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Quiz Session - Attempts With Random Questions

NREMT Paramedic 1.4.12 Exam Questions

Page 7 of 60

121.

Which of the following are examples of corrosives?

Select the 3 answer options which are correct.

  • Toilet bowl cleaner

  • Lye

  • Hydrochloric acid 

  • Paint thinner 

Corrosives are materials that can attack and chemically destroy exposed body tissues. Corrosives can also damage or even destroy metal. They begin to cause damage as soon as they touch the skin, eyes, respiratory tract, or digestive tract.  Corrosives include acids and bases, and examples include hydrochloric acid, lye, toilet bowl cleaner, and sulfuric acid.

Paint thinner is considered a solvent, which are chemicals used to break down other substances.

122.

Your adult patient is showing signs and symptoms of being severely hyperkalemic. Medical control recommends the administration of a high-dose nebulized albuterol treatment as well as calcium chloride. Why is high-dose albuterol being recommended for this patient?

  • To help lower dangerous potassium levels

  • To improve the patient's ventilatory status

  • To assist with metabolic acidosis

  • To increase the amount of available calcium at the cellular level

Correct answer: To help lower dangerous potassium levels

High-dose albuterol treatments are effective in stimulating the body's natural release of insulin. This stimulates the sodium-potassium pump to shift potassium from the bloodstream into the tissues and cells.

Albuterol treatments are normally intended for bronchoconstriction; however, in the event of high potassium levels, high-dose albuterol is effective in stimulating the release of insulin. This causes the sodium-potassium pump to force potassium into the cells, and it helps the body to correct the hyperkalemic state. 

Albuterol administration in normal doses may help correct respiratory acidosis from decreasing hypoxia. However, it is not indicated for the treatment of metabolic acidosis in patients with hyperkalemia. 

High-dose albuterol stimulates the release of insulin; it does not increase the amount of available calcium at the cellular level.

123.

Which of the following is appropriate for the management of a patient with a head injury and signs of increasing ICP?

Select the four answer options which are correct.

  • Rapid, careful intubation

  • Rapid transportation to a trauma center

  • Prevent overheating of the patient

  • Maintain end-tidal 35-40 mmHg

  • Hyperventilation to reduce ICP

  • Maintain end-tidal 35-45 mmHg

The most important intervention for a patient with a head injury and signs of increasing IntraCranial Pressure (ICP) is rapid transportation to a trauma center capable of treating TBI. Other important management principles include rapid, careful intubation with adequate ventilation to maintain oxygenation and reduce ICP; prevent overheating of the patient because this can make the brain injury worse; and ventilate to maintain a target end-tidal CO2 of 35-40 mmHg.

It is not appropriate to hyperventilate a head-injury patient, as this can worsen ICP and make the injury worse. 

124.

You are on-scene with a patient in cardiac arrest. You turn the monitor/defibrillator on and attach the pads to the patient. When it begins to analyze the patient's cardiac rhythm, it signals "low battery" and then shuts off. You have no other batteries available, and an electrical plug is not available. The patient subsequently dies despite adequate CPR and advanced airway and ventilation during transport.

Which of the following could result?

  • Negligence charges could be brought against the paramedic in charge of the unit

  • Battery charges could be brought against the entire service

  • Manslaughter charges could be brought against the entire crew on scene

  • Defamation charges could be brought against the entire crew on scene

Correct answer: Negligence charges could be brought against the paramedic in charge of the unit

It is important to ensure that all life-saving or sustaining equipment is working properly and fully charged at the onset of your shift. Failures, such as dead batteries or carrying defective equipment, could result in negligence charges being filed against the EMS crew that responded to the scene because their actions resulted in the worsening of a manageable condition. They also did not act in the same manner an equally qualified provider would have.

Battery charges could only result from forcing treatment or an unwanted touch or procedure. 

Although manslaughter charges are possible for inappropriate care, it is not likely to occur in this type of situation. Equipment failure is negligent but does not mean the provider intended harm to the patient, and the entire crew on scene would not be charged with manslaughter.

Defamation charges would most likely result from intentionally harming another person's reputation and do not apply in this case.

125.

What are the differences between syndrome of inappropriate ADH secretion (SIADH) and diabetes insipidus (DI)?

Select the 3 answer options which are correct.

  • ADH levels are higher in SIADH

  • Hypotension is present in DI

  • Fluid overload occurs in SIADH

  • ADH levels are lower in SIADH

Diabetes insipidus (DI) and syndrome of inappropriate ADH secretion (SIADH) result from abnormalities in antidiuretic hormone (ADH) regulation.

  • SIADH: ADH levels are abnormally high, leading to decreased urinary output and fluid retention, resulting in fluid overload.
  • DI: ADH levels are abnormally low, leading to excessive urination, dehydration, and often hypotension (low blood pressure).

126.

Scene

Based on the information given in this scenario, which of the following are appropriate to perform at the scene for this patient? 

Select the 3 answer options which are correct.

  • Oxygen via nasal cannula

  • 324 mg of chewable baby aspirin

  • Obtain right-sided 12-lead ECG

  • 0.3 mg nitroglycerin sublingually

  • 12 mg morphine sulfate IV

  • 500 mL isotonic IV fluid bolus

This patient is exhibiting signs and symptoms of a right-sided myocardial infarction. Proper treatments on the scene for this patient include:

  • Administration of oxygen to maintain an SpO2% of 94% or higher
  • IV access
  • 12-lead ECG (repeat on right side based on initial results)
  • 324 mg of baby aspirin 
  • Small, controlled fluid bolus of isotonic IV fluid with close observation
  • Consider Dobutamine (Dobutrex) or Dopamine (Intropin) infusion if signs of cardiogenic shock are present.

Administration of sublingual nitroglycerin is contraindicated and may worsen this patient's condition. Morphine may be administered during the management of this patient if protocols allow, but at a much lower dose than 12 mg. Use extreme caution with morphine in patients with a right-sided MI. A small fluid bolus may be appropriate for this patient, but 500 mL is too much and may worsen his condition.

127.

You have a 70-year-old female patient in cardiac arrest. Your partner begins compressions, and another paramedic on-scene begins ventilating with an OPA and BVM. You look over to the fridge and find the patient's DNR orders that state the patient does not want any life-saving procedures, and it looks to be signed and valid. There is no family on-scene.

What are the next steps that you should take?

  • Discontinue all resuscitation measures, and take the next steps of notifying your dispatch and/or local medical coroner or medical control as laid out by protocol

  • Continue basic CPR and airway control, and transport to the hospital so they can determine whether to continue resuscitation

  • Follow full ACLS protocols for at least two minutes to assess whether the patient can be resuscitated

  • Continue basic resuscitation, and attempt to get in contact with the family to determine whether you should discontinue

Correct answer: Discontinue all resuscitation measures, and take the next steps of notifying your dispatch and/or local medical coroner or medical control as laid out by protocol

DNR orders are a legal document, in which a patient and doctor have determined that it is the patient's wish to not have resuscitation attempted. In the end, it has been determined that the patient does not wish for actions to be taken, and EMS is there for the patient.

This can be an incredibly difficult and stressful situation, but by either continuing CPR and transporting the patient or initiating full resuscitative measures, you are going directly against the patient's wishes and could be tried for assault. This is also why it is not appropriate to continue CPR while attempting to contact the family, as this is the patient's decision, not the family's. 

However, if the family is on-scene and asking you to attempt resuscitation, depending on local protocol, you may continue basic procedures and contact your supervisor or medical control to determine how to handle the situation. 

Refusing to continue treatment in a situation that is already extraordinarily stressful may escalate the situation, so make sure all attempts have been made to determine the best course of action.

128.

You are on-scene with a 59-year-old patient who complains of generalized weakness. On arrival, she is found to be lethargic, hypotensive, and experiencing unexplainable bradycardia at 42 beats per minute. Her breath sounds are clear and equal, and respirations are adequate.

Which of the following could be the possible cause of your findings?

  • An overdose of a beta blocker medication

  • An overdose of narcotic medications

  • Overdose of benzodiazepine medications

  • An overdose of a beta agonist medication

Correct answer: An overdose of a beta blocker medication

Medications that have negative inotropic/chronotropic effects, such as beta blockers, calcium channel blockers, and antiarrhythmic medicines, can cause unexplained bradycardia and hypotension. Hypersensitivity, toxicity, or overdose of one of these medications could cause the findings in this case.

With an overdose of narcotic medications or benzodiazepines, there would be a noticeable decrease in respiration due to the depressant properties of these medications. While the patient has some of the symptoms of an overdose of these medications, because she is experiencing adequate respirations, this is likely not the case. 

An overdose of a beta agonist medication would cause tachycardia.

129.

What is the best way to increase a conscious and alert, dyspneic patient's lung volume and improve her vital capacity while reducing the venous return to the heart and her overall work of breathing?

  • Place the patient in the sitting position with her legs dependent and apply oxygen

  • Assist ventilations using a bag-valve-mask and supplemental oxygen

  • Place the patient supine with the head and foot of the stretcher elevated 10 degrees while applying oxygen

  • Administer a nebulized albuterol treatment with supplemental oxygen

Correct answer: Place the patient in the sitting position with her legs dependent and apply oxygen

A dyspneic patient is suffering from air hunger and is in need of supplemental oxygen as well as a better lung environment for gaseous exchange. The best way to accomplish this in a conscious and alert patient is to sit the patient up and have her legs hanging dependently, which will improve her overall lung volume and capacity while diminishing the work of breathing and venous return to the heart.

It will not improve the patient's lung volume or capacity if a paramedic attempts to ventilate a conscious and alert patient. This would also not be helpful in reducing venous return or reducing the work of breathing because the patient is likely to fight the bag-valve-ventilation attempt. 

It is not an acceptable patient positioning technique to raise the head of the stretcher and the foot of the stretcher ten degrees. An EMS professional should either raise one or the other, never both ends of the stretcher. In this case, neither the head nor the foot elevated would help improve lung and vital capacity or reduce venous return. 

A nebulized albuterol treatment may be effective in improving the quality of a patient's spontaneous respirations by inducing bronchodilation to the constricted air passages, but it does not affect the lung volume and capacity as well as venous return to the heart.

130.

While on-scene with a 70-year-old complaining of chest pain, what is one of the first indicators that should alert the paramedic to the probability that an acute myocardial infarction is occurring?

  • The presence of persistent chest pain not relieved by nitroglycerin therapy

  • The relief to some degree of chest pain after the administration of nitroglycerin

  • The presence of chest pain not changed or relieved by oxygen therapy alone

  • Cyanosis around the patient's mouth, nose, and nail beds

Correct answer: The presence of persistent chest pain not relieved by nitroglycerin therapy

Patients experiencing chest pain suspected of having a cardiac origin are treated as if they are having a true Myocardial Infarction (MI) until it is proven otherwise (usually at the hospital). However, an early indicator that a patient may be experiencing a true myocardial infarction is if the patient's chest pain remains the same or worsens after the administration of nitroglycerin. Nitroglycerin is often effective in reversing ischemic chest pain caused by angina but not in cases of true MI.

Patients who receive some relief of chest pain after the administration of nitroglycerin are more than likely experiencing angina pectoris and not a true myocardial infarction. 

Often, patients experiencing a true MI and/or an ischemic event, such as angina pectoris, report unchanged chest pain after the administration of oxygen therapy alone. Therefore, it is not a reliable indicator of the presence of an MI.

Cyanosis is a bluish, gray discoloration of the skin in areas around the mucosa and nail beds peripherally. It is mainly caused by hypoxia and hypoxemia; it is not normally associated with an acute myocardial infarction or angina pectoris event (unless there is associated congestive heart failure, which is not addressed here). However, if cyanosis were present, it would indicate severe hypoxia to the paramedic; it would not be seen as an indicator of the probability of an MI.

131.

Your pregnant adult patient presents with a headache, blurred vision, and upper right quadrant pain that she rates at 8 on the pain scale. She denies trauma, bleeding, and/or any other complaints not listed. Her skin is warm and dry with +2 pitting edema noted peripherally. Her pulse is 100 per minute, and her blood pressure is 188/120, confirmed in both upper extremities. The patient denies any past medical history or problems throughout the pregnancy but states she has been unable to acquire prenatal care. Evaluating her fundal height, you estimate the patient is around the 24th week of pregnancy. Due to the patient's signs, symptoms, and complaints, which of the following conditions is most likely to cause the abnormal findings in this case?

  • Preeclampsia

  • Eclampsia

  • Gestational diabetes mellitus

  • Ectopic pregnancy

Correct answer: Preeclampsia

Preeclampsia is gestational-caused hypertension with proteinuria. Hypertension can be mild to severe with diastolic pressures exceeding 110 mmHg. The signs and symptoms of preeclampsia are characterized by the results of hypoperfusion of the involved tissues and organ systems. These may include headache with or without hyperreflexia, blurred vision, and diplopia. The patient may complain of right upper quadrant or epigastric pain. The key finding involves hypertension and abdominal pain, especially when the patient has no history of high blood pressure.

Patients experiencing eclampsia typically present with the signs and symptoms associated with preeclampsia as well as new-onset seizure activity caused by the hypoperfusion of brain tissue. Seizure activity is the key finding indicating the progression of the condition from preeclampsia to eclampsia. Gestational diabetes is characterized by the body's inability to properly use glucose during pregnancy. It does not cause a patient to present with signs and symptoms such as headache, hypertension, abdominal pain, and +2 pitting edema. Patients with gestational diabetes are more likely to present with the classic signs and symptoms of high or low blood sugar with abnormal blood glucose readings. A patient with an ectopic pregnancy will likely present with severe lower quadrant abdominal pain, cramping, with vaginal bleeding. The bleeding may be light or heavy; it may even be spotty. However, some patients with an ectopic pregnancy may experience severe hemorrhage and hypovolemic shock, leading to hypotension, not hypertension.

132.

You are assessing a 70-year-old patient for mild shortness of breath. She is breathing 28 times per minute with an SpO2 of 90% on room air. What can you expect the patient's partial pressure of oxygen (PO2) to do at this point?

  • Decrease to 60 mmHg

  • Increase to 80 mmHg

  • Increase to 40 mmHg

  • Decrease to 27 mmHg

Correct answer: Decrease to 60 mmHg 

As a dyspneic patient's blood oxygen saturation (SpO2) drops to 90%, the paramedic can expect the patient's partial pressure of oxygen at the cellular level to decrease from normal to 60 mmHg.

As a dyspneic patient's blood oxygen saturation decreases to 90%, the partial pressure of oxygen also decreases. Therefore, it is not acceptable to assume that if the SpO2 decreases the PO2 will increase. As O2 saturation decreases to 90%, the patient remains well-ventilated and perfusion continues adequately. However, it is not appropriate to assume the patient's partial pressure of oxygen will rise to a level that is considered extremely low. 

If the partial pressure of oxygen dropped to 27 mmHg, the oxygen saturation is reduced to 50%, not 90%.

133.

If a myocardial infarction patient presents with bradycardia and hypotension, which of the following is most likely the cause?

  • Parasympathetic nervous system response to an inferior wall MI

  • Sympathetic nervous system response to an anterior wall MI

  • The vasodilation of peripheral blood vessels caused by the sympathetic nervous system stimulation

  • The inability of the ischemic sympathetic nervous system to maintain an adequate heart rate and blood pressure

Correct answer: Parasympathetic nervous system response to an inferior wall MI

Vital signs response to a myocardial infarction partly depends on the area and type of autonomic nervous system involvement. Inferior wall myocardial infarctions often show a mainly parasympathetic response while anterior wall Myocardial Infarctions (MI) present with a mainly sympathetic response to the infarction. Sympathetic nervous system stimulation caused by an anterior wall myocardial infarction would cause the patient to present with tachycardia and hypertension, not bradycardia and hypotension.

A myocardial infarction patient who presents with bradycardia and hypotension is likely experiencing an inferior wall MI. The bradycardia and hypotension are not caused by the sympathetic nervous system or vasodilation of peripheral blood vessels. 

Bradycardia and hypotension associated with an MI are not caused by an ischemic sympathetic nervous system. The bradycardia and hypotension are caused by the parasympathetic nervous system stimulation of an inferior wall MI. 

134.

Scene

In this scenario, which of the following medications would be the most appropriate to administer first?

  • IV Propanolol (Inderal) 

  • IM Dexamethasone (Decadron)

  • IV Adenosine (Adenocard)

  • IV Midazolam (Versed)

Correct answer: IV Propanolol (Inderal) 

This patient exhibits signs of thyroid storm, for which a beta-blocker such as Propanolol (Inderal) is indicated.

Dexamethasone (Decadron) may be helpful for this patient, but it should be given IV after a beta blocker has been administered. The cause of this patient's tachycardia is the thyroid storm; Adenosine (Adenocard) would not be indicated at this time. Midazolam (Versed) could be used if this patient develops seizures or becomes severely agitated, but the beta blocker would be indicated first.

135.

Which of the following medications may be effective in reversing the signs and symptoms of dystonia?

  • Diphenhydramine

  • Morphine sulfate

  • Promethazine

  • Lidocaine

Correct answer: Diphenhydramine

Diphenhydramine (Benadryl) is an antihistamine that functions as an anticholinergic agent. It helps to reverse the painful muscle spasms associated with dystonia by helping return normal muscle cell stimulation.

Morphine sulfate may be indicated for the pain associated with the severe muscle spasms that accompany dystonia; however, it is not likely to reverse the conditions causing the spasms. 

Promethazine is an antiemetic given for mild sedation, nausea, and vomiting. It is not capable of reversing the muscle spasms associated with dystonia. 

Lidocaine is an antidysrhythmic agent effective in slowing some very fast ventricular heart rates but is not effective in helping reverse the effects of dystonia.

136.

You are on-scene at a motor vehicle accident, and your 20-year-old patient is entrapped. The patient is unconscious and unresponsive and has a palpable carotid pulse that is weak and thready. The patient's breathing is slow and shallow at four times a minute with equal chest wall expansion. There are no obvious deformity injuries or hemorrhage noted. Fire department on-scene has stabilized the vehicle and provided you and your partner a relatively safe environment to manage the entrapped patient. However, access is limited to the seated patient, and extrication is expected to take another twenty minutes.

After having your partner maintain cervical spine stabilization, which of the following would be the best choice for securing the patient's airway?

  • Insert a King LTD and begin assisting ventilations with a bag-valve mask

  • Insert a nasal airway and administer high-flow oxygen therapy

  • Use nasotracheal intubation techniques to gain complete control of the patient's airway and assist ventilation

  • Intubate the patient using the blind orotracheal intubation technique to maintain in-line mobilization of the spine, then assist ventilation

Correct answer: Insert a King LTD and begin assisting ventilations with a bag-valve mask 

The King LTD airway device should be considered before intubation in situations where the patient is breathing and entrapped, and extrication is expected to be lengthy. It is also the airway device of choice in situations where access is limited and/or the patient is in need of airway control and ventilatory assistance. It is a good choice when cervical spine manipulation must be kept to a minimum.

It would not be the best choice to insert a nasal airway in the nares of an unconscious trauma patient due to the high possibility of a skull fracture, especially when better options are available. Blind orotracheal intubation should be withheld until all else has failed to intubate a dying patient, but many local protocols prohibit its use. It would not be indicated in a trauma situation when a patient is breathing on their own.

137.

Scene

Based on the information in this scenario, which of the following would represent the most likely field impression and proper management for this patient?

  • Hypoglycemia – Administer dextrose IV

  • Hypoglycemia – Administer oral glucose

  • Hyperglycemia – Administer Glucagon IM

  • Unintentional overdose of narcotic – Administer Narcan (naloxone) IN

Correct answer: Hypoglycemia – Administer dextrose IV

This patient presents with classic signs and symptoms of hypoglycemia. Because he has an altered mental status, blurred vision, and clammy skin, you can assume his blood glucose level is very low. IV dextrose is the most appropriate management for this patient.

Oral glucose will not be as effective and reliable as IV. Glucagon is only used for hypoglycemia. There is no sign that this is a narcotic overdose, so Narcan would be ineffective.

138.

A diabetic patient experiencing diabetic ketoacidosis presents with Kussmaul respirations. What is the body's purpose for initiating this type of spontaneous breathing pattern?

  • Kussmaul respirations are initiated by the body in an attempt to blow off high levels of carbon dioxide that have accumulated

  • Kussmaul respirations are initiated by the body in an attempt to increase the amount of available oxygen for the tissues of the periphery

  • Kussmaul respirations are caused by the overstimulation of the sympathetic nervous system during diabetic ketoacidosis; it does not have a purpose

  • Kussmaul respirations are the body's way of attempting to correct respiratory acidosis

Correct answer: Kussmaul respirations are initiated by the body in an attempt to blow off high levels of carbon dioxide that have accumulated

Patients experiencing diabetic ketoacidosis are likely to present with deep and labored respirations called Kussmaul respirations. This breathing pattern is created by the body in an attempt to blow off dangerous amounts of carbon dioxide that has accumulated in the respiratory system due to the depletion of blood glucose (hypoglycemia).

Kussmaul respirations are not the body's way to increase the amount of available oxygen for the tissues of the periphery. Low oxygen levels initiate an increase in the rate and depth of regular respirations in this event. 

Overstimulation of the sympathetic nervous system does not cause Kussmaul respirations. A stimulated sympathetic nervous system would likely increase the rate of respiration rather than cause a labored, irregular respiratory pattern of varying rate and depth. 

Kussmaul respirations are not the body's way of correcting respiratory acidosis, which would be caused by a low respiratory rate. 

139.

You have an adult patient with respiratory insufficiency whose respirations are shallow and irregular at six times per minute. Their SpO2 is 76%, and you anticipate carbon dioxide retention due to the decreased respiratory effort. Which of the following should you suspect?

  • Respiratory acidosis

  • Respiratory alkalosis

  • Metabolic alkalosis

  • Metabolic acidosis

Correct answer: Respiratory acidosis

Respiratory acidosis is caused by the direct retention of carbon dioxide and the subsequent increase in partial pressure of carbon dioxide. Ineffective respirations are the most common cause of respiratory acidosis. 

Respiratory alkalosis is caused by an increased respiratory or ventilatory rate. This causes a direct decrease in the available CO2. Hyperventilation syndrome and overaggressive BVM ventilation are the most common causes of respiratory alkalosis in the prehospital setting. 

Metabolic alkalosis is a rare condition that results from a direct loss of hydrogen ions. This is most often caused by excessive nausea/vomiting and diarrhea and is not associated with ineffective respiration. 

Metabolic acidosis is caused by an increase in acids or a decrease in base and is not caused by ineffective respiratory effort.

140.

Which of the following are internal factors that can affect respiration?

Select the 2 answer options which are correct.

  • Pneumonia

  • Heart failure

  • Carbon monoxide (CO) poisoning

  • High altitudes 

Gas exchange in the lungs and tissues is known as respiration. Factors that affect respiration can be categorized as internal or external. Pneumonia causes the alveoli to become saturated with fluid and debris, reducing the surface that is available for gas exchange. It is considered an internal factor. Heart failure causes a backup of fluid in the lung, leading to alveolar collapse. This reduces the area for gas exchange and is considered an internal factor.

Carbon monoxide (CO) is a colorless, odorless, tasteless gas that is caused by incomplete combustion. It has a higher affinity for hemoglobin than oxygen and blocks oxygen binding. This interferes with gas exchange and causes hypoxia. CO is not produced in the body and must be inhaled, so it is considered an external factor. 

At high altitudes, the percentage of oxygen remains the same, but the total atmospheric pressure decreases. This can significantly increase the work of breathing and reduce gas exchange. It is an external factor.

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