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Quiz Session - Attempts With Random Questions

NREMT Paramedic 1.4.12 Exam Questions

Page 9 of 60

161.

Your adult patient called for help after she began to vomit bright red blood. On arrival, the patient is found to be tachycardic and bleeding freely from her mouth. Her respirations are shallow, and her skin is cool with a blood pressure that is 68 systolic. Her only history involves liver disease from chronic alcoholism. She denies drinking recently.

What should be the goal of your pre-hospital intervention with this patient after ensuring her airway and applying oxygen therapy?

  • Fluid resuscitation to maintain a systolic blood pressure of 80-90 systolic

  • Fluid resuscitation to maintain a blood pressure of at least 100 systolic

  • To control the hemorrhage with pharmacologic intervention

  • Maintaining a high blood oxygen saturation to continue perfusion at the cellular level

Correct answer: Fluid resuscitation to maintain a systolic blood pressure of 80-90 systolic

The pre-hospital goal for managing a possible esophageal varices patient is to maintain an adequate airway, administer oxygen, and administer fluid resuscitation to maintain the blood pressure of 80-90 systolic. Bleeding from esophageal varices is not likely to be controlled in the pre-hospital setting. A blood pressure any higher could actually worsen the hemorrhage.

It is recommended that a blood pressure should be kept in the 80-90 systolic range when esophageal varices are suspected. This is thought to lessen the extent of the hemorrhage. A blood pressure of 100 systolic could worsen the bleeding. 

There are no appropriate or accepted pharmacological interventions for the control of hemorrhage from esophageal varices in the pre-hospital setting. It is an emergency surgical condition. 

It is appropriate to attempt to maintain a high SPO2 level. However, fluid resuscitation is important to keep the blood containing the oxygen reaching the cells.

162.

You are called to assist a 55-year-old male who complained of sudden onset chest pain, dyspnea, and palpitations. On arrival, he is found unconscious with a pulse rate too fast to palpate and a blood pressure of 75/43. Once on the monitor, you immediately recognize Torsades de Pointes at approximately 200 beats per minute.

Which of the following would be the most appropriate intervention for this patient?

  • High-energy unsynchronized shock

  • Start Mag Sulfate infusion of 4 g over 30 minutes

  • Administer synchronized cardioversion at 50-100 joules

  • Administer Adenocard 6 mg rapid IVP followed by a 10 cc saline flush

Correct answer: High-energy unsynchronized shock

Irregularly irregular ventricular rhythms, known as polymorphic ventricular tachycardia (VT), can quickly (and most often do) deteriorate to ventricular fibrillation. It is appropriate to deliver high-energy defibrillation in an attempt to convert the rhythm to a viable rhythm. Synchronization is not likely possible in the case of polymorphic VT.

Magnesium Sulfate is indicated for polymorhpic VT / Torsades, but it should be administered after an attempt at one unsynchronized shock and the correct dose is 1-2 g over 20 minutes.

It is appropriate to deliver high-energy defibrillation (use the highest setting based on your device recommendations) to patients with polymorphic ventricular tachycardia. The nearly-chaotic rhythm is not likely to respond to low energy (50 joules) or stacked shocks. Torsades de Pointes will usually not permit synchronized cardioversion. It is not acceptable to administer adenosine (Adenocard) to a patient experiencing unstable tachycardia.

163.

Which of the following is true regarding a first degree AV block?

  • The PR interval is prolonged

  • The QRS complex is greater than  0.12 seconds

  • It is also known as a Wenckebach block

  • It occurs in tachycardia

Correct answer: The PR interval is prolonged 

A first degree AV block can occur at any rate. The P waves are upright and matching, and the QRS complexes are regular and constant. The PR interval is prolonged, greater than 0.2 seconds.

A Wenckebach block is a Mobitz I second degree AV block that is caused by a progressively weakening AV node.

164.

You are treating a 50-year-old male with a cardiac history currently complaining of chest pain. He is breathing at 20 times a minute, has an irregular heart rate of 136 beats per minute, and a blood pressure of 120/60. His twelve-lead-tracing indicates the presence of an ST-elevation myocardial infarction (STEMI).

What makes the ST-elevation infarction treatment different from a non-STEMI patient's treatment?

  • ST-elevation infarctions may respond to fibrinolytics, so time and destination are critical for this patient

  • A non-ST elevation infarction may respond to fibrinolytics, so destination is important for this patient

  • ST-elevation patients will need a fluid bolus to maintain an adequate blood pressure

  • Nothing, both types will respond to fibrinolytic therapy equally

Correct answer: ST-elevation infarctions may respond to fibrinolytics, so time and destination are critical for this patient

ST-elevation myocardial infarction (STEMI) patients often respond well to fibrinolytics, so these patients should have a thrombolytic screening and be transported to a specialty medical facility that can handle a STEMI.

A non-STEMI patient can be treated and transported to the nearest facility with or without fibrinolytic capabilities. These patients are not likely candidates for the administration of fibrinolytic therapy. ST elevation does not typically require blood pressure maintenance with fluid blouses. The difference is that STEMI responds to fibrinolytics while a non-STEMI will not.

165.

Which of the following heart rhythms is treated with atropine?

  • Bradycardia

  • Tachycardia

  • Sinus arrhythmia

  • Supraventricular tachycardia

Correct answer: Bradycardia 

Atropine, when given, increases a patient’s heart rate, therefore should be avoided at all costs if a patient is already tachycardic. It is used for symptoms such as bradycardia, and persistent sinus arrests and sinus block.

166.

Which of the following is indicated as a treatment for atrial fibrillation lasting greater than 48 hours?

  • IV heparin

  • Defibrillation

  • Beta blockers

  • Atropine

Correct answer: IV heparin

The goal of treatment in atrial fibrillation that is greater than 48 hours old is to control the heart rate and to prevent the risk of blood clots. Treatment options include anticoagulant therapy, IV heparin, and an echocardiogram to rule out blood clots before cardioversion. Beta blockers and atropine are not indicated therapies. Defibrillation is a treatment for ventricular fibrillation and ventricular tachycardia.

167.

Scene

Using the Incident Command System (ICS) in the given scenario, what groups should be established?

Select the 3 answer options which are correct.

  • Treatment

  • Transport

  • Extrication/Rescue

  • Command

  • Finance/Administration

The groups of treatment, triage, extrication/rescue and transport should be established for this incident. More groups such as rehab may be needed as the incident progresses. The treatment group is responsible for providing medical care to patients at the scene of the incident. The rescue group is responsible for extricating and rescuing patients who are trapped or inaccessible due to the collapse of the stage. The transport group is responsible for arranging and coordinating the transportation of patients from the scene to hospitals.

Command for this incident will most likely be singular, as it is considered a closed incident, so a group for command is not needed. The incident commander has already been established by the pre-plan.  Finance/Administration is not needed at this scale of an incident, that section occurs with large natural disasters that will be ongoing for days or weeks.

168.

Scene

Which of the following are appropriate treatments for the patient in the given scenario?

Select the 3 answer options which are correct.

  • Establish large bore IVs and give fluids

  • Continue oxygen via NRB mask

  • Decompress the stomach

  • Perform a needle thoracotomy on the left side

  • Perform medication-assisted intubation

  • Assist ventilations with a BVM attached to 100% oxygen

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

Assisting ventilations with a BVM may worsen his condition, and he is able to maintain his breathing, so it should be avoided at this point. The patient's airway is patent and maintainable, so there is no indication that intubation is necessary at this point. There are no signs of a tension pneumothorax, so needle thoracotomy is not indicated.

169.

There are five types of arrhythmias. The type that causes electrical activity from a focus other than the sinus node is called:

  • Ectopic rhythm

  • Reentrant arrhythmia

  • Preexcitation arrhythmias

  • Conduction blocks

Correct answer: Ectopic rhythm 

An ectopic rhythm is activity that occurs from a focus that is not the sinus node. Arrhythmias of sinus origin contain the same conduction path but are irregular, too fast, or too slow.

Reentrant arrhythmias can occur anywhere in the heart and have a varied array of electrical activity, depending on anatomic issues with the heart. Conduction blocks are sinus rhythms that are either delayed or blocked completely from their path. Preexcitation syndromes form a shortcut from the normal pathways to accessory pathways.

170.

Which of the following joints can a paramedic try to reduce in a prehospital setting if allowed by protocols or medical control? 

Select the 3 answer options which are correct.

  • Shoulder

  • Knee 

  • Wrist 

  • Elbow 

In most EMS systems, a paramedic may make one attempt to reduce a dislocated joint (e.g., shoulder, knee, and wrist) in a prehospital setting, with the only exception being the elbow joint. 

Elbow dislocations pose a high risk of vascular injury and should be immobilized in place without attempts to realign or reduce them. 

171.

What is the purpose of mounting an EKG?

  • To secure the strip to the patient's chart

  • To flag the strip for the provider to review

  • To shred the EKG paper in compliance with HIPAA guidelines

  • To send a copy home with the patient

Correct answer: To secure the strip to the patient's chart 

An EKG mount secures the rhythm to the patient's physical chart, to prevent it from being lost. A mount must be reviewed by a provider before being placed in the chart. An EKG must not be thrown out, as it belongs in the patient's medical record. 

172.

Identify the medications that may be administered intranasally. 

Select the 3 answer options which are correct.

  • Naloxone (Narcan)

  • Glucagon (GlucaGen)

  • Midazolam (Versed) 

  • Epinephrine (Adrenaline) 

The following medications have been approved for intranasal administration: naloxone (Narcan), glucagon (GlucaGen), midazolam (Versed), ketorlac (Toradol), flumazenil (Romazicon), and fentanyl citrate (Duragesic). Most protocols require 2 to 2.5 times the normal dose when giving a medication intranasally. 

Epinephrine is not formulated to be given intranasally. 

173.

You hook a patient up to a 12 lead EKG and notice a small spike in the rhythm followed by a wide and bizarre QRS complex. Based on your knowledge of irregular rhythms, you identify this abnormality as:

  • The sign of a ventricular pacemaker

  • A PVC

  • The beginning of ventricular tachycardia

  • Prinzmetal angina

Correct answer: The sign of a ventricular pacemaker

When a ventricular pacemaker fires, it will show on the EKG as a small spike, followed by a wide QRS complex that looks similar to a PVC. The difference between this and a PVC is the presence of that pacemaker spike.

Ventricular tachycardia is usually preceded by a ventricular rhythm, caused by lethal rhythms such as a third-degree heart block. Prinzmetal angina is characterized by an elevated ST wave.

174.

The most widely used water rescue model includes which of the following?

Select the 2 answer options which are correct.

  • Reach 

  • Throw 

  • Float 

  • Pull 

The most widely used water rescue model consists of reach, throw, row, and go:

  • Reach: The victim is located close to the shoreline and rescuers can retrieve them by reaching with an outstretched arm or leg, a rescue pole or hook, an oar, a backboard, etc. without having to enter the water. 
  • Throw: The victim is too far away from the shoreline to be reached with a rigid object. Rescuers can throw ropes, rope bags, flotation rings or discs tied to a rope, a life vest tied to a rope, etc. to retrieve the victim without having to enter the water. 
  • Row: The victim is too far away from the shoreline to be reached or to have a flotation device thrown to them. Rescuers must use a boat or approved watercraft to access and retrieve the victim without having to enter the water. 
  • Go: Rescuers must physically enter the water and swim to the victim to retrieve them. This method may be used from the shoreline or a boat depending on the circumstances and should only be attempted by trained rescuers. 

Float is not part of the water rescue model.

175.

In which of the listed conditions should the paramedic consider the potential presence of hyponatremia?

Select the three correct answer options.

  • Addison's disease

  • Renal disease

  • SIADH

  • Cushing's syndrome 

Hyponatremia is often seen in patients with adrenal insufficiency (Addison's disease), renal diseases, and syndrome of inappropriate anti-diuretic hormone (SIADH) due to fluid balance abnormalities associated with these conditions. 

Cushing's syndrome often results in hypernatremia, not hyponatremia, due to sodium retention. 

176.

Which of the following medical conditions or injuries is most likely to cause problems with both the internal and external processes of normal respiration?

  • Emphysema

  • Congestive heart failure

  • Lung cancer

  • Chronic hypertension

Correct answer: Emphysema

Emphysema is an obstructive airway disease that progresses over years. Patients with emphysema have problems with getting inspired air into their lungs due to decreased lung compliance (external respiration) and problems with the oxygen/carbon dioxide exchange at the tissue level. This interferes with internal respiration or gaseous exchange (internal respiration).

Patients with congestive heart failure have problems exchanging oxygen/carbon dioxide at the tissue level (internal respiration) due to the presence of pulmonary edema and fluid shift. However, they do not have problems with the actual process of breathing (external respiration). 

Patients with lung cancer have diffusion problems in the lungs making the normal exchange of oxygen and carbon dioxide impossible at the cellular/tissue level (internal respiration). Lung CA patients without COPD (emphysema, asthma, chronic bronchitis), do not have problems with the actual inspiratory/expiratory phase of respiration (internal respiration). 

Patients with chronic hypertension may have problems with proper oxygen/carbon dioxide exchange at the cellular/tissue level (internal respiration) due to the high pressure involved. However, chronic hypertension patients without COPD do not have problems with the actual act of breathing (external respiration).

177.

Your adult patient is exhibiting the signs and symptoms of shock a week after experiencing a small myocardial infarction that kept the patient in the hospital for two days. The patient reports the doctor had said that there was no permanent damage to the heart, yet the patient has not returned to full activity. The patient's heart rate is 110 with a blood pressure of 68 systolic. Skin is cool, clammy, and diaphoretic with rales auscultated throughout the patient's lungs.

Which of the following would be most appropriate?

  • Dopamine infusion at 2-20 mcg/kg/minute titrated to a systolic BP of 90 mmHg

  • Norepinephrine infusion of 0.5-1.0 mcg/kg/min titrated to a systolic BP of 90 mmHg

  • Administer a fluid challenge of 500-1,000 milliliters of normal saline

  • Dobutamine infusion at 0.5-1 mcg/kg/minute titrated to a BP of 90 mmHg systolic

Correct answer: Dopamine infusion at 2-20 mcg/kg/minute titrated to a systolic BP of 90 mmHg

The patient may be experiencing the signs and symptoms of cardiogenic shock due to the recent Myocardial Infarction (MI) and today's findings. The most appropriate intervention for this patient would be a dopamine infusion. While norepinephrine may be used in most cases of cardiogenic shock, due to the recent history of a myocardial infarction, dopamine is more appropriate due to it being inotropic with minimal increase on the oxygen demand of the heart; norepinephrine is inotropic and chronotropic, putting more strain on a possible weakened heart.

It is not recommended to administer fluid boluses to a patient suspected of experiencing cardiogenic shock. 

Dobutamine is sometimes administered with dopamine in the prehospital setting to reduce the possible adverse effects of dopamine, but it would not be the first-line medication for a patient in cardiogenic shock with a blood pressure of 68 systolic.

178.

The Department of Transportation's (DOT) North American Emergency Response Guidebook (ERG) sorts hazards into nine different classes. Which classes below are matched correctly?

Select the three correct answer options.

  • DOT Class 1: Explosives 

  • DOT Class 5: Oxidizers and organic peroxides 

  • DOT Class 8: Corrosives 

  • DOT Class 4: Radioactive materials 

  • DOT Class 3: Toxic & infectious substances

Here are the nine DOT chemical families recognized in the ERG: 

  • DOT Class 1: Explosives
  • DOT Class 2: Gases
  • DOT Class 3: Flammable/combustible liquids
  • DOT Class 4: Flammable solids, dangerous when wet or water-reactive
  • DOT Class 5: Oxidizers and organic peroxides
  • DOT Class 6: Toxic substances and infectious substances
  • DOT Class 7: Radioactive
  • DOT Class 8: Corrosive substances
  • DOT Class 9: Miscellaneous hazards

179.

What can the paramedic expect to find when evaluating the pupillary response of a patient suspected of suffering from herniation?

  • A unilaterally, unequal, and non-reactive pupil

  • Bilateral pupil dilation

  • Sluggish response, but equal pupils

  • Bilaterally, unequal, and non-responsive pupils

Correct answer: A unilaterally, unequal, and non-reactive pupil

Pupil evaluation is very important in an unconscious patient. When a patient is suffering from herniation, the paramedic can expect to see agonal respirations; a unilaterally, unequal, and non-reactive pupil; and posturing in the later stages. 

Bilateral pupil dilation indicates a sympathetic nervous system response. 

Sluggish pupils are commonly caused by medications or some sort of neurological event but not generally herniation. 

Bilaterally and unequal, non-reactive pupils are seen in some neurological events. They are common in strokes.

180.

When writing a patient care report using the SOAP format to organize the data, in which section would the paramedic want to include any statements made by the family or bystanders concerning the patient?

  • Subjective data section

  • Objective data section

  • Assessment data section

  • Patient care plan section

Correct answer: Subjective data section

The subjective data section of the Patient Care Report (PCR) is the initial section of the format. It is used to document the patient's chief complaint, symptoms, past history, current medications, and allergies. It is also the section that includes anything the patient, family, or bystanders tell you about the patient. Subjective data is information that is told to you.

The objective section of the PCR is used to document the physical exam findings, vital signs, electrocardiogram findings, blood glucose levels, and pulse oximetry readings. Objective data comes from your findings or things you can see. 

The assessment data section of the PCR is used to document the paramedic's general impression of the patient's overall condition based on both the subjective and objective data collected. 

The patient care plan section is used to lay out the current treatment and any additional orders from medical command.

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