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Quiz Session - Attempts With Random Questions

NREMT Paramedic Exam Questions

Page 3 of 60

41.

Which of the following would be indicated in refractory ventricular fibrillation when repeated shocks and epinephrine fail to convert the lethal rhythm?

  • Amiodarone

  • Atropine

  • Procainamide

  • Lidocaine

Correct answer: Amiodarone

Amiodarone is the drug of choice for the treatment of a patient experiencing refractory ventricular fibrillation after the administration of stacked shocks and epinephrine or vasopressin fails to convert the lethal rhythm to a viable rhythm.

Atropine is not indicated for the treatment of patients in ventricular fibrillation; therefore, it would not be used. Procainamide and lidocaine are used in the treatment of accelerated tachycardias such as PSVT; they are not indicated in the treatment of ventricular fibrillation.

42.

You are on-scene with a patient who accidentally lacerated the lateral aspect of their right upper thigh with a chainsaw. You are able to quickly control the hemorrhage with a pressure dressing and direct pressure; however, the loss of blood was obviously significant prior to your arrival. The patient is conscious but confused with cool, pale, and diaphoretic skin and is tachycardia and tachypneic. The patient's only complaint is being cold and increasing shortness of breath.

Why is your patient most likely becoming increasingly dyspneic?

  • The loss of erythrocytes decreases the amount of oxygen the available blood can carry to the tissues of the body

  • The sympathetic response to shock causes an increase in the rate of ventilation, and the decreased blood volume causes hypoperfusion of the lungs

  • The shortness of breath is being caused by the increased oxygen demand of the vital organs in times of hypoperfusion (shock)

  • The increasing shortness of breath is being caused by the associated respiratory acidosis caused by shock

Correct answer: The loss of erythrocytes decreases the amount of oxygen the available blood can carry to the tissues of the body

The main priority of erythrocytes, or Red Blood Cells (RBC), is to carry oxygen to the tissues and organs of the body and carry carbon dioxide from the tissues back to the lungs to be re-oxygenated. Each erythrocyte molecule is capable of carrying four oxygen molecules to the tissues of the body. When the patient suffers a significant loss of blood, erythrocyte counts can significantly drop. This loss of RBCs can cause shortness of breath due to the decreased oxygen reaching the tissues.

Although the sympathetic response to blood loss and shock causes an initial increase in the rate and depth of ventilation and heart rate, it is not the cause of increasing shortness of breath as shock progresses. The direct cause of shortness of breath associated with significant blood loss is associated with the loss of RBCs and the oxygen-carrying capabilities of the remaining blood volume. 

The increasing shortness of breath during shock is not associated with increased oxygen demand. It is directly related to the loss of erythrocytes, or red blood cells. 

Respiratory acidosis is caused by a decrease in respirations or hypoventilation. This patient is experiencing tachypnea, not bradypnea.

43.

Your 30-year-old patient presents with severe anxiety, agitation, and hyperactivity. His heart rate is 138 beats per minute and irregular. He is hypertensive and quickly admits to cocaine ingestion in the past few hours. He is very agitated and fears he will die.

Which of the following would be most effective in managing this patient?

  • Diazepam

  • Nitroglycerin

  • Morphine

  • Naloxone

Correct answer: Diazepam

The mainstay of treatment for cocaine toxicity/overdose is the rapid administration of benzodiazepines such as diazepam. It helps reduce the associated anxiety, aggression, and fear associated with cocaine ingestion. It will also reduce the possibility of associated seizures and reduces the firing of nerve impulses.

Nitroglycerin and morphine would be appropriate in the management of cocaine-induced chest pain; however, chest pain is not mentioned in this case. 

Naloxone (Narcan) is a narcotic antagonist; it is not effective in reversing the adverse effects of stimulant drugs such as cocaine.

44.

What is the normal time for the QR interval?

  • 0.06 to 0.1 seconds

  • 0.12 to 0.15 seconds

  • 0.12 - 0.2 seconds

  • 0.05 seconds

Correct answer: 0.06 to 0.1 seconds

The QR interval is usually between 0.06 - 0.1 seconds. The time it takes for the total QRS interval to occur is .08 to .12 seconds.

45.

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.

46.

You are on-scene with a 60-year-old patient complaining of dyspnea, chest pain, and nausea/vomiting. Once on the monitor, it is clear the patient is experiencing pronounced polymorphic ventricular tachycardia with a weak, thready carotid pulse and a blood pressure of 60 mmHg.

Which of the following is the most appropriate initial intervention?

  • High-energy unsynchronized shocks

  • Low-energy synchronized shocks

  • A single precordial thump

  • Establish an IV, and give 1 mg of epinephrine

Correct answer: High-energy unsynchronized shocks

Patients who present with conscious polymorphic ventricular tachycardia are likely to deteriorate into pulseless ventricular fibrillation rapidly. Therefore, it is imperative to recognize the life-threatening dysrhythmia and react rapidly with unsynchronized defibrillation at higher than normal energy levels (300-360 joules).

Low-energy synchronized shocks are not effective for treating polymorphic ventricular tachycardia. Synchronization is not possible with irregular waveforms, and the low-energy level is not likely to convert the chaotic rhythm. A single precordial thump is an approved treatment for witnessed onset of ventricular tachycardia. However, it is not recommended when the ventricular tachycardia is polymorphic and not witnessed. The initial treatment for polymorphic ventricular tachycardia is to treat the rhythm as if it were ventricular fibrillation. The treatment should start with high-energy unsynchronized shocks. IV epinephrine administration is secondary and is usually given after the patient loses consciousness.

47.

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.

48.

What is the purpose of the heart valves?

  • To prevent backflow of blood in the heart chambers

  • To push the blood forward through the ventricles

  • To keep oxygenated blood apart from deoxygenated blood

  • To contract the ventricles

Correct answer: To prevent backflow of blood in the heart chambers 

The heart valves open and close primarily to prevent blood from backing up. Ventricular contraction is a multifaceted process, caused by mechanical contraction and electrophysiology of the heart cells. 

49.

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.

50.

When you are auscultating a patient's heart sounds, what does the cardiac cycle's first sound (S1) indicate?

  • Closure of the atrioventricular valves

  • Opening of the atrioventricular valves

  • Closure of the aortic and pulmonic valves

  • Opening of the aortic and pulmonic valves

Correct answer: Closure of the atrioventricular valves

Heart sounds occur as a result of the closure of the heart valves. The "lub-dub" sounds are both closure sounds, the sounds made when the valves close, not open. The first heart sound of the cardiac cycle occurs with the closing of the atrioventricular valves during ventricular systole.

The first heart sound of the cardiac cycle is not the opening of the atrioventricular valves; it is the closing of the AV valves during ventricular systole. The second heart (not the first) sound heard during the cardiac cycle is when the aortic and pulmonic valves close, signaling the beginning of ventricular diastole. The opening of any valves does not cause the first heart sound.

51.

Cushing's triad is indicative of brainstem herniation in the closed head injury patient. The three components of Cushing's triad include which of the following? 

Select the 3 answer options which are correct.

  • Widening pulse pressure

  • Bradycardia 

  • Changes in respirations 

  • Loss of consciousness 

  • Tachycardia 

  • Pinpoint pupils

The three components of Cushing's triad include widening pulse pressure, bradycardia, and changes in respirations. 

Loss of consciousness is common in most head injuries but does not by itself indicate brainstem herniation. It is not part of Cushing's triad. 

52.

You are on-scene with a patient who was struck by a car on her bicycle. She is conscious and alert but has a possible closed right mid-shaft femur fracture. The patient advises you that she is sixteen but does not need parental consent to be treated. Which of the following situations would make this statement true?

  • She is an emancipated minor granted by the court

  • She is an orphaned minor who lives alone

  • She is not a US citizen and is visiting on a student visa

  • She can be treated under implied consent because her injury may become life-threatening

Correct answer: She is an emancipated minor granted by the court

In most states, a minor is not an adult until the age of eighteen unless the person is an emancipated minor. Emancipation is the legal release of an individual from parental control, supervision, and responsibility. An example would be a married minor, a minor who is a parent themselves, and minors in the military before the age of eighteen.

Orphaned minors will have a legal power of attorney even if the guardian is the state. They do not possess the legal right to make medical decisions on their own behalf. 

Persons visiting the US on student visas are normally assigned to a US family or a staff member within the college. This person would more than likely have the legal authority to make medical decisions for the minor. This is known as medical power of attorney. 

The only time that implied consent would be useful in this type of scenario is if the minor patient was unconscious.

53.

You are called to the scene where a 36-year-old male was shot in the back while running away from an assailant. While treating and attempting to stabilize the patient, what should be done with the clothing he was wearing?

  • Place them in a paper bag along with the disposable latex gloves you were wearing when you took or cut the clothing off; seal the bag, listing the items it contains; document the patient's name, time/date, and your name and title on the bag

  • Place them in a plastic evidence bag; do not seal the bag; label it with the time, date, and your name with affiliation; give it to law enforcement on-scene

  • Lay them to the side when they are cut or taken off; notify the officers on-scene to allow them to gather the evidence properly

  • Place all cut or removed clothing between the patient's legs on the stretcher during transport to ensure the items make it to the emergency department where law enforcement will gather them properly

Correct answer: Place them in a paper bag along with the disposable latex gloves you were wearing when you took or cut the clothing off; seal the bag, listing the items it contains; document the patient's name, time/date, and your name and title on the bag

When dealing with a crime scene and a victim, it is best not to touch anything that is not completely necessary to deliver adequate patient care to the victim. If clothing is to be removed that may contain blood or other evidence, it is protocol in most regions of the country for EMS personnel to place the items of clothing in a paper bag; seal the bag; and label it with the time, date, and your credentials.

EMS personnel should not place items of potential evidence in an evidence bag used by law enforcement. Red-tagged evidence bags should only be used by the trained law enforcement handling the scene. This is to avoid any problems with the chain of evidence. Place evidence in a paper bag, and law enforcement will properly process the evidence. 

If items of clothing involved in a crime scene are just left to the side or placed between the victim's legs for law enforcement to gather later, it will likely result in lost evidence. These scenes are so chaotic and fast paced that items often get misplaced or lost if a simple but straightforward method of gathering the evidence is not observed.

54.

Diastole can be broken down into three phases. In which phase does the pressure between the atria and ventricles become equal?

  • Diastasis

  • Atrial kick

  • Isovolumetric relaxation

  • Rapid filling phase

Correct answer: Diastasis

The phases of diastole are as follows:

  1. Rapid filling phase - when the AV valves are open and blood flows into the ventricles
  2. Diastasis - when the pressure between the atria and ventricles begin to equalize
  3. Atrial kick - when the atria contract and expel what little blood is in the chambers into the ventricles.

Isovolumetric relaxation is a phase in systole.

55.

Which of the following are indicators of lower airway obstruction?

Select the 3 answer options which are correct.

  • Rales

  • Rhonchi 

  • Wheezing

  • Stridor 

Wheezing is associated with bronchospasm, indicating lower airway obstruction. Rales, also known as crackles, are associated with fluid in the alveoli and indicate a lower airway issue. Rhonchi are sounds caused by mucus or other secretions in the larger airways, indicating lower airway obstruction.

Stridor is a high-pitched, wheezing sound caused by disrupted airflow, typically indicating an upper airway obstruction.

56.

Identify the rhythm.

  • Ventricular pacing

  • Atrial pacing

  • Dual chamber pacing

  • Cardioversion

Correct answer: Ventricular pacing

The rhythm is being depolarized by a ventricular pacemaker, as evidenced by the spike followed by the wide QRS complex.

In atrial pacing, a spike precedes a P wave. Both of these spikes occur in dual chamber pacing. Cardioversion is used when a patient is in acute atrial flutter/atrial fibrillation.

57.

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.

58.

Your 15-year-old patient took a direct hit, helmet first, to his chest while playing in a football game. The patient is complaining of chest pain and palpitations. The patient has no past medical history and does not take any medications. What should you do?

  • Perform a 12-lead ECG

  • Place the pads and prepare for defibrillation

  • Place the pads and prepare for synchronized cardioversion

  •  Have the patient perform vagal maneuvers

Correct answer: Perform a 12-lead ECG

The patient took a direct hit to the chest and is now complaining of chest pain. There are several conditions that could occur with this mechanism of injury. Since the patient is complaining of chest pain and palpitations, you must perform a 12-lead ECG to see if there has been damage to the heart.

There is no need to place pads for defibrillation or synchronized cardioversion because the patient is showing no signs or symptoms that warrant this action. Also, there is no need to perform vagal maneuvers because we do not know the patient's heart rate. 

59.

Post-Scene

You are completing a patient care report for the given scenario. Which of the following would be the most accurate to include in the patient care report (PCR)?

  • The patient's initial GCS was 13 and returned to normal after ALS treatment on-scene.

  • The patient's initial GCS was 12 and returned to normal after ALS treatment on-scene.

  • The patient's initial GCS was 12 and increased to 14 after ALS treatment on-scene.

  • The patient's initial GCS was 10 and improved to 13 after ALS treatments on-scene.

Correct answer: The patient's initial GCS was 13 and returned to normal after ALS treatment on-scene.

The Glasgow Coma Scale (GCS) consists of three components: eye-opening, verbal response, and motor response, with scores ranging from 3 to 15.

A score of 15 indicates normal neurological function, while lower scores indicate various degrees of impairment. In this scenario, the patient's initial GCS was 13 because his eyes were open spontaneously, he used inappropriate words when asked his name, and he obeyed commands. After receiving advanced life support (ALS) treatment on the scene, the patient's GCS returned to normal.

60.

Which of the following arrhythmias is resolved by carotid massage?

  • Paroxysmal supraventricular tachycardia

  • Atrial flutter

  • Paroxysmal atrial tachycardia

  • Multifocal atrial tachycardia

Correct answer: Paroxysmal supraventricular tachycardia 

Carotid massage has zero effect on atrial flutter, multifocal atrial tachycardia, and paroxysmal atrial tachycardia. For paroxysmal supraventricular tachycardia, carotid massage helps slow down or terminate the rhythm.

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