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Quiz Session - Attempts With Random Questions

NREMT Paramedic Exam Questions

Page 6 of 60

101.

Depolarization of the atrial myocardial cells results in:

  • Contraction of the atria

  • Contraction of the ventricles

  • Atrial repolarization

  • Ventricular relaxation

Correct answer: Contraction of the atria 

Depolarization of the myocardial cells in the atria result in atrial contraction. Ventricular contraction is caused by ventricular polarization. During atrial repolarization, the atria are relaxed, which allows the chambers of the heart to fill with blood before the next contraction. Conclusively, ventricular relaxation/filling happens during ventricular repolarization.

102.

Which of the following are steps in performing synchronized cardioversion?

Select the 3 answer options which are correct.

  • Activate the sync mode after delivery of each synchronized shock.

  • Press the sync control button to engage the synchronization mode.

  • Look for markers on the R wave indicating sync mode.

  • Verify capture after each shock.

Follow these steps to perform synchronized cardioversion, modifying the steps for your specific device.

  • Sedate all conscious patients unless unstable or deteriorating rapidly.
  • Press the sync control button to engage the synchronization mode.
  • Look for markers on the R wave indicating sync mode.
  • Select the appropriate energy level. Deliver synchronized shocks according to your device’s recommended energy level to maximize the success of the first shock.
  • Announce to team members: “Charging defibrillator—stand clear!”
  • Press the charge button.
  • Clear the patient when the defibrillator is charged.
  • Press the shock button(s).
  • Check the monitor. If tachycardia persists, increase the energy level (joules) according to the device manufacturer’s recommendations.
  • Activate the sync mode after delivery of each synchronized shock. Most defibrillators default back to the unsynchronized mode after delivery of a synchronized shock. This default allows an immediate shock if cardioversion produces VF.

Verifying capture occurs in Transcutaneous Pacing (TCP), not synchronized cardioversion.

103.

You are performing orotracheal intubation on an average-sized, apneic adult. At what depth marking should the airway be properly positioned 2 to 3 cm above the carina?

  • 19 to 23 centimeters

  • 9 to 13 centimeters

  • 32 to 36 centimeters

  • 29 to 32 centimeters

Correct answer: 19 to 23 centimeters

The paramedic must check the depth markings on the ET tube during intubation. In an average-sized adult, the tube is properly positioned when the patient's teeth are between 19 and 23 cm. The carina is usually located within 27 cm, so inserting the tube to the 19 to 23 cm mark will place the tube about 2 to 3 cm above the carina.

The distance from the teeth to the carina is around 27 cm in the average adult. Therefore, it would not be appropriate to stop at the 9 to 13 cm mark. The tube would not be in the trachea or esophagus at that depth. 

Inserting the ET tube to 29 to 36 cm would most likely put the tip of the tube into the left mainstem bronchus, occluding airflow to the right lung.

104.

In accordance with 2020 AHA guidelines, when can unsynchronized high-energy shocks be administered?

Select the three correct answer options.

  • When you are unsure whether monomorphic or polymorphic VT is present in an unstable patient

  • For patients who are unstable or deteriorating and synchronization cannot be immediately accomplished

  • For clinical deterioration when you think a delay in converting the rhythm will result in cardiac arrest

  • For patients presenting in narrow complex pulseless electrical activity (PEA)

  • For patients with supraventricular tachycardia (SVT) who are symptomatic but stable

Unsynchronized high-energy shocks are recommended:

  • For a patient with no pulse (VF/pVT)
  • For clinical deterioration (in prearrest), such as those with severe shock or polymorphic VT, when you think a delay in converting the rhythm will result in cardiac arrest
  • For patients who are unstable or deteriorating and synchronization cannot be immediately accomplished
  • When you are unsure whether monomorphic or polymorphic VT is present in the unstable patient
  • If the shock causes VF (occurring in only a small minority of patients despite the theoretical risk), immediately attempt defibrillation

Unsynchronized high-energy shocks are not recommended for patients presenting in pulseless electrical activity (PEA); chest compressions would be indicated. Unsynchronized high-energy shocks are not recommended for patients presenting with SVT. Synchronized cardioversion would be indicated. 

105.

What ECG lead is less prone to artifact due to movement?

  • Lead V1

  • Lead I

  • Lead II

  • Lead III

Correct answer: Lead V1

Leads I and II are limb leads and are more prone to artifact when a patient is in motion. Because V1 is placed on the chest, it is less prone to artifact due to movement. Lead III is not represented by a single physical electrode; it is a combination of Leads I and II.

106.

Which of the following conditions is most likely to be associated with a right axis deviation on the twelve-lead electrocardiogram?

  • Chronic obstructive pulmonary disease

  • Chronic hypertension

  • Ventricular tachycardia

  • Left-sided hemiblock

Correct answer: Chronic obstructive pulmonary disease

Patients with conditions such as Chronic Obstructive Pulmonary Disease (COPD), left-sided tension pneumothorax, pulmonary embolus, and right ventricular hypertrophy as well as others are most likely to present with a right axis deviation. It is caused by the changing size or position of the heart, causing a shift or muscle enlargement that deviates toward the right side of the chest.

Chronic hypertension is more likely to cause a left axis deviation due to myocardial ventricle enlargement. 

Patients suffering from ventricular tachycardia will likely have a left axis deviation due to the accelerated ventricular rate. 

A left-sided hemiblock is more evident and seen as a left axis deviation rather than a right axis deviation.

107.

You suspect a patient has an air embolism. In what position should you transport the patient?

  • Turn the patient on their left side with the head lowered 10 degrees

  • Transport the patient supine with the head of the stretcher elevated 30 degrees

  • Turn the patient onto their right side with the head higher than the rest of the body

  • Transport the patient in the Trendelenburg position with their feet elevated 20-30 degrees

Correct answer: Turn the patient on their left side with the head lowered 10 degrees

If an air embolism is suspected, transport the patient on the left side with about 10 degrees of head-down tilt, in an attempt to trap the embolus in the right ventricle of the heart before it can enter the pulmonary circulation.

Transporting the patient with the head elevated would likely help the embolus travel through the heart and lodge in the pulmonary circulation. 

Positioning the patient on their right side with the head of the stretcher higher than the feet is not a good position to trap the air embolism in the right ventricle but would rather likely help the embolus move freely into the pulmonary circulation.

It is not recommended to transport a patient with a suspected air embolism in the Trendelenburg position unless the feet are only slightly raised and the patient is turned onto their left side. Regular supine Trendelenburg positioning may help the embolus travel freely through the heart unimpeded and lodge in the pulmonary circulation. This condition could result in a critical situation with the possibility of rapid death if the pulmonary embolism is severe.

108.

Which of the following statements are true regarding the proper ET tube suctioning procedure?

Select the 2 answer options which are correct.

  • Use a sterile technique to reduce the likelihood of airway contamination.

  • Apply suction while withdrawing the catheter with a rotating or twisting motion.

  • Apply suction while inserting the catheter with a rotating or twisting motion. 

  • Suction until the tube is clear.

Follow these steps to perform ET tube suctioning:

  • Use a sterile technique to reduce the likelihood of airway contamination.
  • Gently insert the catheter into the ET tube but no further because it may injure the ET mucosa or stimulate coughing or bronchospasm.
  • Apply suction by occluding the side opening only while withdrawing the catheter with a rotating or twisting motion.
  • Do not exceed ten seconds for a suction attempt.
  • To avoid hypoxemia, precede and follow suctioning attempts with a short period of administration of 100% oxygen.
  • Keep a container of sterile water close to clear the suction catheter if needed. Do not spray sterile water directly into the ET tube.

109.

Scene

Based on the information given in the scenario, which of the following is the correct field impression of this patient?

  • Serotonin syndrome

  • TCA overdose

  • Opioid syndrome

  • Sympathomimetic overdose

Correct answer: Serotonin syndrome

Sertraline (Zoloft) is an SSRI anti-depressant, and this patient has possibly ingested nearly 20 times the prescribed dose. SSRI overdoses can lead to serotonin syndrome. Signs of serotonin syndrome include myoclonus, hyperreflexia, dilated pupils, and flushed and hot skin with diaphoresis.

Sertraline (Zoloft) is not a tricyclic antidepressant (TCA) or an opioid. Miosis would be present with an opioid overdose. A sympathomimetic overdose would result from substances such as cocaine or amphetamines, not an SSRI medication.

110.

Which of the following is an acceptable initial intervention to treat stable paroxysmal tachycardias in an attempt to slow the heart rate and decrease the force of atrial contraction in the pre-hospital setting?

  • Vagal maneuvers

  • Unsynchronized cardioversion beginning at 50 joules

  • Atropine therapy

  • Diltiazem

Correct answer: Vagal maneuvers

Vagal maneuvers can slow the heart and decrease the force of atrial contraction. These maneuvers stimulate the parasympathetic nerve fibers in the wall of the atria and in specialized tissues of the SA and AV nodes. It is appropriate to attempt vagal maneuvers before pharmacological or electrical intervention in cases of stable patients without signs and symptoms of hypoperfusion or chest pain.

Unsynchronized cardioversion is the appropriate initial intervention for unstable patients with wide complex tachycardia. Atropine is the drug of choice for symptomatic bradycardia. Diltiazem is an appropriate second-line medication for PSVT. It would be appropriate in some cases in place of adenosine or if adenosine is unavailable.

111.

Acute hyperfunction of the thyroid gland can cause a thyroid storm. It is characterized by the rapid onset of restlessness, agitation, tachycardia, and/or delirium with warm skin and may result in a coma. Which of the following disorders is capable of causing similar signs and symptoms?

  • Hyperglycemia

  • Hypoglycemia

  • Addison's disease

  • Cushing's syndrome

Correct answer: Hyperglycemia

Patients experiencing hyperglycemia often present with restlessness, agitation, tachycardia, and/or delirium with warm skin. Severe hyperglycemia may result in coma. The signs and symptoms of a thyroid storm are caused by an overactive thyroid that stimulates an adrenergic response, while hyperglycemia stimulates the sympathetic nervous system to release epinephrine to elicit a similar response.

Hypoglycemia patients are more likely to present with cool, clammy skin, decline in mental status, and snoring respirations. 

Patients with Addison's disease are more likely to present with weakness, weight loss, anorexia, and darkened dry, warm skin. 

Patients with Cushing's syndrome are more likely to present with increases in body fat, humpback, insomnia, and psychiatric disturbances.

112.

Which of the following are types of incomplete spinal cord injuries?

Select the 2 answer options which are correct.

  • Brown-Séquard syndrome

  • Central cord syndrome 

  • Paraplegia 

  • Quadriplegia

Incomplete spinal cord syndromes result from injury to part of the spinal cord, causing partial disruption of spinal tracts. Central cord syndrome, Brown-Séquard syndrome, anterior cord syndrome, and posterior cord syndrome are the most common types of incomplete spinal cord injuries.

Quadriplegia and paraplegia result from complete spinal cord injury (i.e., transection), which is a total disruption of all tracts of the spinal cord, causing paralysis.

113.

Scene

In the given scenario, a law enforcement officer radios you that the scene is secure, and she is going to look around and see if she can find clues to the mechanism of injury. As your partner obtains a set of vital signs, the law enforcement officer comes into the garage and tells you she found a 10-foot stepladder on its side at the back of the house, and the wooden deck railing is broken. You ask the patient if he fell off the ladder and struck the railing, and he nods yes. Which of the following conditions should you have a high index of suspicion for?

Select the 2 answer options which are correct.

  • Sternal fracture

  • Myocardial contusion

  • Cardiac tamponade

  • Hemothorax

You should have a high index of suspicion for myocardial contusion and sternal fracture for this patient. Anticipate cardiogenic shock and cardiac rhythm disturbances. This patient will require ECG monitoring and IV access. The lung sounds are clear, so hemothorax would not be suspected at this point. Cardiac tamponade is more likely to occur with penetrating trauma, and the mechanism here is blunt force trauma.

114.

Which of the following are reperfusion goals established by the AHA when a suspected STEMI patient arrives at the emergency department?

Select the 2 answer options which are correct.

  • PCI should begin within 90 minutes from first medical contact to balloon inflation

  • Fibrinolytic administration should begin within 30 minutes of the patient’s arrival 

  • Obtain initial cardiac marker levels and complete blood counts and coagulation studies within 30 minutes 

  • Confirm STEMI on 12-lead ECG within 30 minutes

For a patient with STEMI (ST-elevation myocardial infarction), the goals of reperfusion include the following: 

  • PCI should begin within 90 minutes from first medical contact to balloon inflation.
  • Fibrinolytic administration should begin within 30 minutes of the patient’s arrival in the ED if PCI is not available within 90 minutes.
  • Obtain 12-lead ECG and initial cardiac marker levels and complete blood counts and coagulation studies within ten minutes of patient arrival.

115.

Identify the following rhythm.

  • Supraventricular tachycardia

  • Atrial fibrillation

  • First degree AV block

  • Sinus tachycardia

Correct answer: Supraventricular tachycardia 

Supraventricular tachycardia (SVT) is a tachycardic rhythm that originates above the ventricles. The identifying symptom is the absence of P waves, in addition to the regular, tachycardic rhythm.

116.

Your newborn patient is in need of a fluid bolus to return his circulating blood volume to a near-normal level after a bleeding injury has occurred, but the bleeding is now controlled. What is an acceptable fluid bolus amount for the newborn patient?

  • 10 milliliters per kilogram of body weight over 5 to 10 minutes

  • 40 milliliters of normal saline delivered over one minute

  • 100 milliliters total over 1 to 3 minutes and can be repeated twice

  • 25 milliliters per kilogram of body weight over an hour

Correct answer: 10 milliliters per kilogram of body weight over 5 to 10 minutes

The standard for newborn fluid resuscitation is 10 milliliters per kilogram of body weight.

It is not considered the standard of care to deliver a set 40 milliliters of fluid to a newborn in need of fluid resuscitation. Forty milliliters would only be acceptable if the patient weighs four kilograms. No acceptable standard allows a total of 300 milliliters to be delivered to a newborn. Newborn dosages are typically weight-regulated. Fluid infusions, rather than boluses are administered over an hour. 25 milliliters per kilogram of body weight would be 2.5 times more than a standard acceptable bolus amount.

117.

Identify the following rhythm.

  • Sinus rhythm progressing to ventricular tachycardia

  • Sinus rhythm progressing to ventricular fibrillation

  • Sinus rhythm with Type 2 AV block

  • Sinus rhythm progressing to sinus tachycardia

Correct answer: Sinus rhythm progressing to ventricular tachycardia

Ventricular tachycardia is characterized by wide, bizarre QRS complexes with an absence of any real rhythm. Prompt treatment is required to revert the patient to sinus rhythm. 

118.

For which of the following heart arrhythmias should a synchronized shock be considered?

Select the three correct answer options.

  • Unstable SVT

  • Unstable atrial flutter

  • Unstable atrial fibrillation

  • Uncertainty about monomorphic or polymorphic VT in an unstable patient

Synchronized shocks are recommended for patients with a pulse and tachycardias, such as:

  • Unstable SVT
  • Unstable atrial fibrillation
  • Unstable atrial flutter
  • Unstable regular monomorphic tachycardia with pulses

If you are unsure whether monomorphic or polymorphic ventricular tachycardia is present in an unstable patient, unsynchronized high-energy shocks are recommended.

119.

Identify the following rhythm.

  • First-degree AV block

  • Third-degree AV block

  • Mobitz block

  • SVT

Correct answer: First-degree AV block

A first-degree AV block is a prolonged PR interval caused by a delay in the impulse being sent to the ventricles.

A third-degree heart block is a complete block, not a delay, and will show a dropped QRS beat. A type 2 Mobitz block is a second-degree block, where the AV node becomes weaker over time, showing PR intervals that become longer, followed by a dropped P wave. An SVT is a regular tachycardic rate, typically caused by the firing of several foci in the atrial tissue.

120.

You are cleaning the back of the truck after transporting a trauma patient to the emergency department. Which of the following contaminated items should not be placed in a plastic biohazard bag?

  • Plastic IV catheter

  • French suction catheter

  • Blood-soaked gauze pads

  • Nasopharyngeal or oral airway

Correct answer: Plastic IV catheter

The end of an IV catheter (the plastic catheter without the needle) is sharp and can cut you. Therefore, it should be placed in a puncture-proof sharps container, not a plastic biohazard bag.

Items that are blood-soaked or are otherwise contaminated but cannot puncture, such as a French suction catheter, blood-soaked gauze, and nasopharyngeal or oral airways can safely be placed in a plastic biohazard bag.

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