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Quiz Session - Attempts With Random Questions

NREMT Paramedic Exam Questions

Page 7 of 60

121.

The sinus node is firing at a rate of 70 bpm; however, the AV node begins to fire at a rate of 80 bpm. What is occurring?

  • Usurpation

  • Escape

  • Cardiac arrest

  • Ventricular tachycardia

Correct answer: Usurpation

Usurpation occurs when the lower pacemaker cells become irritable and fire at a rate faster than the sinus node, usurping the higher pacemaker.

122.

En-Route 

Based on the information in the given scenario, which of the following statements is correct?

  • You should request that the air medical unit be diverted to the helipad at the critical access hospital.

  • You should request cancelation of the air medical response.

  • You should request law enforcement to clear traffic near the scene to make room for a landing zone.

  • You should request that the air medical unit be diverted to the small airport 15 miles to the north of the scene.

Correct answer: You should request that the air medical unit be diverted to the helipad at the critical access hospital.

The paramedic should prioritize the closest secured helipad, typically located at the critical access hospital, over the airport for air medical transport. It is closer to the airport and a better option. If personnel on the scene believe an air medical response is needed, you should have them continue until you at least have performed an assessment of the patient. Patient assessment is essential for determining the need for air medical transport. Canceling prematurely may compromise patient care. Requesting law enforcement to clear traffic for a landing zone may not be feasible if the incident commander deems the area unsuitable. Law enforcement personnel may already be occupied with managing heavy traffic and may be unable to assist with clearing a landing zone.

123.

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

124.

Your adult patient is experiencing paroxysmal supraventricular tachycardia at 166 beats per minute. He is hypotensive and short of breath with cool, clammy, and diaphoretic skin. Which of the following interventions would be indicated at this point?

  • Synchronized cardioversion at your specific device's recommended energy level to maximize first shock success 

  • Vagal maneuvers, including the Valsalva maneuver

  • Adenosine 6 mg with a 20 mL saline flush

  • Verapamil 2–5 mg slow IV bolus

Correct answer: Synchronized cardioversion at your specific device's recommended energy level to maximize first shock success 

The key to management of a patient with any tachycardia is to first determine whether pulses are present and, if so, to then determine whether the patient is hemodynamically stable or unstable, and then provide treatment based on the patient's condition and cardiac rhythm. In this case, you have a patient with tachycardia and a pulse. The next step in the evaluation of this patient is to determine if they are hemodynamically stable. Signs of hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, or acute heart failure indicate that the patient is unstable. This case takes on clinical significance because the arrhythmia rate is greater than 150 bpm, and the instability suggested by hypertension, shortness of breath, and cool clammy skin is most likely due to the arrhythmia.

According to the AHA 2020 Guidelines, for patients with tachycardia exhibiting serious signs and symptoms, proceed to immediate cardioversion and refer to your specific device's recommended energy level to maximize first shock success.

If symptoms persist despite adequate oxygenation and ventilation, do not delay immediate cardioversion. 

Vagal maneuvers, including the Valsalva maneuver, should be considered only when a patient is hemodynamically stable. Adenosine is the medication of choice for pharmacological cardioversion as long as the patient is hemodynamically stable, and there are no signs and symptoms of congestive heart failure. When administered, Adenosine is given in three increments (6 mg, 12 mg, and if needed, a second dose of 12 mg) about five minutes apart, as long as the stable PSVT continues. Verapamil is a calcium channel blocker that may be effective in slowing the heart rate of patients with PSVT. However, it is not the first drug of choice and is contraindicated when the patient is hemodynamically unstable.

125.

Which of the following signs or symptoms may indicate sepsis in a patient? 

Select the three correct answer options. 

  • Hypothermia

  • Fever

  • Tachycardia

  • Bradycardia

  • Hypoglycemia 

Signs and symptoms of sepsis include:

  • Elevated white blood cell count
  • Fever
  • Hypothermia 
  • Tachypnea
  • Hypotension
  • Tachycardia 

Abnormal blood glucose levels are not associated with sepsis. 

126.

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).

127.

When preparing to initiate a synchronized electrical cardioversion procedure on a patient with symptomatic paroxysmal supraventricular tachycardia, the ECG displays a marker denoting the location where the desired energy will be discharged. During what part of the cardiac cycle should the marker appear on the oscilloscope screen?

  • On the peak of each and every R-wave

  • On the peak of every P-wave

  • It does not matter where in the cardiac cycle the marker is located

  • At the point where the S-waves return to the isoelectric line

Correct answer: On the peak of each and every R-wave

Synchronized cardioversion is designed to deliver a set (synchronized) shock ten milliseconds after the peak of the R-wave during each cardiac cycle. Once the patient's electrodes are attached and the oscilloscope screen is on, a marker will appear on the peak of each R-wave. It is delivered a fraction of a second after the R-wave to avoid the shock being delivered during the vulnerable relative refractory period of the ventricles. Shocks delivered during this period increase the ventricular fibrillation threshold. Synchronized cardioversion decreases the chance of causing ventricular fibrillation with cardioversion.

When preparing to administer synchronized cardioversion, the marker on the oscilloscope screen is meant to appear on the peak of the R-wave. If it appears at the peak of the P-wave, another lead should be selected to visualize the marker in the proper location on the peak of the R-wave, not the P-wave. Synchronized cardioversion delivers its energy in an organized manner in an attempt to slow a supraventricular rhythm. 

The marker location matters; it must be placed on the peak of the R-wave or synchronized cardioversion is not being utilized; unsynchronized cardioversion or defibrillation is being initiated when the impulse marker is not located on the R wave, and the probability of ventricular fibrillation increases dramatically.

It is not appropriate to assume a marker located on the isoelectric line at the end of the QRS complex is going to help deliver a synchronized energy impulse that will be effective in slowing the heart rate without complications.

128.

Which of the following cardiac rhythms is appropriate to defibrillate?

  • Ventricular fibrillation

  • Monomorphic ventricular tachycardia with a pulse

  • Atrial fibrillation

  • 3rd-degree heart block

Correct answer: Ventricular fibrillation

In EMS, the only proper rhythms to defibrillate are ventricular fibrillation and ventricular tachycardia without a pulse.

Both atrial fibrillation and monomorphic ventricular tachycardia with a pulse may require synchronized cardioversion. While mechanically similar to defibrillation, it is important to "synchronize" the shock using your EKG, as this will avoid R-on-T, which can cause the patient to go into PEA. Follow your device’s specific recommended energy level to maximize the success of the first shock.

For a 3rd-degree heart block, the patient may require pacing, which, instead of delivering a shock to try to "reset" the heart back into a properly perfusing rhythm, uses electricity to override the natural pacemaker in the heart to have the heartbeat consistent enough to cause adequate perfusion.

129.

Which of the following is not a sign/symptom of cholecystitis?

  • Upper left quadrant abdominal pain

  • Loose, light-colored stool

  • Nausea and vomiting

  • Jaundice and fever

Correct answer: Upper left quadrant abdominal pain

Signs and symptoms of cholecystitis include:

  • Upper right quadrant pain (especially after eating fatty foods)
  • A positive Murphy's sign (elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area.; if pain occurs on inspiration, it is positive)
  • Nausea
  • Vomiting
  • Fever
  • Jaundice
  • Loose, light-colored bowel movements

130.

Which chamber of the heart pumps blood to the lungs?

  • Right ventricle

  • Left atrium

  • Left ventricle

  • Right atrium

Correct answer: Right ventricle

The right ventricle receives deoxygenated blood from the right atrium and sends it to the lungs for oxygen exchange. It is then pumped through the left atrium, then to the left ventricle to be sent out into the body’s circulation.

131.

Which of the following are nondepolarizing neuromuscular blocking agents used for Rapid Sequence Intubation (RSI)?

Select the 3 answer options which are correct.

  •  Vecuronium bromide (Norcuron) 

  • Pancuronium bromide (Pavulon)

  • Rocuronium bromide (Zemuron)

  • Succinylcholine (Anectine) 

Rocuronium bromide (Zemuron), pancuronium bromide (Pavulon) and vecuronium bromide (Norcuron) are nondepolarizing neuromuscular blocking agents used in Rapid Sequence Intubation (RSI). 

Succinylcholine (Anectine) is the only depolarizing neuromuscular blocking agent used for RSI. Use succinylcholine with caution; it causes muscle fasciculations and may have contraindications. 

132.

What important question do you ask yourself when determining if the rhythm on the EKG strip is a normal sinus rhythm?

  • Are the QRS complexes narrow?

  • Is the T wave wide?

  • Are the P waves narrow?

  • Is there one T wave preceding each QRS complex?

Correct answer: Are the QRS complexes narrow?

When reading an EKG strip, ask yourself these important questions:

  1. Are the QRS complexes narrow?
  2. Are normal P waves present?
  3. Is there one P wave preceding every QRS complex?

A normal sinus rhythm has all of these characteristics. If you answer "no" to one of these questions, the rhythm is irregular.

133.

Which of the following would be considered a major burn?

  • Partial-thickness burn that involves the full circumference of an appendage or body part

  • Full-thickness burns that are less than 10 percent of the total body surface area in adults

  • Partial-thickness burns less than 25 percent of the total body surface area in an adult

  • Partial-thickness burns that are less than 20 percent of the total body surface area in children

Correct answer: Partial-thickness burn that involves the full circumference of an appendage or body part 

A major burn is any partial-thickness burn that involves the full circumference of an appendage or body part. This is because of compartment syndrome and the dangers associated with the condition. 

Full-thickness burns less than 10 percent of the total body surface area are considered moderate burns and do not require the immediate attention of a major burn. 

Partial-thickness burns less than 25 percent of the total body surface area in an adult are considered moderate, while partial-thickness burns greater than 25 percent of the total body surface area in an adult are considered major burns. 

Partial-thickness burns less than 20 percent of the total body surface area in children are considered moderate burns, while partial-thickness burns greater than 20 percent of the total body surface area in children are considered major burns. 

134.

You and your partner are called to an elementary school for a nine-year-old child with a swollen, painful deformity to the right lower extremity. The parents are already on-scene. Which of the following would be most appropriate?

  • Ensure the parents remain aware of what you are doing by communicating with them often throughout the treatment

  • Tell the parents that the child must be transported to the hospital

  • Use the appropriate medical terminology at all times

  • Advise the parents it would be much cheaper for them to transport the child to the hospital for evaluation

Correct answer: Ensure the parents remain aware of what you are doing by communicating with them often throughout the treatment

It is important to keep both the patient and the family aware of what you are doing. Avoid medical terminology when possible. When caring for children specifically, inform the parents of the need for ambulance transportation and why; doing so will provide them with the information necessary to make an informed decision.

It would not be appropriate to tell the parents that the child must be transported to the hospital. Although you are there to render aid, it is not your final decision. Parents still have all the decision-making rights. It is better to tell them, "It is a good idea for you to allow the child to be transported to the hospital for the child's own good." 

It does not make you look intelligent to use medical terminology to the parents of an injured child. Rather, it may create a communication gap and feelings of mistrust among the family of the child.

Never tell a parent of a sick or injured child that it would be cheaper for the family to transport the child themselves. Doing so makes it look like you do not want to do your job or do not care about their child's best interests. Parents are not usually initially concerned with costs when it comes to the health of their child.

135.

You are on-scene with a 70-year-old female who complains of being awakened in the middle of the night by sudden-onset dyspnea and sweating. She is breathing 32 times per minute with inspiratory/expiratory wheezing and rales auscultated in all fields bilaterally, with an SpO2 of 88 percent on room air. Her heart rate is 136 beats per minute, showing an irregular narrow-complex tachycardic rhythm on the monitor.

Which of the following is most likely causing the patient's current signs and symptoms?

  • Paroxysmal nocturnal dyspnea

  • Acute renal failure

  • Acute Respiratory Distress Syndrome

  • Chronic bronchitis

Correct answer: Paroxysmal nocturnal dyspnea

Paroxysmal Nocturnal Dyspnea (PND) is an abnormal condition of the respiratory system characterized by sudden attacks of shortness of breath, profuse sweating, tachycardia, and wheezing that awakens the patient at night from a sound sleep. It is often associated with Left Ventricular Failure (LVF).

Acute Renal Failure (ARF) patients often experience pedal edema, ascites, and pulmonary edema secondary to the fluid retention caused by kidney failure. They are not often awakened with sudden-onset dyspnea and diaphoresis. ARF patients do not often present with tachycardia as seen in PND patients. 

Acute Respiratory Distress Syndrome (ARDS) patients often present with severe dyspnea and ineffective spontaneous respiration/ventilation that usually follows an acute respiratory ailment or severe injury to the lungs. It is not associated with being awakened by shortness of breath, diaphoresis, and/or wheezing. 

Chronic bronchitis patients are known as blue bloaters because of the associated cyanosis and ischemia at the cellular level. They do not present with nocturnal dyspnea and diaphoresis.

136.

Which of the following medication types are used to decrease the workload of the heart by blocking sympathetic stimulation of receptors that work on the SA node and myocardial cells, thus decreasing the force of myocardial contraction and directly reducing a patient's heart rate?

  • Beta-blockers

  • Calcium-channel blockers

  • Sodium-channel blockers

  • Alpha-adrenergic agents

Correct answer: Beta-blockers

Beta-blockers are a group of cardiac medications that effectively reduce heart rate by blocking sympathetic stimulation of the beta receptors that stimulate the SA node and other myocardial cells. They effectively decrease the force of the myocardial contractions, causing a direct reduction in heart rate. Examples of beta-blocking agents include metoprolol, labetalol, sotalol, and propranolol.

Calcium-channel blockers work by relaxing smooth muscles to provide vasodilation as well as reducing heart rate and stroke volume of the heart. They do not effectively block the beta-receptors on the SA node. Examples include diltiazem (or Cardizem), verapamil, and nicardipine. 

Sodium-channel blockers work by impairing conduction of sodium ions through sodium channels used in the treatment of cardiac dysrhythmias. They do not effectively block the sympathetic stimulation of the beta-cells that work on the SA node. An example of this type of agent is lidocaine. 

Alpha-adrenergic blockers are used to lower blood pressure by dilating peripheral blood vessels, causing a decrease in peripheral vascular resistance. They do not block the beta-cells nor do they slow heart rate. Common examples include Cardura, Minipress, and Flowmax.

137.

What interval on the EKG represents the time between the end of ventricular depolarization to the start of ventricular repolarization?

  • ST segment

  • T wave

  • PR interval

  • PR segment

Correct answer: ST segment

The ST segment is the line between the S wave (of the QRS complex) and the T wave. Therefore, it measures the end of ventricular depolarization to the start of ventricular repolarization.

The T wave simply illustrates ventricular repolarization. The PR interval measures the time between the start of atrial depolarization to the start of ventricular depolarization. The PR segment measures the time between the end of atrial depolarization and the start of ventricular depolarization.

138.

What occurs when one of the lower pacemakers begins to fire at an accelerated rate, and steals control from the predominate pacemaker?

  • Usurpation

  • Escape

  • Junctional rhythm

  • Bradycardia

Correct answer: Usurpation

Usurpation occurs when the cells of a lower pacemaker become irritable to take over the electrical impulse from the higher pacemaker. The result is a higher than normal heart rate.

Escape is when the lower pacemaker takes control of the electrical impulse after the higher pacemaker fails. Bradycardia is a rate of below 60 beats per minute. A junctional rhythm is when electrical impulses begin specifically at the AV node and results in a narrow QRS complex.

139.

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.

140.

In which of the following conditions would obtaining an ECG not be a priority? 

  • Patient with multi-system trauma 

  • Patient with suspected heat stroke

  • Patient with shortness of breath

  • Patient with swollen feet and abdomen

Correct answer: Patient with multi-system trauma 

An ECG is not a priority for a patient with multi-system trauma, as they will need other priority interventions other than an ECG, such as airway management and treatment for shock. Shortness of breath and edema may be a symptom of cardiac conditions and require an ECG as a priority. Heat stroke can cause arrhythmias, so an ECG would be a priority during the assessment.

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