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Quiz Session - Attempts With Random Questions

NREMT Paramedic Exam Questions

Page 5 of 60

81.

While evaluating the 12-lead electrocardiogram of your adult patient, where would you expect to see the axis in a normally conducting myocardium?

  • Between negative thirty (-30) and positive ninety degrees (+90)

  • Between zero (0) and negative ninety degrees (-90)

  • Between positive ninety (+90) and negative one-hundred-eighty degrees (+/-180)

  • Between negative ninety (-90) and positive one-hundred-eighty degrees (+/180)

Correct answer: Between negative thirty (-30) and positive ninety degrees (+90)

Lead I and aVF are the two leads instrumental in determining the axis. A normal axis is between negative thirty (-30) and positive ninety degrees (+90). An axis that falls between the two points is considered to have a normal axis.

If the cardiac axis falls between zero (0) and negative ninety degrees (-90), it is said to have left axis deviation, not a normal axis. If the cardiac axis were to fall between positive ninety (+90) and positive or negative one-hundred-eighty degrees (+/-180), it would have a right axis deviation. If the cardiac axis falls between negative ninety (-90) and positive or negative one-hundred-eighty degrees (+/180), it is said to have an indeterminate axis, not a normal axis.

82.

Which of the following is a complication of extubating a patient?

  • Laryngospasm

  • Seizure 

  • Bradycardia

  • Bronchoconstriction 

 The most common complications of extubation are overestimation of the patient's ability to manage their own airway and acute laryngospasm. Paramedics should anticipate laryngospasm when performing extubation.  

Seizure, bradycardia, or bronchoconstriction are not complications of extubating a patient.

83.

What is diaphoresis?

  • Sweaty, clammy skin

  • Low blood pressure

  • Inadequate blood flow to the body

  • Chest pain

Correct answer: Sweaty, clammy skin 

Diaphoresis is sweaty and clammy skin; it can be a symptom of decreased cardiac output (inadequate blood flow to the body) or low blood pressure (hypotension). It can also occur in response to chest pain during a heart attack.

84.

According to the AHA, what is the proper dosage of amiodarone for an adult patient in cardiac arrest (V-Tach or V-Fib)?

  • 300mg IV/IO, repeat with 150mg IV/IO after 3–5 minutes

  • 150mg IV, repeat in 2 minutes with 150mg IV

  • 1.5mg/kg IV, followed with repeat doses of 0.5–7.5mg/kg every 5–10 minutes for a max of 3mg/kg

  • 6mg IV, followed by 12mg IV, and if needed, a third dose at 12mg

Correct answer: 300mg IV/IO, repeat with 150mg IV/IO after 3-5 minutes

The correct dosage for a patient in cardiac arrest due to ventricular tachycardia or ventricular fibrillation is 300mg IV/IO proceeded by 150 mg IV/IO 3–5 minutes later. This correlates with the adult cardiac arrest algorithm, which switches between epinephrine and an antiarrhythmic given every 2 minutes.

The dosage of 150mg IV followed with another 150mg dosage is too low for an initial dose. 

The dosage of 1.5mg/kg IV, followed with repeat doses of 0.5–7.5mg/kg every 5–10 minutes for a max of 3mg/kg is the correct dose for giving lidocaine to an adult cardiac in arrest from VT or VF. It should be noted that, according to the AHA, amiodarone is the first-line medication to be given before lidocaine, but this may change with local protocol. 

The 6mg, 12mg, 12mg dosage regimen is for adenosine, which, while being an antiarrhythmic, is not indicated for cardiac arrest but instead for Paroxysmal SupraVentricular Tachycardia (PSVT) and may be given as a diagnostic tool for regular monomorphic wide-complex tachycardia with a pulse.

85.

Which of the following mechanisms of injury should be considered significant and transported to the highest-level trauma center available?

Select the 2 answer options which are correct.

  • Adult who fell 30 feet from a ladder

  • Adult in an auto crash with death in the same passenger compartment

  • Adult in an ATV crash going 20 mph 

  • Adult struck by a car traveling <20 mph 

Mechanisms of injuries (MOIs) that should be considered significant and transported to the highest-level trauma center available include: 

1. Falls

  • Adults: >20 feet (one story = 10 feet)
  • Children: >10 feet or two to three times the height of the child

2. High-risk auto crash

  • Intrusion, including roof: >12 inches occupant site; > 18 inches any site
  • Ejection (partial or complete) from automobile
  • Death in the same passenger compartment
  • Vehicle telemetry data consistent with a high risk for injury

3. Automobile versus pedestrian/bicyclist thrown, run over, or with significant (>20 mph) impact

4. Motorcycle or ATV crash >20 mph (with or without a helmet) 

86.

What is the medication type of choice for relieving bronchospasm associated with COPD in the pre-hospital setting?

  • Beta-agonists

  • Steroids

  • Anticholinergics

  • Sympathomimetics

Correct answer: Beta-agonists

The medications used in the pre-hospital setting to relieve bronchospasm and reduce constriction of the lower airways are the beta-agonist agents such as albuterol and levalbuterol.

Other medication types such as steroids may be prescribed for the patient after ER physician evaluation. Steroids include medications such as methylprednisolone. 

Nebulized anticholinergics are often prescribed after physician evaluation to help relieve bronchoconstriction that has not improved with beta-agonists and steroids. 

Sympathomimetic medications have both alpha and beta effects and are often prescribed by the patient's physician. They are not often ordered in the pre-hospital setting due to the higher incidence of side effects.

87.

After attempting to slow the bleeding associated with natural childbirth by non-invasive means, your patient continues to bleed significantly. Per medical direction, after ensuring a second fetus is not present, which of the following would be the most appropriate intervention for the new mother?

  • Mix 10 units of oxytocin to 1 liter of lactated Ringer's solution and run at 20–30 gtts/min

  • Rapidly administer a 2–3 liter glucose-containing IV solution, such as D5W, using a pressure infusion

  • Apply firm, direct pressure to the area above the pubic bone while inserting a sterile ABD pad into the opening of the birth canal

  • Mix 4 mg of magnesium sulfate in 250 mL normal saline and infuse over 20 minutes

Correct answer: Mix 10 units of oxytocin to 1 liter of lactated Ringer's solution and run at 20–30 gtts/min

It is best to administer a volume-expanding fluid that contains some of the electrolytes and other substances that were lost during the birthing process. Oxytocin (Pitocin) is a medication designed to help control post-partum hemorrhage by altering intra-uterine calcium. To avoid unwanted effects of Pitocin, encourage the natural release of oxytocin through procedures such as fundal massage and encouraging the newborn to breastfeed. The nipple stimulation causes natural oxytocin release.

IV fluid replacement should be initiated for a patient experiencing prehospital childbirth. However, it would not be recommended to administer three liters of volume-expanding fluid unless hypotension ensues after all means of stopping the hemorrhage prove unsuccessful, including Pitocin infusion. 

Applying pressure to the suprapubic region and packing the opening of the birth canal is contraindicated following prehospital childbirth. 

Magnesium sulfate is not used to treat post-partum bleeding; it is used to treat preeclampsia. 

88.

Which of the following electric conduction blocks is capable of looking like an ST-elevation myocardial infarction on the electrocardiogram, making it impossible to use ST elevation to determine the existence of an acute infarction?

  • Left bundle branch block

  • Third-degree atrioventricular block

  • Second degree, type I atrioventricular block (Wenckebach)

  • Right bundle branch block

Correct answer: Left bundle branch block

A left bundle branch block is capable of impairing repolarization and may look like an ST-elevation myocardial infarction. Therefore, if a left bundle branch block is evident on the monitor, ST-elevation measurements cannot be used as an adequate means of determining if an infarction is occurring.

A third-degree atrioventricular block is a block at the level of the AV node that separates the electrical continuity of the atria and ventricle. It does not interfere with repolarization of the ventricles and does not alter the ST segment. If present, ST elevation can be used to determine if a STEMI is occurring. Second degree, type I atrioventricular block (Wenckebach) is a block that causes an intermittent pause between each P wave and QRS complex that progressively lengthens. It is not responsible for repolarization issues and does not affect repolarization. ST elevation can be used to determine if a STEMI is present. A right bundle branch block does not mimic a STEMI and can be present when using ST elevation as a determining factor of the presence of a current myocardial infarction.

89.

Which of the following are signs/symptoms of Addison's disease? 

Select the three correct answer options.

  • Hyperpigmentation of the skin 

  • Hyperkalemia 

  • Hyponatremia 

  • Hypernatremia 

  • Hypokalemia 

Chronic renal insufficiency is known as Addison's disease. Symptoms include hyperpigmentation of the skin, hyperkalemia, and hyponatremia. Other signs include weight loss, fatigue, abdominal pain, and anorexia. 

Hypernatremia is not found in Addison's disease. 

90.

You are on scene with a 12-year-old trauma patient who has a large laceration on the inner aspect of their upper right arm with an estimated blood loss of around 15%. The bleeding has now decreased while the patient remains conscious, alert, and anxious. The patient's skin is warm, heart rate is 96 bpm, and blood pressure is 108/50.

After assessing the child, you believe the patient may be in hypovolemic shock. If so, which stage of shock is the patient most likely experiencing?

  • Stage 1

  • Stage 2

  • Stage 3

  • Stage 4

Correct answer: Stage 1

Stage 1 of hypovolemic shock occurs when intravascular blood volume is decreased by 15%. At this point in the shock cascade, the patient's blood pressure and heart rate are relatively normal. The shock state is easily managed if the hemorrhage is stopped in the 15% range.

Stage 2 of shock occurs after the patient has lost more than 15% of the circulating blood volume. At this point, the patient's heart rate and blood pressure will initially increase in an attempt to correct the low fluid volume. So, if the patient were in stage 2 of hemorrhagic shock, the heart rate and blood pressure would have both initially increased before the blood pressure began to fail in late stage 2.

Stage 3 of shock is known as the refractory stage. In this stage of shock, the body becomes resistant to medical interventions but may still respond to aggressive IV fluid and life support measures. In this stage of shock, distal tissue cells switch to anaerobic metabolism, increasing lactic acid formation. These patients will be hypotensive and bradycardic and have decreased effective respiration.

In stage 4 of hypovolemic shock, the patient's organs and organ systems begin to fail. In most cases, the liver fails first, followed by the kidneys, lungs, and heart. It is characterized by the presence of pulmonary edema and respiratory failure.

91.

What is the defining characteristic of a premature ventricular contraction (PVC)?

  • Wide, irregular QRS complex

  • Chaotic atrial activity

  • Occurrence of P waves at a rate of 250-350 beats per minute

  • It requires immediate cardiopulmonary resuscitation

Correct answer: Wide, irregular QRS complex

A premature ventricular contraction will be displayed as a rhythm containing wide, irregular QRS complexes.

Chaotic atrial activity or irregular, frequent P waves is a sign of atrial fibrillation. The occurrence of P waves at over 250 per minute is seen in atrial flutter. Ventricular fibrillation is a lethal rhythm, as the ventricle is quivering and the heart is not actively pumping; this rhythm requires cardiopulmonary resuscitation.

92.

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.  

93.

Which of the following advanced airway procedures is considered a supraglottic airway device?

  • King LTD airway

  • Endotracheal tube 

  • Double lumen endotracheal tube

  • Oropharyngeal airway 

Correct answer: King LTD airway

Supraglottic airway devices deliver oxygen to an area of the trachea above the glottic opening or vocal cords. This type of advanced airway control is achieved with devices such as a King LTD, a Combitube, and a laryngeal mask airway.

Endotracheal tubes deliver O2 below the level of the vocal cords.

There is not a double-lumen endotracheal tube, only cuffed single-lumen or uncuffed ET tubes.

An oropharyngeal airway is inserted in the oropharynx to keep the airway patent by preventing the tongue from covering the epiglottis. It is not considered a supraglottic airway device.

94.

En-Route 

While responding to the call in the scenario, your partner tells you, "I am deathly allergic to bee stings; if there are still bees around the patient, what should we do?" You have no known allergies. Which of the following is the most appropriate response?

  • "We will evaluate the scene from the ambulance, and if there are still bees around the scene, we will direct the patient to the ambulance." 

  • "I will have a fire/rescue unit dispatched to ensure the scene is safe."

  • "We will evaluate the scene from the ambulance, and if there are still bees around the scene, I will go retrieve the patient and bring her to the ambulance while you wait inside."

  • "I will have a police unit dispatched to ensure the scene is safe."

Correct answer: "We will evaluate the scene from the ambulance, and if it appears there are still bees around the scene, we will direct the patient to the ambulance." 

Always ensure scene safety before entering a scene. You should direct the patient to the ambulance if bees are still present. You can use the PA system in the ambulance if you need it. An allergic reaction can occur any time a bee sting occurs.

Do not put yourself at risk if the scene is not safe. At this point, there is no need to tie up other emergency units. If you arrive at a scene and determine that there is no way to treat the patient while ensuring your safety, request resources available in your system to secure the scene. Your safety, and that of other responders, is always a priority before anything else.

95.

Which of the following conditions is considered an autoimmune disorder that can cause respiratory muscle paralysis as the disease progresses?

  • Guillain-Barre syndrome

  • Spina bifida

  • Muscular dystrophy

  • Parkinson's disease

Correct answer: Guillain-Barre syndrome

Guillain-Barre syndrome is an autoimmune disorder that causes worsening muscle weakness progressing to muscle paralysis. It can paralyze the muscles of respiration, leaving the patient unable to breathe spontaneously.

Spina bifida is a congenital defect in which part of one or more vertebrae fails to develop completely. This leaves a portion of the patient's spinal cord exposed. It can lead to many developmental problems for the patient but is not directly related to respiratory muscle paralysis. 

Muscular dystrophy is an inherited muscle disorder of unknown origin. The disease is marked by the slow but progressive degeneration of muscles, especially skeletal muscles. It is not likely to cause respiratory muscle paralysis from destruction of the nerves that induce spontaneous respiration. 

Parkinson's disease usually begins as a small, one-sided hand, arm, leg, or foot tremor that develops into stiffness, weakness, and trembling of many major skeletal muscle groups bilaterally as the disease process progresses.

96.

After being unable to clear a foreign body obstruction from the airway of your now unconscious adult patient using the Heimlich maneuver, which of the following interventions would be the most appropriate?

  • Initiate chest compressions

  • Supine abdominal thrusts

  • Direct laryngoscopy and Magill forceps

  • Blind finger sweeps

Correct answer: Initiate chest compressions

If a conscious patient, becomes unconscious while attempting supine abdominal thrusts, immediate chest compressions are indicated.

Supine abdominal thrusts should have already been attempted when the Heimlich maneuver was being attempted. Therefore, repeating the abdominal thrust is not likely to produce results. 

Magill forceps and direct laryngoscopy are not recommended until after chest compressions. 

Blind finger sweeps would not be appropriate when attempting to clear the obstruction, especially after employing the use of a laryngoscope. Use Magill forceps to remove any visible foreign matter only.

97.

Which of the following correctly identifies an effect of epinephrine in treating anaphylaxis? 

  • It reduces the release of chemical mediators from the mast cells

  • It causes peripheral vasoconstriction to reduce the itching associated with the reaction

  • It causes vasodilation to improve peripheral perfusion

  • It is effective in reducing the inflammatory response of the reaction

Correct answer: It reduces the release of chemical mediators from the mast cells

Epinephrine is the drug of choice for anaphylaxis because it is effective in combating bronchoconstriction and vasodilation and reduces the release of chemical mediators from the mast cells.

Epinephrine does cause peripheral vasoconstriction, but it is not effective in reducing the associated itching. An antihistamine such as diphenhydramine would be best for combating the associated itching. Epinephrine is effective in helping increase blood pressure by combating vasodilation. Epinephrine does not cause vasodilation but rather vasoconstriction.  Epinephrine is not effective in reducing the inflammation associated with anaphylaxis. A corticosteroid, such as methylprednisolone, would be suitable for inflammation reduction during the reaction.

98.

Identify the artifact.

  • Undersensing and loss of capture

  • Oversensing and failure to fire

  • Loss of capture only

  • No artifact is present

Correct answer: Undersensing and loss of capture

The pictured rhythm has pacemaker spikes in inappropriate locations, such as in the first QRS complex, a sign of undersensing. There is also loss of capture occurring, as evidenced by the pacemaker spikes with no QRS rhythms following them.

99.

In a mass casualty or large scale event, the Incident Command System (ICS) is used to coordinate resources and improve efficiency in response and scene management. Which of the following are components of the medical or EMS group of the ICS? 

Select the 3 answer options which are correct.

  • Triage unit leader

  • Transportation unit leader

  • Treatment unit leader

  • Public Information Officer (PIO) 

The EMS group of ICS will establish, at a minimum, triage, treatment, and transportation units. Each unit will have an established leader. Other units may be formed as needed or necessary, such as a rehabilitation unit, a rescue/extrication unit, etc. 

The Public Information Officer (PIO) is part of the incident command staff and would not be a component of the EMS group. 

100.

All the following would most likely be present in a trauma patient with blood loss in a Class III hemorrhage except: 

  • A rapid, bounding pulse 

  • Tachypnea

  • Confusion and anxiousness

  • Hypotension

Correct answer: A rapid, bounding pulse 

The pulse will not be bounding in this stage of hemorrhage due to hypotension and blood loss. 

A trauma patient with blood loss in a Class III hemorrhage will present as seriously ill with the following:

  • A rapid, thready pulse (> 120)
  • Hypotension
  • Delayed cap refill
  • Tachypnea (> 28)
  • Cold, pale, moist skin
  • Confusion/anxiousness
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