be used on all patients over age eight. 

A 7-mm cuffed ET tube would be used on an average weight and height adult patient. It would not be appropriate for use on a 23-kg, six-year-old child. 

A 4-mm uncuffed ET tube would be appropriate for use on a 10- or 11-kg toddler, not a six-year-old, 23-kg child.

76.

Which of the following are appropriate treatments for the patient with thyrotoxicosis?

Select the 3 answer options which are correct.

  • Beta blockers

  • Dextrose

  • Fluid resuscitation 

  • Active rewarming 

EMS treatment for thyrotoxicosis (thyroid storm) is mostly supportive: providing intravenous fluids and dextrose as needed, cooling the body with external measures, and rapid transport to an emergency department. Beta blockers may be used for tachycardia that does not improve after fluid boluses and cooling the patient. 

The patient with thyrotoxicosis will already be hyperthermic, so active rewarming would be inappropriate. 

77.

You have an intubated patient who is unconscious but has a pulse of 90 and a BP of 120/80. You have capnography in-line with your ET tube, and you have a CO2 reading of 30 mmHg. What should you do because of this reading?

  • Check your ventilation rate; you may need to slow it down

  • Increase your ventilation rate

  • Increase the FiO2

  • Administer albuterol through an in-line nebulizer

Correct answer: Check your ventilation rate; you may need to slow it down

The normal reading for end-tidal CO2 is 35-45 mmHg. A reading of 30 is indicative that there is less than normal CO2 retention by the respiratory system. Especially in a mechanically ventilated patient, it is likely that their respiratory rate is too fast, which is corrected by slowing down respirations. A good number to shoot for is one breath every six seconds, or 10 breaths per minute.

Increasing the Fi02 would not affect the ETC02 levels, so it would not be appropriate. 

As stated above, the issue is that the patient is being ventilated too rapidly, so the ventilation rate should be slowed down instead of sped up. While a low EtCO2 number can be indicative of patient deterioration and insufficient blood flow for proper gas exchange, the reading for this patient is only marginally lower than normal and does not mean that the patient's heart will soon stop. 

With a patient requiring albuterol, the reading would generally be elevated above normal to reduce ventilation ability because of bronchial constriction.

78.

Which of the following illnesses result from infection and will most likely cause respiratory distress in pediatric patients?

Select the three correct answer options.

  • RSV

  • Croup 

  • Epiglottitis 

  • Asthma 

Croup is a viral infection of the upper airway. Epiglottitis is swelling of the epiglottis that results from an upper respiratory infection. RSV (respiratory syncytial virus) is a common respiratory viral infection. All these are likely to cause respiratory distress in pediatric patients. 

Asthma is a reactive airway disease and is not caused by an infection. It will also likely cause respiratory distress in pediatric patients. 

79.

You are on-scene with a 15-year-old male patient with difficulty breathing and possible airway burns from an accidental ingestion of a caustic material. As his spontaneous respirations and level of consciousness continue to decrease, you quickly note he still has an intact gag reflex. 

Fearing he may not be able to control his own airway, which airway control device would be most appropriate for use with this patient?

  • Nasopharyngeal airway (NPA)

  • King LTD airway

  • Esophageal-Tracheal airway (Combitube)

  • Oropharyngeal airway (OPA)

Correct answer: Nasopharyngeal airway (NPA)

NasoPharyngeal Airways (NPAs) are used to maintain an open airway in unconscious patients or in patients who may have an altered level of consciousness to the point of not being able to appropriately control their own airway. It is an appropriate temporary airway device for use in patients who may have acquired airway burns with or without caustic substances. In the event of airway burns, the patient's airway may swell shut unexpectedly. Many of the advanced airway techniques and devices are not intended for use on patients who may have airway burns associated with caustic material. In this case, a temporary airway is better than no airway, and a nasal airway is the best choice.

A King LTD and an esophageal-Tracheal airway (Combitube) are airway devices indicated for use on patients who would benefit from tracheal intubation, but either it is not possible or the patient is conscious/semi-conscious without an active gag reflex. They are also contraindicated in patients who may have caustic airway burns. 

An OroPharyngeal Airway (OPA) is used to keep the airway out of the posterior airway. It is contraindicated in patients with active gag reflex or possible airway burns. Therefore, the best option for this patient is to insert an NPA.

80.

Which of the following is true regarding junctional rhythms?

  • It is an escape rhythm

  • The rate is usually below 40 beats per minute

  • It is an irregular rhythm

  • Vagal maneuvers are a recommended treatment

Correct answer: It is an escape rhythm

A junctional rhythm is considered an escape rhythm that originates in the AV junction. It is a regular rhythm, and the rate stays between 40 to 60 beats per minute. Vagal maneuvers should be avoided to prevent a drop in the heart rate.

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