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Quiz Session - Attempts With Random Questions

NREMT Paramedic Exam Questions

Page 4 of 60

61.

En-Route

The police officer arrives at the scene before your ambulance. Which of the following could they possibly quickly evaluate before you enter the scene?

Select the 3 answer options which are correct.

  • The presence of hazardous materials

  • Possible seizure condition

  • Possible diabetic condition

  • Possible sepsis

  • Possible stroke

  • An overdose of prescription medications

The police officer can evaluate the vehicle for possible hazardous conditions such as chemicals or carbon monoxide. They can also look for a medical ID bracelet, for which common conditions warranting a medical ID bracelet include seizure disorders or diabetics.

Unless a prescription medication bottle is clearly visible in the vehicle, this would not be a condition they could quickly evaluate. Stroke or sepsis would not be quickly determined by a police officer.

62.

Your patient is a 50-year-old female with a history of hypertension and liver cirrhosis. Her chief complaint today includes abdominal pain with nausea and vomiting of bright red blood. With her history and current findings, which of the following should you suspect?

  • Esophageal varices

  • Bleeding peptic ulcer

  • Acute hepatic failure

  • Congestive heart failure

Correct answer: Esophageal varices

Esophageal varices are bleeding veins in the esophagus. They usually cause sudden massive hemorrhage in patients with alcohol dependency issues and liver disease. Many patients will bleed to death within minutes. Esophageal varices are a true emergency.

Patients with alcohol dependency issues and sometimes liver disease from years of drinking alcohol will sometimes develop bleeding ulcers. However, bleeding ulcers usually present as vomitus that looks like coffee grounds and not bright red blood. 

Patients who experience liver (hepatic) failure lose the ability to filter the blood and remove toxic metabolites from their blood. These patients will likely present with jaundiced skin and sclera as well as nausea and vomiting. However, bright red blood indicates surface bleeding in most cases, such as esophageal varices. 

Congestive heart failure patients are more likely to present with pulmonary edema and pink-tinged sputum, not the bright red, major blood loss as is seen with varices.

63.

Which of the following rhythms requires cardioversion for treatment?

  • Junctional tachycardia

  • Junctional bradycardia

  • Junctional rhythm

  • Accelerated junctional rhythm

Correct answer: Junctional tachycardia 

The treatment for junctional tachycardia is cardioversion, while the treatment for junctional bradycardia is pacing. Junctional rhythm and accelerated junctional rhythms are treated by identifying the cause.

64.

Somatic tremor, a type of artifact, can be caused by:

  • A patient having tremors

  • Deep breathing

  • Electrical interference

  • A broken wire

Correct answer: A patient having tremors 

Somatic tremors are caused by patient tremors or anything that shakes the electric wires. Baseline sways are related to a patient’s breathing pattern. A 60 cycle interference is caused by electrical interference. A broken recording is caused by a frayed or broken wire.

65.

While conducting an EKG on your post-myocardial infarction patient, you note the presence of consistently wide QRS complexes greater than 120 ms in duration. What does this most likely indicate?

  • An intraventricular conduction delay or right/left bundle branch block

  • The patient has a congenital heart defect and should not require emergency care

  • The patient is likely suffering from a myocardial infarction currently

  • A complete heart block indicating no relationship between the atria and ventricles

Correct answer: An intraventricular conduction delay or right/left bundle branch block

Anything that delays the normal conduction through the ventricles will likely cause a conduction delay to appear. The normal QRS duration is fewer than 120 milliseconds. When the duration is greater than 120 milliseconds, it is likely due to intraventricular conduction delay or right/left bundle branch block.

It is beyond the scope of the paramedic to assume a congenital heart defect is the cause of a conduction block present on an electrocardiogram tracing. 

A conduction delay between the atria and ventricles is no reason to assume a myocardial infarction is occurring without the associated signs and symptoms of an infarction. 

A complete heart block would be present if the P-waves and QRS complexes had no relationship with one another. This would indicate they were functioning separately.

66.

Your 40-year-old patient was involved in an ATV accident. She is ambulatory on your arrival but complains of abdominal pain and nausea. The patient is conscious and alert with an unremarkable physical exam except for abdominal tenderness, mild abdominal rigidity, and bruising around the umbilicus.

Which of the following should be suspected until proven otherwise at the trauma center?

  • Retroperitoneal hemorrhage

  • Gastrointestinal bleeding

  • Splenic rupture

  • Liver laceration

Correct answer: Retroperitoneal hemorrhage

Patients who have sustained blunt-force abdominal trauma may have signs and symptoms of different possible internal injuries. Bluish discoloration (Cullen's sign) around the umbilicus is a good indicator of retroperitoneal hemorrhages, such as pancreatic hemorrhage.

Cullen's sign is not a good indicator of patients with gastrointestinal bleeding. This type of hemorrhage may be associated with blunt-force trauma but often causes bleeding from the esophagus or rectum. 

Patients with splenic rupture are more likely to present with referred left shoulder pain from the hemorrhage. It is not as likely to cause periumbilical hemorrhage. 

Liver laceration does not usually cause bleeding around the umbilicus but rather is more likely to cause frank hypotension and upper abdominal distension.

67.

Which of the following is true regarding sinus arrhythmia?

  • Its rate usually varies with the patient's breathing pattern

  • Immediate treatment with an antiarrhythmic is required

  • It is a regular rhythm

  • It contains repetitive P waves

Correct answer: Its rate usually varies with the patient’s breathing pattern

Sinus arrhythmia is an irregular rhythm that originates from the sinus node. Its pattern is cyclic and corresponds with the patient’s breathing pattern. It has an irregular P-P interval, and one P wave to every QRS interval. There is no treatment required.

68.

Identify the following heart rhythm.

  • Normal Sinus Rhythm

  • First-Degree AV Block

  • Sinus Bradycardia

  • Premature Ventricular Contraction

Correct answer: Normal Sinus Rhythm

There are no abnormalities that suggest a First Degree AV Block (a prolonged PR interval) or a Premature Ventricular Contraction (a wide QRS and irregular rhythm). The heart rate on the rhythm strip is approximately 75 bpm. Bradycardia is defined as a heart rate below 60 bpm.

69.

You walk into your patient’s room to check the EKG machine and see that the cord has an exposed wire. The wire is not touching the patient. Which of the following is the correct action for you to take?

  • Immediately change the cord

  • Cover the exposed wire with a piece of tape so it does not touch the patient

  • No action is indicated, as the wire is not directly touching the patient’s skin

  • Call the unit’s biomechanical team to replace the wire

Correct answer: Immediately change the cord

Macroshocks and microshocks can be fatal; therefore, it is vital to change out any broken or frayed wires immediately to prevent harm to the patient.

70.

Which characteristic of cardiac cells gives them the ability to send electrical impulses through the heart?

  • Conductivity

  • Contractility

  • Excitability

  • Automaticity

Correct answer: Conductivity

Conductivity is the ability to pass electrical impulses along neighboring cells.

Automaticity is the cell’s ability to create impulse without any outside stimulation. Contractility is the ability to contract the cardiac muscle. Excitability is the cell’s ability to respond to electrical impulses by depolarization.

71.

You decide to administer CPAP to your spontaneously breathing patient who is complaining of dyspnea. What should the initial pressure valve setting be on a fixed rate FiO2 CPAP device?

  • Between 5 and 10 cm H2O

  • Between 2 and 5 cm H2O

  • Between 1 and 3 cm H2O

  • Greater than 10 cm H2O

Correct answer: Between 5 and 10 cm H2O

CPAP can be attached to a well-fitting face mask that is delivering oxygen to the patient. The breathing circuit may have a fixed or adjustable FiO2 setting and a programmable pressure valve. The initial pressure valve setting for the CPAP device in the pre-hospital setting should be between 5 and 10 cm H2O. This setting should deliver enough pressure to help keep the alveoli open at the end of the respiratory cycle without altering perfusion at the tissue level.

A pressure valve setting below 5 cm H2O will not deliver enough end of respiration pressure to the alveoli to keep them from collapsing. 

A pressure valve setting on the CPAP device that exceeds 10 may be needed to effectively improve perfusion by keeping the alveoli open at the end of respiration; however, most local protocol and medical command physicians recommend initial pressure settings of between 5 cm and 10 cm H2O, increased in 1cm increments until the desired effect is achieved and perfusion improves.

72.

Identify the following rhythm.

  • Sinus rhythm with PVC

  • Junctional rhythm

  • AV block

  • Ventricular tachycardia

Correct answer: Sinus rhythm with PVC 

PVCs are premature beats that originate in the ventricles and will be illustrated on the EKG as a wide, bizarre QRS complex. It is a normal rhythm that is interrupted.

Junctional rhythms originate in the AV junction and, therefore, will present as an irregular P wave. An AV block will present as an irregular PR interval or a dropped QRS. Ventricular tachycardia is a lethal rhythm characterized by large, malformed QRS complexes.

73.

All the following are indications that artificial ventilation is adequate except: 

  • ETCO2 levels are above 45 cm/H2O

  • The pulse returns to a normal rate

  • Adequate chest rise and fall

  • SpO2 rises from 88% to 94%

Correct answer: ETCO2 levels are above 45 cm/H2O

ETCO2 levels can be an indicator of adequate ventilations. Normal ETCO2 levels are 35–45 cm/H20, so a level above 45 would most likely indicate that ventilations are not adequate. 

Artificial ventilations are indicated for a patient with insufficient breathing. Using a bag-valve mask is the most effective way to deliver artifical ventilations. Indications that ventilations are effective include adequate chest rise and fall, oxygen saturation level increases, and the pulse returning to a normal rate. Another indication would be if lung sounds can be auscultated during ventilations. 

74.

Which of the following stages of shock is responsible for the development of a decreased systolic and diastolic blood pressure?

  • Uncompensated shock

  • Compensated shock

  • Reversible shock

  • Irreversible shock

Correct answer: Uncompensated shock

This stage of shock occurs when the body can no longer maintain systemic blood flow to the tissues of the body. The systolic pressure normally begins to fall first in this stage of shock due to the blood loss.

The blood pressure remains normal or slightly elevated in the compensated stage of shock. Uncompensated shock is signaled by the fall in systolic and then diastolic blood pressures. There is not a reversible stage in the progression of shock. However, some refer to the compensated stage, as the reversible stage of shock. Either way, it is not the stage characterized by a fall in systolic pressure. In irreversible shock, hypotension has already taken effect and the body tissues become hypoxic.

75.

On a 12 lead EKG strip, the horizontal side of the strip measures:

  • Time

  • Amplitudes

  • Leads

  • Data

Correct answer: Time

The horizontal side of the EKG strip represents time, while the vertical side represents amplitude. Data is recorded on the EKG strip as a way of assessing the function of the heart. This data is recorded on the EKG by leads attached to the patient's chest.

76.

Diastole can be broken down into three phases. During which phase do the atria contract, squeezing out the remainder of the blood into the ventricles?

  • Atrial kick

  • Diastasis

  • Rapid filling phase

  • Isovolumetric contraction

Correct answer: Atrial kick

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.

77.

Targeted temperature management (TTM) has been proven to improve neurologic recovery after cardiac arrest. Which of the following are true regarding AHA guidelines for TTM in adult patients? 

Select the 2 answer options which are correct.

  • For TTM, healthcare providers should select and maintain a constant target temperature between 32 °C and 36 °C for at least 24 hours.

  • To protect the brain and other organs, TTM should be started in patients who remain comatose with ROSC after cardiac arrest.

  • In the pre-hospital setting, cool patients after ROSC with rapid infusion of cold IV fluids.

  • TTM is contraindicated in STEMI patients with ROSC after cardiac arrest.

To protect the brain and other organs, the high-performance team should start TTM in patients who remain comatose with the return of spontaneous circulation (ROSC) after cardiac arrest. TTM is the only intervention demonstrated to improve neurologic recovery after cardiac arrest. The optimal duration of TTM is at least 24 hours. For TTM, healthcare providers should select and maintain a constant target temperature between 32 °C and 36 °C for at least 24 hours. Although the optimal method of achieving the target temperature is unknown, any combination of rapid infusion of ice-cold, isotonic, non–glucose-containing fluid (30 mL/kg), endovascular catheters, surface cooling devices, or simple surface interventions (e.g., ice bags) appears to be safe and effective. 

In the pre-hospital setting, do not routinely cool patients after the ROSC with rapid infusion of cold IV fluids. Current evidence indicates no direct outcome benefit from these interventions.

TTM would be indicated in a STEMI patient with ROSC after cardiac arrest. 

78.

Which type of cardiac cells sends electrical impulses from the atria to the AV node?

  • Internodal tracts

  • Interatrial tracts

  • Bundle of His

  • Purkinje fibers

Correct answer: Internodal tracts

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.

The interatrial tracts are specialized cardiac cells that serve as a highway between the SA node through the atria.

79.

You are preparing to intubate an apneic patient and decide to use a Macintosh blade. When using a curved blade on an adult, where should the tip of the laryngoscope blade be placed?

  • Directly into the vallecula

  • Directly under the epiglottis

  • Space below the vallecula

  • Directly on the epiglottis

Correct answer: Directly into the vallecula

When using a curved blade, advance the tip of the blade into the vallecula (the space between the base of the tongue and the pharyngeal surface of the epiglottis).

It would not be appropriate to place the tip of the blade below the epiglottis. This would not allow the direct line of vision that a curved blade provides when it is placed and used appropriately. Although it is normal practice to place the tip of a straight blade directly under the epiglottis, placing the tip of the curved blade into the space below the vallecula would place the tip too low and destroy the straight-line visibility of the vocal cords. It would not be appropriate to place the tip of the blade on the epiglottis. After placing the blade tip, it is lifted up and away. Therefore, there is a lot of pressure put on the blade. The epiglottis would be damaged, and the improper placement would not help line up the trachea for intubation.

80.

Identify the following heart rhythm.

  • Usurpation

  • Escape rhythm

  • Junctional rhythm

  • Tachycardia

Correct answer: Usurpation

During usurpation, one of the lower pacemakers fires at an accelerated rate, taking control from the predominate pacemaker. This will result in a faster rhythm than the previous. 

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