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Quiz Session - Attempts With Random Questions

NREMT Paramedic Exam Questions

Page 8 of 60

141.

Select the correct path of blood flow through the human body:

  • Aorta → Arteries → Arterioles → Capillary Bed → Venules → Veins → Vena cava

  • Aorta → Arteries → Capillary Bed → Veins → Vena Cava

  • Vena Cava → Venules → Veins → Capillary Bed → Arterioles → Arteries → Aorta

  • Left main coronary artery → Aorta → Arterioles → Capillary Bed → Venules → Veins → Vena Cava

Correct answer: Aorta → Arteries → Arterioles → Capillary Bed → Venules → Veins → Vena cava

Above is the correct course of the blood as it travels through the systemic circulation.

142.

If a paramedic commits a scope of practice violation, which of the following may result?

  • Criminal charges

  • Civil charges

  • Negligence charges

  • Defamation charges

Correct answer: Criminal charges

The scope of practice refers to the range of duties and skills that medics are allowed and expected to perform when the need arises. It defines the boundaries between the paramedic and laypersons. It also defines the boundaries for professionals such as paramedics, EMTs, and physicians. If a paramedic commits a scope of practice violation, it is a criminal offense.

Civil charges and liabilities (a tort is a wrongful act that injures or interferes with another's person or property) may arise from certain aspects of patient care involving scope of practice; however, it is mainly seen as malpractice liability in the civil arena. 

Negligence charges may arise when a paramedic does not treat a patient as thoroughly or appropriately as another trained paramedic would have. 

Defamation charges would result from writing or telling untrue statements about a patient rather than from treating a patient outside the realm of the medic.

143.

In which of the following situations would nitroglycerin administration be contraindicated? 

Select the three correct answer options.

  • The patient has taken sildenafil in the last 24 hours

  • The patient has a pulse of 136

  • The patient has an SBP of 88 mm Hg 

  • A 12-lead ECG indicates anterior infarction

  • The patient's SBP is 140 mm Hg

Nitroglycerin is a venodilator; use it cautiously or not at all in patients with inadequate ventricular preload such as an inferior wall MI (myocardial infarction) and RV (right ventricular) infarction. If you confirm RV infarction by right-sided precordial leads, or if an experienced provider confirms it through clinical findings, then nitroglycerin and other vasodilators (morphine) or volume-depleting drugs (diuretics) are contraindicated in many EMS systems. If used, they must be used with extreme caution and close monitoring. Avoid using nitroglycerin in patients with hypotension (SBP less than 90 mm Hg), marked bradycardia (heart rate less than 50/min), or marked tachycardia (heart rate greater than 120). Avoid using nitroglycerin if you suspect or know that the patient has taken sildenafil or vardenafil within the previous 24 hours or tadalafil within 48 hours. 

An anterior MI is not a contraindication for the administration of nitroglycerin; the patient may benefit from it in this case. 

144.

Identify the following heart rhythm.

  • Regular rhythm with a premature beat

  • Irregular rhythm with a pause

  • Regular rhythm with a pause

  • Irregular rhythm with a premature beat

Correct answer: Regular rhythm with a premature beat 

This is a rhythm with all the components needed to be a sinus rhythm; however, it is interrupted by a premature beat. An example of this type of rhythm is a premature ventricular complex (PVC).

145.

Which of the following criteria should be met for terminating ALS resuscitative efforts of an adult cardiac arrest patient in the pre-hospital setting?

Select the 3 answer options which are correct.

  • The arrest was not witnessed by EMS

  • No bystander CPR was provided 

  • No ROSC after full ALS care in the field 

  • An advanced airway has been placed 

All the following criteria should be met for terminating ALS resuscitative efforts of an adult cardiac arrest patient in the pre-hospital setting:

  • The arrest was not witnessed by EMS
  • No bystander CPR was provided
  • No Return of Spontaneous Circulation (ROSC) after full ALS care in the field
  • No AED shocks were delivered before transport
  • Reliable criteria indicate irreversible death

An advanced airway is recommended, but not required, before calling for termination of efforts.

146.

The human body regulates homeostasis by communicating at the cellular level through the nervous and endocrine systems. Which of the following is responsible for serving as the command and control center for linking the systems together?

  • Hypothalamus

  • Pituitary gland

  • Adrenal gland

  • Thyroid gland

Correct answer: Hypothalamus

The hypothalamus is responsible for controlling homeostasis by linking the nervous system with the endocrine system. It serves as the command center responsible for body temperature regulation, water balance, sleep cycles, appetite, and sexual arousal.

While the pituitary gland is controlled by the hypothalamus, it is responsible for hormone regulation through communication from the hypothalamus instead of acting as a direct link between the nervous and endocrine systems. 

The adrenal glands are located on top of each kidney and are responsible for releasing epinephrine and, to a lesser extent, norepinephrine when it is needed to help maintain homeostasis. The adrenal glands do not serve as a link between the nervous and endocrine systems. 

The thyroid gland is responsible for the secretion of thyroxine and triiodothyronine; it does not link the nervous and endocrine systems to help maintain homeostasis.

147.

Which of the following are considered lower airway infections? 

Select the 3 answer options which are correct.

  • RSV

  • Bronchiolitis 

  • Pneumonia 

  • Cystic fibrosis 

Respiratory Syncytial Virus (RSV), bronchiolitis, and pneumonia are considered lower airway infections. 

Cystic fibrosis is a disease that affects the lower airways and is caused by genetic factors, not an infection. 

148.

On rare occasions, the EMT may be faced with a limb presentation during birth. After covering the limb with a sterile towel, the mother should be placed:

  • on her back, with her head down and pelvis elevated, and high-flow oxygen to assist with the stress of the mother and child

  • on her back, with only the pelvis elevated, and oxygen low-flow to assist with the stress of the mother and child

  • left lateral recumbent position, and low-flow oxygen to assist with the stress of the mother and child

  • trendelenburg position, and high-flow oxygen to assist with the stress of the mother and child

Correct answer: on her back, with her head down and pelvis elevated, and high-flow oxygen to assist with the stress of the mother and child

On rare occasions, the EMT may be faced with a limb presentation during birth. The correct procedure is to cover the limb with a sterile towel,  place the mother on her back, with her head down and pelvis elevated. Apply high-flow oxygen as the mother and the baby are likely to be physically stressed. Low-flow oxygen does not supply enough oxygen to help both mother and child.

Trendelenberg position and high-flow oxygen are more commonly used in the treatment of shock.

Left lateral recumbent position is used to transport a pregnant woman to take the pressure off the vena cava.

149.

Which of the following is responsible for overseeing emergency medical care provided at a mass casualty incident?

  • Medical branch officer

  • EMS medical director

  • Senior or highest-ranking paramedic on scene

  • Incident commander

Correct answer: Medical branch officer

The EMS medical director has ultimate authority for all patient care issues. However, the Medical Branch Officer is responsible for overseeing all emergency care provided at the scene.

The EMS medical director is ultimately responsible for all treatments but is not available in most cases on the scene. Therefore, treatment officers make treatment decisions on the scene of a mass-casualty incident. 

The highest-ranking paramedic may be asked to be the triage officer or even the treatment officer in some situations. The paramedic would only make treatment decisions when they are the recognized treatment officer in the treatment area of the incident. Being the lead paramedic does not make it their right or responsibility. 

The incident commander leads all collaborations of the various divisions of the mass-casualty-incident. However, they do not make patient care decisions on-scene.

150.

Which part of the cardiac conduction system sends electrical impulses to the ventricles?

  • Bundle of His

  • Purkinje fibers

  • Interatrial tracts

  • Internodal tracts

Correct answer: Bundle of His

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

151.

Your patient was stung by a bee. She is very agitated and shows all the symptoms associated with anaphylaxis. She tells you she thinks she is going to die. While you begin to treat her symptoms, she deteriorates further, exhibiting loss of consciousness and seizure activity.

What is the most likely cause of this rapid progression?

  • Increasing cerebral hypoxia from hypoxemia

  • Venom is neurotoxic, causing seizures

  • An adverse reaction to epinephrine

  • Reduced blood pressure and decreased end-organ perfusion

Correct answer: Increasing cerebral hypoxia from hypoxemia

As anaphylaxis progresses, it causes a lower-than-normal level of oxygen to be present in arterial blood from bronchoconstriction and laryngeal swelling. As the condition further reduces the amount of oxygen in the blood, it greatly reduces the amount of blood and oxygen reaching the brain. Brain hypoxia causes the seizures associated with anaphylaxis.

Venom from the insect sting is seen by the body as a foreign invader and initiates the allergic reaction. This does not cause the associated seizure activity. Decreased oxygen delivery to the brain from vasodilation and bronchoconstriction causes cerebral hypoxia. Cerebral hypoxia is the cause of the seizure. 

Epinephrine is capable of causing a hypersensitive reaction and possible seizure. However, the question does not state that epinephrine was administered to the patient. Seizures during anaphylaxis are treated as if hypoxia is the cause because the chances of epinephrine causing the seizure are much less likely.

Anaphylaxis causes cerebral hypoxia if not quickly reversed. Decreased blood pressure and end-organ perfusion create problems during anaphylaxis, including worsening hypoxia by failing to deliver blood to the brain, but it is not the primary cause of seizure activity. The worsening hypoxia is the cause of seizures during anaphylaxis.

152.

Identify the following heart rhythm.

  • Escape rhythm

  • Usurpation

  • Bradycardia

  • Junctional rhythm

Correct answer: Escape rhythm

In an escape rhythm, the dominant pacemaker (typically the sinoatrial node) is unusually slow or fails, causing the lower pacemakers to take over. This new rhythm will be slower than the previous rhythm. In this case the escape rhythm is a idioventricular rhythm.

153.

Which of the following is included in the rules of malignancy for PVCs?

  • Runs of consecutive PVCs

  • One PVC per every normal sinus beat

  • Two normal sinus beats for every PVC

  • Any isolated PVC in an asymptomatic heart

Correct answer: Runs of consecutive PVCs

The rules of malignancy for PVCs include the following:

  1. The rhythm has frequent PVCs
  2. The PVCs run consecutively, at least three or more in a row
  3. The PVCs will vary in their appearance (also known as multiform PVCs)
  4. PVCs will fall on the T wave of the last beat. This symptom places the patient in danger of going into ventricular tachycardia.

154.

You are on-scene with a cardiac history patient experiencing unstable ventricular tachycardia that is not responding well to prehospital interventions. The patient and family want the patient transported to a hospital across town; however, there is a facility more capable of handling the cardiac event much closer.

Which of the following would be most appropriate?

  • Explain the situation to the patient and family, then transport to the closer facility to benefit the patient

  • Tell the patient and family they have no choice and transport the patient to the closer facility

  • Transport the patient to the closer facility, then explain to the patient and family on arrival at the appropriate facility

  • Transport the patient to the facility of their choice regardless of medical condition

Correct answer: Explain the situation to the patient and family, then transport to the closer facility to benefit the patient

The facility choice should be based on the patient's immediate needs and the capabilities of the chosen facility. If possible, the paramedic should honor the wishes of the patient. However, when a patient's condition and protocol make it mandatory to transport the patient to the closer facility, it is not appropriate to tell the patient that they have no choice. If all other explanation attempts fail, remain professional and contact medical command.

It is unethical and dishonest to allow a patient and family to believe they are going to be transported to one facility when you know this is not true. 

It is always best to give a patient and their family the choice of which facility they would like to be transported to. However, if the prolonged transport causes the demise of the patient, the paramedic could be held liable. Always choose a closer facility when your patient's life depends on it.

155.

Which of the following may be indicated for an adult patient with pulmonary edema? 

Select the 2 answer options which are correct.

  • Nitroglycerin

  • CPAP

  • Albuterol 

  • Aspirin 

Nitroglycerin has proven to be highly beneficial when used for patients with pulmonary edema, as it leads to a reduction in arteriolar pressure that decreases hydrostatic pressure in the capillary bed. This reduces fluid being forced out of the capillary into the lungs. Continuous positive airway pressure (CPAP) treats pulmonary edema by increasing pressure in the alveoli, forcing fluid back into the interstitial space and out of the lungs.  

Albuterol is a bronchodilator used frequently to reverse bronchospasm, but it has little effect on pulmonary edema. Aspirin is used in acute coronary syndromes to reduce thrombosis and slow the progression of a myocardial infarction (MI). It is not useful in managing pulmonary edema. 

156.

Which of the following corticosteroids is produced by the adrenal cortex and may be potentially fatal for a patient with Addison's disease if the deficiency worsens?

  • Cortisol and aldosterone

  • Epinephrine and norepinephrine

  • Acetylcholine and dopamine

  • Insulin and glucagon

Correct answer: Cortisol and aldosterone

Addison's disease is a potentially life-threatening condition because it causes a deficiency in corticosteroid production. It is caused by a deficiency of the corticosteroid hormones cortisol and aldosterone that are normally produced by the adrenal cortex.

Epinephrine and norepinephrine are produced by the medulla area of the adrenal cortex but are not corticosteroids associated with the onset of Addison's disease. 

Acetylcholine and dopamine are neurotransmitters produced by the pituitary gland. They are not corticosteroids responsible for the development of Addison's disease. 

Insulin and glucagon are produced by the pancreas. Insulin is produced and released by the beta cells (B cells), and glucagon is produced by the alpha cells (A cells) of the pancreas.

157.

Your trauma patient sustained a large laceration to her left thigh that was bleeding profusely on your arrival, but now the bleeding is controlled with a bulky pressure dressing. There are no other injuries. The patient is confused, pale, and found to have a blood pressure of 90 systolic just after the injury was treated. After medical intervention and treatment for shock, the patient's blood pressure continues to fall.

Which of the following most likely caused this to occur?

  • Increasing hypoxemia and lactic acidosis

  • Lowering lactic acid levels

  • Increased oxygen availability and metabolic alkalosis

  • An increase in the hydrostatic pressure in the capillaries, allowing fluids to be reabsorbed

Correct answer: Increasing hypoxemia and lactic acidosis

A shock patient with significant blood loss and hypovolemic shock must have the bleeding stopped and the fluid imbalance corrected as quickly and safely as possible. Once the bleeding is controlled, the blood pressure will normally rebound if the shock state is corrected quickly. If it is not, the progression leads to the opening of precapillary sphincters, which worsens volume depletion and hypotension.

Even though the patient is being treated effectively and the bleeding has stopped, increased oxygen and metabolic alkalosis are unlikely to cause a further reduction in blood pressure. 

An increase in the hydrostatic pressure in the capillaries that allows fluid to be reabsorbed is not likely to cause a further reduction in blood pressure following successfully stopping a hemorrhagic injury.

158.

Which of the following conditions may lead to respiratory alkalosis? 

Select the three correct answer options.

  • Aspirin overdose

  • Fever 

  • Hyperventilation syndrome 

  • Opioid overdose 

  • Asthma attack

Aspirin overdose, fever, and hyperventilation are associated with respiratory alkalosis due to excess carbon dioxide loss through rapid breathing caused by these conditions. 

Opioid overdose is associated with respiratory acidosis due to retaining carbon dioxide from slow respirations. An asthma attack would also lead to respiratory acidosis, not alkalosis, due to the retention of carbon dioxide. 

159.

In which of the following situations would evaluating the ST segment elevation of a patient suffering from a suspected myocardial infarction not be indicated to determine if an infarction exists?

  • In the presence of a left bundle branch block

  • When the patient is hypotensive

  • In the presence of pulmonary edema

  • When a pre-existing right bundle branch block is present

Correct answer: In the presence of a left bundle branch block

A left bundle branch block may impair repolarization, making it look like an ST Elevation Myocardial Infarction (STEMI). Therefore, if a left bundle branch block is present during the evaluation of a patient for the possibility of a STEMI, ST elevation measurements will not be effective in determining if a STEMI exists.

A patient with pulmonary edema or a hypotensive patient does not make ST elevation measurement for the determination of a STEMI contraindicated. Hypotensive patients or patients with acute pulmonary edema may be experiencing a STEMI. Traditional ST segment measurement can be helpful in determining the existence of an ST-elevation myocardial infarction. 

Patients with a right bundle branch block can be evaluated for ST elevation to determine a STEMI. It is only ineffective when evaluating a patient with a left bundle branch block.

160.

The GEMS diamond mnemonic was created to help EMS providers recall key concepts about the assessment of geriatric patients. Which of the following are categories of the GEMS diamond? 

Select the three correct answer options. 

  • Environmental assessment 

  • Social assessment 

  • Medical assessment 

  • GI assessment

The GEMS diamond assessment system is a simple way to recall elements key to working with older demographic groups. Most importantly, it's essential to remember older patients have the same thoughts, ideals, and motivations as their younger cohorts. 

  • G = Geriatric patient
  • E = Environmental assessment
  • M = Medical assessment
  • S = Social assessment 
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