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Quiz Session - Attempts With Random Questions

NREMT Paramedic Exam Questions

Page 9 of 60

161.

Which of the following are indicators of return of spontaneous circulation (ROSC) in an adult cardiac arrest patient? 

Select the 2 answer options which are correct.

  • End-tidal CO2 suddenly increases

  • Pulse becomes palpable 

  • SpO2 suddenly decreases 

  • End-tidal CO2 suddenly decreases

Signs of ROSC include an organized ECG rhythm with a palpable pulse and blood pressure and an abrupt, sustained increase in end-tidal CO2 (typically 40 mm Hg or higher).

A sudden drop in SpO2 would not be an indicator of ROSC, but it may indicate insufficient airway management. If chest compressions become easier, check to ensure proper hand placement. It is not an indicator of ROSC. 

162.

What is the normal amount of time for a PR interval?

  • 0.12 - 0.2 seconds

  • Less than 0.12 seconds

  • 0.1 seconds

  • 1 second

Correct answer: 0.12 - 0.2 seconds 

The normal time for the PR interval is 0.12 - 0.2 seconds.

163.

Which of the following is correct regarding the difference between DKA and HHS?

Select the 2 answer options which are correct.

  • Ketones are present in DKA and not in HHS

  • Blood glucose levels are higher in HHS

  • Level of consciousness is not altered in DKA

  • The pulse changes little in HHS

The biggest differences between HHS and DKA are blood glucose levels (they tend to be much higher in HHS) and the presence of ketones (absent in HHS). 

Level of consciousness changes are present in both DKA and HHS and if not corrected, both will lead to a comatose state. The pulse will increase significantly in both DKA and HHS, leading to tachycardia. 

164.

Your adult motor vehicle accident patient has sustained a closed pneumothorax that is quickly approaching a tension pneumothorax while you are still twenty minutes from the trauma center. He is tachycardic, breathing rapidly with decreased breath sounds on the right side, and increasing jugular vein distension. At last reassessment, he begins showing signs and symptoms of shock and hypotension. What should be your next intervention in this situation?

  • Chest decompression using an 8-mm or larger, 10- or 14-gauge IV catheter inserted in the second intercostal space in the midclavicular line, just above the rib

  • Chest decompression using a 5-mm or longer, 8- or 10-gauge IV catheter inserted in the second or third intercostal space laterally on the unaffected side

  • Chest decompression using a 6-mm or larger, 10- or 14-IV catheter inserted in the first intercostal space in the midclavicular line, just below the rib

  • Chest decompression using a 5-mm or larger, 10- or 14-gauge IV catheter inserted in the second intercostal space in the midaxillary line on the affected side

Correct answer: Chest decompression using an 8-mm or larger, 10- or 14-gauge IV catheter inserted in the second intercostal space in the midclavicular line, just above the rib

If a paramedic is forced to decompress a tension pneumothorax in the pre-hospital setting, it is important to contact medical command for direction. Once the decision has been made to decompress a patient's chest, it should be accomplished by using an 8 mm or larger, 10- or 14-gauge IV catheter. The site of choice, if possible, is the second intercostal space in the midclavicular line. The tip of the catheter should enter anteriorly, just above the rib, to avoid damaging the nerve, artery, and vein that runs under each rib.

A 5-mm IV catheter is too short to effectively pierce the chest wall and pleural space in any adult decompression situation. Also, the catheter should be inserted in the fourth or fifth intercostal space laterally on the affected side, not the second or third intercostal space on the unaffected side. A 6-mm or larger catheter would likely be too short to effectively pierce the chest wall and pleural space. In addition, the catheter should not be inserted in the first intercostal space and never below the rib. A 5-mm IV catheter would be too small to effectively pierce the chest wall and pleural space; it requires an 8-mm or larger. The catheter should be inserted in the fourth or fifth intercostal space laterally, not the second.

165.

En-Route

While responding to the given scenario, your EMT partner asks where the ambulance should be positioned. Which of the following is correct?

  • Park the ambulance 100 feet past the scene on the same side of the road if possible

  • Position the ambulance 50 feet in front of the scene in the fend-off position

  • Position the ambulance downhill and downwind if hazardous materials are involved

  • Position the ambulance 100 feet before the scene in the fend-off position

Correct answer: Park the ambulance 100 feet past the scene on the same side of the road if possible

If law enforcement or fire rescue have secured the scene, the ambulance should be parked 100 feet past the crash, on the same side of the road. If this is not possible, try to park at least 50 feet from the wreckage. If hazardous materials are involved, park upwind and uphill. If law enforcement or fire rescue have not secured the scene, position the ambulance 50 feet in front of the scene in the fend-off position. Since law enforcement and fire rescue are on scene, park 100 feet past the crash if possible.

166.

Which of the following are nerve agents that cause an immediate onset of symptoms when exposed?

Select the three correct answer options.

  • Tabun 

  • Sarin

  • VX

  • Lewisite 

Tabun, sarin, and VX are nerve agents. Soman is another nerve agent. Symptoms begin immediately after exposure to all these and will vary in severity depending on the route of exposure, duration of contact, and amount of exposure. 

Lewisite is a vesicant, not a nerve agent. It causes severe damage to skin and mucous membranes if inhaled. 

167.

If a patient is suffering from pulmonary edema, which of the following will be helpful in increasing the patient's lung volume and vital capacity while reducing venous return to the heart and helping to diminish the overall work of breathing without affecting blood pressure?

  • Placing the patient in a sitting position with legs dependent

  • Administering 0.04 mg of nitroglycerin sublingually

  • Administering 2 mg of morphine sulfate intravenously

  • Placing the patient on the left side and ventilating at a fast rate with BVM

Correct answer: Placing the patient in a sitting position with legs dependent

The paramedic should place the patient with pulmonary edema in a sitting position with their legs dependent. This position increases the patient's lung volume and vital capacity. It also directly reduces venous return and the work of breathing.

Nitroglycerin is a powerful vasodilator; it is not effective in increasing lung volume or capacity. 

Morphine is a narcotic analgesic effective in reducing venous return and reducing work of breathing but does not increase lung volume or vital capacity. 

Placing the patient on the left side will not decrease venous return to the heart, BVM may help increase ventilation but not the vital capacity or volumes without risk of barotrauma.

168.

If a patient has stopped breathing due to a spinal cord injury, which of the following nerves is likely involved in the injury?

  • Phrenic nerve

  • Vagus nerve

  • Brachial nerve

  • Trochlear nerve

Correct answer: Phrenic nerve

The phrenic nerve is composed mostly of motor neurons responsible for initiating contractions of the diaphragm. The diaphragm is the primary muscle responsible for respiration. If a spinal cord injury stops or blocks the motor impulses from reaching the diaphragm, it cannot contract and increase the size of the chest cavity, creating negative pressure and initiating inspiration.

The vagus nerve runs throughout the body and is responsible for the function and regulation of several bodily systems such as the heart and digestive tracts. It is not responsible for initiating or controlling respiration. 

The brachial nerve belongs to a plexus of nerves in the upper extremities that control most of the muscles of the upper and lower arms. It is not responsible for respiration and could not affect a patient's breathing. 

The trochlear nerve belongs to a group of nerves responsible for the movement of the eyes and eyelids. It would not affect a patient's respiration or breathing effort.

169.

An unresponsive adult trauma patient exhibits pale, cold, and clammy skin that appears ashen/cyanotic. The patient is breathing less than eight times a minute, has a heart rate of 32 beats a minute, and shows an irregular bradyarrhythmia on the monitor in lead II. The patient is experiencing frank hypotension that is barely palpable.

Which of the following stages of shock is most likely causing this patient's presentation?

  • Irreversible shock

  • Uncompensated shock

  • Compensated shock

  • Reversible shock

Correct answer: Irreversible shock

The patient with irreversible shock will be extremely ill. They will present with cold, pale, clammy skin, often approaching cyanotic. The clinical signs of irreversible shock include bradycardia with associated dysrhythmias, frank hypotension, and evidence of multi-system organ failure.

Patients with a form of uncompensated shock will present with mild tachycardia, a delayed capillary refill, cold extremities, and hypotension. These patients can be saved with quick, aggressive fluid resuscitation and oxygen therapy. They have not yet reached the stage of no return. 

Patients with compensated or reversible shock will present with mild tachycardia, delayed capillary refill, and cool, pale skin. These patients are often slightly hypertensive or have normal blood pressure, initially. They are not nearly as critically ill as the patient in this scenario. Irreversible shock patients have a 0% chance of surviving.

170.

Which of the following is not a criterion for an arrhythmia?

  • Narrow QRS complexes

  • Abnormally long PR intervals

  • Abnormally short PR intervals

  • Irregular rhythm with pauses or premature beats

Correct answer: Narrow QRS complexes 

Signs of irregular rhythms include rhythms with pauses, premature beats, abnormally short or long PR intervals, inconsistent PR intervals, and wide (not narrow) QRS complexes.

171.

Which of the following common toxic substances is a colorless, flammable, and extremely hazardous gas that smells like rotten eggs and is capable of affecting several body systems, especially the nervous system?

  • Hydrogen sulfide

  • Methyl bromide

  • Hydrogen cyanide

  • Halogenated hydrocarbon

Correct answer: Hydrogen sulfide

Hydrogen sulfide is considered a poison that affects several body systems, especially the nervous system. It is a colorless, flammable, and extremely hazardous gas that smells like rotten eggs. Hydrogen sulfide can be easily made by mixing household cleaners. It is sometimes used by young adults attempting suicide.

Methyl bromide is a colorless, non-flammable gas produced industrially to prevent insects. It does not smell like rotten eggs and is not flammable. 

Hydrogen cyanide is a colorless, flammable gas that is very similar to hydrogen sulfide but does not smell like rotten eggs. Hydrogen cyanide often smells like burnt almonds. 

Halogenated hydrocarbons are toxic substances known as hepato-toxins. They accumulate in the body until they reach a toxic level and cause significant kidney damage. They are not a colorless, flammable gas that smells like rotten eggs.

172.

Which of the following is true regarding Prinzmetal angina?

  • It is characterized by ST-segment elevation

  • It is characterized by the absence of T waves

  • It is characterized by tall, peaked T waves

  • It is brought on by very warm temperatures

Correct answer: It is characterized by ST-segment elevation

Prinzmetal angina is characterized by ST-segment elevation and may include T-wave inversion. This type of angina can occur at any time, and the patient affected may not have any atherosclerotic disease. It is caused by spasms of the coronary artery and is treated with nitroglycerin. It may occur with exertion but most commonly occurs while at rest. It may also occur in some healthy patients if they are outside in very cold temperatures, but it is not associated with warm temperatures.  

Tall, peaked T waves are indicative of hyperkalemia, not Prinzmetal angina.

173.

Which heart valve is located between the aorta and the left ventricle?

  • Aortic valve

  • Mitral valve

  • Pulmonic valve

  • Tricuspid valve

Correct answer: Aortic valve 

The aortic valve is located between the aorta and the left ventricle. It is a semilunar valve that separates a ventricle from an artery. 

The pulmonic valve is located between the right ventricle and the pulmonary artery. The tricuspid valve is located between the right atrium and right ventricle. The mitral valve is located between the left atrium and left ventricle.

174.

Your adult female postpartum patient delivered her newborn with the assistance of her husband five minutes prior to your arrival on the scene. The mother continues to bleed heavily after an adequate fundal massage and encouraging the infant to breastfeed. Her current heart rate is 125 bpm; her blood pressure is 108/60, and she is breathing 22 times a minute with an SpO2 of 97.

After ensuring a second infant is not present, which of the following interventions would medical command most likely recommend?

  • Administer oxytocin infusion (1 unit per 100 mL of lactated Ringer's solution) at 20 to 30 gtts/min (micro-drip tubing), depending on bleeding severity

  • Administer a fluid bolus of 1,000 mL of normal saline, and transport the patient in the Trendelenburg position

  • Administer lactated Ringer's solution run wide open using macro-drip tubing under pressure

  • Continue fundal massage, and pack the vagina with sterile ABD or trauma pads

Correct answer: Administer oxytocin infusion (1 unit per 100 mL of lactated Ringer's solution) at 20 to 30 gtts/min (micro-drip tubing), depending on bleeding severity

After childbirth, the mother sometimes continues to bleed heavily vaginally. In this case, the paramedic should locate the fundus and apply gentle, yet firm, massage to the crown of the fundus for no less than 10 minutes in an attempt to control the hemorrhage. If this procedure fails to stop the bleeding, it is appropriate to have the infant breastfeed in an attempt to stop the bleeding naturally through uterine contractions. If these procedures fail to stop the hemorrhage, MCP may recommend/order the administration of oxytocin (Pitocin) to cause a uterine contraction that will likely stop the bleeding. The proper dosage would involve mixing 1 unit of oxytocin in every 100 mL of lactated Ringer's solution and run the infusion at 20 to 30 gtts/min using a micro-drip 60 gtts IV tubing set, depending on MCP orders and the severity of the bleeding.

A fluid bolus may be recommended (not likely a full 1,000 mL unless hypotension/hypovolemia is present) after the bleeding is controlled but is not going to stop the bleeding from the uterus. If anything, it may worsen the bleeding by thinning the blood further. Fluid resuscitation is appropriate when a postpartum female is bleeding. However, it is intended to replace fluid and electrolytes lost through bleeding and is not helpful in actually stopping the hemorrhage. 

It would not be appropriate to run a lactated Ringer's solution IV wide open using macro-drip tubing and under pressure. This would likely thin the blood and cause clotting issues. Also, the patient's blood pressure does not warrant a fluid bolus or fluid running wide open under pressure. 

It is never acceptable for a paramedic to pack anything into the birth canal after childbirth.

175.

Your suspected myocardial infarction patient has exhibited ST elevation in Leads II, III, and aVF on the electrocardiogram. What area of the heart do you suspect is being damaged?

  • Inferior wall

  • Septal wall

  • Anterior wall

  • Lateral wall

Correct answer: Inferior wall

An inferior wall myocardial infarction is the most commonly seen MI in the prehospital setting. It is evident by the presence of ST segment elevation in Lead II, III, and aVF.

A septal wall myocardial infarction is likely when ST segment elevation is seen in Leads V1 and V2. 

An anterior wall myocardial infarction is most evident with ST elevation in V3 and V4. Anterior wall MIs are the most lethal type of myocardial infarction. 

A lateral wall myocardial infarction is evident by ST segment elevation in Leads I, aVL, V5, and V6.

176.

Which of the following is true regarding ventricular rhythms?

  • The P wave is lost in the abundance of wide QRS complexes

  • They originate in one or more irritable foci above the conduction system pathway

  • This loss of conduction produces a rapid ventricular arrhythmia with narrowed QRS complexes

  • Slow ventricular rhythms are not as lethal as rapid ventricular rhythms

Correct answer: The P wave is lost in the abundance of wide QRS complexes 

Ventricular rhythms originate in irritable foci in the ventricular tissues below the conduction system. The loss of conduction produces either a rapid or slow ventricular arrhythmia and wide QRS complexes greater than 0.12 seconds. No P waves are seen as they are lost in the abundance of bizarre QRS complexes. Slow and fast ventricular rhythms are both lethal and require immediate attention.

177.

You hook a patient up to a 12 lead EKG and notice a small spike in the rhythm followed by a wide and bizarre QRS complex. Based on your knowledge of irregular rhythms, you identify this abnormality as:

  • The sign of a ventricular pacemaker

  • A PVC

  • The beginning of ventricular tachycardia

  • Prinzmetal angina

Correct answer: The sign of a ventricular pacemaker

When a ventricular pacemaker fires, it will show on the EKG as a small spike, followed by a wide QRS complex that looks similar to a PVC. The difference between this and a PVC is the presence of that pacemaker spike.

Ventricular tachycardia is usually preceded by a ventricular rhythm, caused by lethal rhythms such as a third-degree heart block. Prinzmetal angina is characterized by an elevated ST wave.

178.

An inferior mycardial infarction (MI) is most likely due to an occlusion or damage to what vessel?

  • Right coronary artery

  • Left anterior descending artery

  • Circumflex artery

  • Right anterior descending artery

Correct answer: Right coronary artery

Inferior myocardial infarctions (MI's) are most commonly caused by an occlusion of the right coronary artery. A posterior MI would be caused by an occlusion of the circumflex, and an anterior MI would most likely be caused by an occlusion of the left anterior descending artery (LAD). There is no right anterior descending artery.

179.

During which wave, complex, interval, or segment of an electrocardiogram tracing does the absolute refractory period take place in a normally functioning heart?

  • Q-T interval

  • P-R interval

  • S-T segment

  • P wave

Correct answer: Q-T interval

The Q-T interval is measured from the beginning of the Q wave to the end of the T wave. It measures the time from the onset of ventricular depolarization to the end of ventricular repolarization. It is during the initial phase of the interval that the heart is said to be in the absolute refractory period. This means that the heart muscle cannot be stimulated to initiate a heartbeat or impulse, no matter how strong the stimulus is. 

The P-R interval represents the time it takes for an electrical stimulus to be conducted through the atria and AV node up to the instant of ventricular depolarization. It does not represent the time interval in which the absolute refractory period occurs. 

The S-T segment represents the early phase of ventricular repolarization. It follows the QRS complex and ends with the onset of the T wave. The absolute refractory period occurs in the early part of the Q-T interval, just before the onset of the S-T segment. 

The P wave represents atrial depolarization and is usually upright in lead II. The absolute refractory period cannot occur in the P wave because the absolute refractory period follows atrial depolarization in the early part of ventricular depolarization.

180.

The most widely used water rescue model includes which of the following?

Select the 2 answer options which are correct.

  • Reach 

  • Throw 

  • Float 

  • Pull 

The most widely used water rescue model consists of reach, throw, row, and go:

  • Reach: The victim is located close to the shoreline and rescuers can retrieve them by reaching with an outstretched arm or leg, a rescue pole or hook, an oar, a backboard, etc. without having to enter the water. 
  • Throw: The victim is too far away from the shoreline to be reached with a rigid object. Rescuers can throw ropes, rope bags, flotation rings or discs tied to a rope, a life vest tied to a rope, etc. to retrieve the victim without having to enter the water. 
  • Row: The victim is too far away from the shoreline to be reached or to have a flotation device thrown to them. Rescuers must use a boat or approved watercraft to access and retrieve the victim without having to enter the water. 
  • Go: Rescuers must physically enter the water and swim to the victim to retrieve them. This method may be used from the shoreline or a boat depending on the circumstances and should only be attempted by trained rescuers. 

Float is not part of the water rescue model.

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