Chapter 37 - Patients with Special Challenges Flashcards

1
Q

A 13-year-old child is on a home ventilator. The parents called because the mechanical ventilator is malfunctioning and the child has increasing respiratory distress. You should:

Select one:

A. reset the ventilator by unplugging it for 30 to 60 seconds.
B. disconnect the ventilator and apply a tracheostomy collar.
C. place a call to the home health agency treating this patient.
D. attempt to troubleshoot the mechanical ventilator problem.

A

B. disconnect the ventilator and apply a tracheostomy collar.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

A 70-year-old male complains of shortness of breath. During your assessment, you note that he has bilateral hearing aids. When you ask him questions related to his chief complaint, he does not answer you. You can hear a whistling sound coming from his hearing aids. You should:

Select one:

A. try repositioning the hearing aid or remove it and turn down the volume.
B. recognize that the batteries in his hearing aids are probably depleted.
C. remove his hearing aids, turn up the volume, and replace them in his ears.
D. remove both of his hearing aids and use pencil and paper to communicate.

A

A. try repositioning the hearing aid or remove it and turn down the volume.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

A person is said to be obese when he or she is ________ over his or her ideal weight.

Select one:

A. 30% or more
B. 10% or more
C. 20% or more
D. 40% or more

A

A. 30% or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

A surgical procedure that creates an opening between the intestine and the surface of the body that allows for the elimination of waste products is called a(n):

Select one:

A. intestinal shunt.
B. colostomy.
C. gastric stoma.
D. gastrostomy.

A

B. colostomy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

According to the “E” in the DOPE mnemonic, which of the following actions should you perform to troubleshoot inadequate ventilation in a patient with a tracheostomy tube?

Select one:

A. Attempt to pass a suction catheter into the tube.
B. Listen to breath sounds to assess for a pneumothorax.
C. Look for blood or other secretions in the tube.
D. Check the mechanical ventilator for malfunction.

A

D. Check the mechanical ventilator for malfunction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

According to the Emergency Medical Treatment and Active Labor Act (EMTALA):

Select one:

A. a patient maintains the legal right to recant his or her consent to emergency treatment, even after signing in to the emergency department.
B. all health care facilities are legally obligated to provide assessment and care only if the patient is critically ill or injured.
C. all health care facilities must provide a medical assessment and required treatment, regardless of the patient’s ability to pay.
D. a health care facility has the right to refuse assessment and treatment to a patient, but only if his or her condition is not deemed critical.

A

C. all health care facilities must provide a medical assessment and required treatment, regardless of the patient’s ability to pay.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Because a tracheostomy tube bypasses the nose and mouth:

Select one:

A. severe swelling of the trachea and bronchi can occur.
B. secretions can build up in and around the tube.
C. the risk of a local infection is significantly high.
D. bleeding or air leakage may occur around the tube.

A

B. secretions can build up in and around the tube.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cerebral palsy is characterized by poorly controlled ________ movement.

Select one:

A. neck
B. eye
C. body
D. extremity

A

C. body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Common complications associated with central venous catheters include all of the following, EXCEPT:

Select one:

A. clotting of the line.
B. a local infection.
C. bleeding around the line.
D. rupture of a central vein.

A

D. rupture of a central vein.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Down syndrome is a genetic defect that occurs as the result of:

Select one:

A. a separation of chromosome 21.
B. an extra pair of chromosomes.
C. a sperm that contains 24 chromosomes.
D. a triplication of chromosome 21.

A

D. a triplication of chromosome 21.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Spina bifida is defined as:

Select one:

A. chronic pressure on the brain caused by excess cerebrospinal fluid.
B. congenital inflammation of the spinal cord, usually in the neck.
C. a birth defect in which the child is born without spinal vertebrae.
D. a birth defect caused by incomplete closure of the spinal column.

A

D. a birth defect caused by incomplete closure of the spinal column.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The purpose of a ventricular peritoneum shunt is to:

Select one:

A. prevent excess cerebrospinal fluid from accumulating in the brain.
B. monitor pressure within the skull in patients with a head injury.
C. remove fluid from the abdomen of patients with right-sided heart failure.
D. divert excess cerebrospinal fluid to the ventricles of the brain.

A

A. prevent excess cerebrospinal fluid from accumulating in the brain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Under what circumstances is a left ventricular assist device used?

Select one:

A. To permanently replace the function of one or both of the ventricles
B. To reduce ventricular pumping force in patients with aortic aneurysms
C. To ensure that the ventricles contract at an adequate and consistent rate
D. As a bridge to heart transplantation while a donor heart is being located

A

D. As a bridge to heart transplantation while a donor heart is being located

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When caring for a patient who is visually impaired, it is important to:

Select one:

A. allow a service dog to remain with the patient at all times, even if the patient is critically ill.
B. stand to the side of the patient when speaking if his or her peripheral vision is impaired.
C. tell him or her what is happening, identify noises, and describe the situation and surroundings.
D. leave items such as canes and walkers at the residence if the patient will be carried on a gurney.

A

C. tell him or her what is happening, identify noises, and describe the situation and surroundings.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which of the following conditions would MOST likely be encountered in a patient with cerebral palsy?

Select one:

A. Paralysis
B. Brain tumors
C. Seizure disorder
D. Type 2 diabetes

A

C. Seizure disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which of the following statements regarding autism is correct?

Select one:

A. The majority of patients with autism do not speak at all.
B. Most cases of autism are diagnosed by 3 years of age.
C. Impairment of motor activity is a classic sign of autism.
D. Autism affects females four times greater than males.

A

B. Most cases of autism are diagnosed by 3 years of age.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which of the following statements regarding interaction with the caregiver of a child or adult with special health care needs is correct?

Select one:

A. Before performing an assessment of the patient’s ABCs, the EMT should ask the caregiver about the patient’s medical condition.
B. Communication with the patient’s caregiver or family members is important because they are the most familiar with the patient’s condition.
C. In general, the EMT should only speak with a certified home health care provider because he or she is the expert on the patient’s illness.
D. In most cases, it is more appropriate for the EMT to contact medical control prior to speaking with the patient’s primary caregiver.

A

B. Communication with the patient’s caregiver or family members is important because they are the most familiar with the patient’s condition.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which of the following statements regarding patients with intellectual disabilities is correct?

Select one:

A. Speaking with the patient’s family is the least effective way to determine how much the patient understands.
B. Patients with intellectual disabilities are susceptible to the same disease processes as other patients.
C. Most patients with intellectual disabilities have normal cognitive function, but abnormal physical features.
D. An intellectual disability differs from mental retardation in that it is the result of a congenital abnormality.

A

B. Patients with intellectual disabilities are susceptible to the same disease processes as other patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which of the following would be the MOST practical method of communicating with a hearing-impaired patient until his or her hearing aids can be located?

Select one:

A. Using a piece of paper and writing utensil to ask questions
B. Contacting dispatch and requesting a sign language interpreter
C. Using a high-pitched voice while speaking directly into the ear
D. Attempting to use body language to determine the problem

A

A. Using a piece of paper and writing utensil to ask questions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

You are assessing a 440-lb man who complains of shortness of breath and lower back pain. The patient is conscious and alert, his blood pressure is 148/98 mm Hg, and his heart rate is 120 beats/min. Your MOST immediate action should be to:

Select one:

A. ask a member of your team to locate the best route to move him to the ambulance.
B. perform a secondary assessment, focusing on his respiratory system and back.
C. avoid placing him in a supine position if possible and administer oxygen.
D. notify the receiving facility and advise them of the patient’s weight and status.

A

C. avoid placing him in a supine position if possible and administer oxygen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

EMTs are dispatched for a patient whose central venous catheter is malfunctioning. When they arrive and assess the patient, they find bleeding from the tubing attached to the line. The EMTs should:

carefully remove the catheter and transport.

apply direct pressure to the tubing and transport.

request an ALS ambulance to clamp the tubing.

gently manipulate the catheter to reduce the bleeding.

A

apply direct pressure to the tubing and transport.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When caring for a morbidly obese patient, you should:

leave him or her in a supine position, as this often facilitates breathing.

ask the patient if he or she knows what led to his or her obesity problem.

call for ALS backup because obese patients are at high risk for heart attack.

establish his or her chief complaint and then communicate your plan to help.

A

establish his or her chief complaint and then communicate your plan to help.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

In contrast to conductive hearing loss, sensorineural hearing loss is caused by:

barotrauma.

nerve damage.

earwax accumulation.

eardrum perforation.

A

nerve damage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

You receive a call to a residence for an apneic 2-month-old male. When you arrive at the scene, the infant’s mother tells you that her son was born prematurely and that his apnea monitor has alarmed four times in the past 30 minutes. Your assessment of the infant reveals that he is conscious and active. His skin is pink and dry, and he is breathing at an adequate rate and with adequate tidal depth. His oxygen saturation reads 98% on room air. You should:

request an ALS ambulance to transport the infant to the hospital.

advise the mother to observe her son and call 9-1-1 again if necessary.

administer high-flow oxygen and observe for a drop in oxygen saturation.

transport the infant to the hospital and bring the apnea monitor with you.

A

transport the infant to the hospital and bring the apnea monitor with you.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

An important aspect in the assessment of a patient who experienced a previous brain injury involves:

presuming that he or she has cognitive impairment until proven otherwise.

contacting the patient’s physician to determine the extent of the brain injury.

recalling that most patients with a brain injury have other organ dysfunction.

speaking with the patient and family to establish what is considered normal for the patient.

A

speaking with the patient and family to establish what is considered normal for the patient.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

You respond to a residence for a 9-year-old female with Down syndrome who is sick. When you arrive at the scene and assess the patient, you determine that she is unresponsive and has gurgling respirations. You should:

insert an oropharyngeal airway and begin assisting her ventilations with a bag-valve mask.

open her airway with the jaw-thrust maneuver and assess the rate and depth of her breathing.

immediately apply high-flow oxygen via a nonrebreathing mask and then assess her pulse rate.

open her airway with a manual maneuver, suction her oropharynx, and insert a simple airway adjunct.

A

open her airway with a manual maneuver, suction her oropharynx, and insert a simple airway adjunct.

27
Q

Which of the following statements regarding gastrostomy (gastric) tubes is correct?

Gastrostomy tubes are placed directly into the small intestine.

Most gastrostomy tubes are temporary and are not sutured in place.

Patients with a gastrostomy tube may still be at risk for aspiration.

Gastrostomy tubes are used for patients who cannot digest food.

A

Patients with a gastrostomy tube may still be at risk for aspiration.

28
Q

Autism is defined as a:

psychiatric condition related to an imbalance of serotonin in the brain.

mental disability caused by insufficient cognitive development of the brain.

congenital condition caused by factors such as malnutrition or birth complications.

pervasive developmental disorder characterized by impairment of social interaction.

A

pervasive developmental disorder characterized by impairment of social interaction.

29
Q

Which of the following statements regarding cerebral palsy is correct?

Conditions such as brain injury at birth, postpartum infections, and fetal hypoxia can cause cerebral palsy.

Most cases of cerebral palsy develop within the first 10 years of life and are typically caused by meningitis.

Approximately 25% of patients with cerebral palsy possess some varying degrees of developmental delay.

A key clinical feature of cerebral palsy is paralysis of the respiratory muscles, which confines the patient to a ventilator.

A

Conditions such as brain injury at birth, postpartum infections, and fetal hypoxia can cause cerebral palsy.

30
Q

A service dog is easily identified by its:

size.

breed.

color.

harness.

A

harness.

31
Q

MS personnel would MOST likely be called to the residence of a patient receiving home health care when the home care provider:

needs simple assistance in providing patient care.

must confirm that a specific intervention is required.

has recognized a change in the patient’s health status.

has a question that is specific to the patient’s condition.

A

has recognized a change in the patient’s health status.

32
Q

In contrast to an automated implanted cardioverter/defibrillator, an internal cardiac pacemaker:

regulates the patient’s heart rate if it falls below a preset value.

delivers a shock to the heart if the rate becomes exceedingly fast.

is implanted under the skin in the left upper abdominal quadrant.

will only activate if it detects rhythms such as ventricular fibrillation.

A

regulates the patient’s heart rate if it falls below a preset value.

33
Q

Vagal nerve stimulators may be an alternative treatment to medication for patients with:

chronic seizure disorders.

inherently slow heart rates.

certain psychiatric conditions.

chronic muscle pain and fatigue.

A

chronic seizure disorders.

34
Q

Which of the following statements regarding hearing aids is correct?

Over time, hearing aids can restore normal hearing.

In-the-canal hearing aids fit in the outer part of the ear.

Hearing aids cannot restore hearing to normal levels.

A whistling sound indicates correct hearing aid placement.

A

Hearing aids cannot restore hearing to normal levels.

35
Q

Characteristic anatomic features of Down syndrome include:

a proportionately small tongue.

a round head with a flat occiput.

bulging eyes and a large face.

long hands with wide fingers.

A

a round head with a flat occiput.

36
Q

Common associated conditions in patients with spina bifida include all of the following, EXCEPT:

hydrocephalus.

spastic limb movement.

extreme latex allergy.

loss of bladder control.

A

spastic limb movement.

37
Q

For which of the following conditions would you MOST likely encounter a ventricular peritoneum shunt?

Epidural hematoma

Hydrocephalus

Cerebral palsy

Subdural hematoma

A

Hydrocephalus

38
Q

If suctioning of the tracheostomy tube is necessary, the EMT should:

A. attach a bag-valve mask to the tracheostomy tube and hyperventilate the patient for 2 minutes.

B. instill 20 mL of saline into the tracheostomy tube and suction for no longer than 20 seconds.

C. attempt to use the patient’s suction device first because it is probably already sized correctly.

D. insert the suction catheter to a depth of no more than 15 cm and set the suction unit to 140 mm Hg.

A

C. attempt to use the patient’s suction device first because it is probably already sized correctly.

39
Q

EMTs are dispatched for a patient in cardiac arrest. When they arrive, they find that the patient is pulseless and apneic and is wearing an external defibrillator vest. In this situation, the EMTs should:

perform CPR and leave the vest in place.

quickly remove the vest and perform CPR.

apply the AED pads over the vests’ pads.

wait 5 minutes prior to using the AED.

A

perform CPR and leave the vest in place.

40
Q

The tip of a central venous catheter rests in the:

vena cava.

left atrium.

right ventricle.

pulmonary vein.

A

vena cava

41
Q

A ventricular atrium shunt drains excess fluid from the ventricles of the brain into the:

A. Left atrium of the heart

B. right ventricle of the heart

C. right atrium of the heart

D. left ventricle of the heart

A

C. right atrium of the heart

42
Q

If a patient’s mechanical ventilator malfunctions, you should remove the patient from the ventilator and:

A. Begin ventilations with a bag-valve mask.

B. Place the patient on a nasal cannula.

C. Contact medical control.

D. Place the patient on a number breathing mask.

A

A. Begin ventilations with a bag-valve mask.

43
Q

A plastic tube placed in a stoma

A

Tracheostomy tube

44
Q

A surgical opening between the small intestine and the outside of the body

A

Ileostomy

45
Q

Insufficient development of the brain

A

Developmental disability

46
Q

A tube that drains fluid from the brain or other parts of the body

A

Shunt

47
Q

A surgical opening between the colon and the outside of the body

A

Colostomy

48
Q

Which of the following statements is NOT true regarding patients with autism?

A. They may have extreme difficulty with complex tasks that require many steps

B. They will talk with normal tone and speech patterns.

C. They will have difficulty making eye to eye contact.

D. They fail to use or understand nonverbal communication

A

B. They will talk with normal tone and speech patterns.

49
Q

Down syndrome patients are at an increased risk for medical complications. Which of the following is NOT one of those potential complications?

A. Endocrine complications

B. Cardiovascular complications

C. Respiratory complications

D. Gastrointestinal complications

A

C. Respiratory complications

50
Q

Which of the following does NOT usually contribute to or cause obesity?

A. Genetic predisposition

B. Rapid metabolism

C. High caloric intake

D. Low metabolic rate

A

B. Rapid metabolism

51
Q

Airway management can be challenging in patients with Down syndrome because their:

A. Tongue is relatively small and falls back in the throat

B. Mandibles large, which inhibits a mask to face seal

C. Teeth are misaligned and they have a large tongue

D. Occiput is round, which causes flexion of the neck

A

C. Teeth are misaligned and they have a large tongue

52
Q

When caring for patients with cerebral palsy, it is important to remember that:

A. They are unable to walk and are totally dependent upon you

B. Most patients have the ability to walk, but have an unsteady gait

C. Their limbs are often underdeveloped and are prone to injury

D. Hearing aids are usually ineffective for patients with hearing loss

A

C. Their limbs are often underdeveloped and are prone to injury

53
Q

Because hearing-impaired patients typically have more difficulty hearing high-frequency sounds, it is important for you to:

a. Lower the pitch of your voice

B. Increase the pitch of your voice

C. Speak in a monotone voice

D. Try basic sign language first

A

a. Lower the pitch of your voice

54
Q

General techniques for communicating with hearing-impaired patients include:

A. Removing any hearing aids and using a pen and paper to ask questions new

B. Position yourself approximately 18 inches directly in front of the patient

C. Speaking directly into the patient’s ear with an increased voice pitch

D. Exaggerating your lips to ensure the patient understands

A

B. Position yourself approximately 18 inches directly in front of the patient

55
Q

Comfort care, or _______ _______, improves the patient’s quality of life before the patient dies.

A

palliative care

56
Q

You may allow a patient with a visual impairment to rest his or her hand on your ________, because this may help with balance and security while moving.

A

Shoulder

57
Q

A(n) _______ ________ ________ _________ is a special piece of medical equipment that takes over the function of either one or both heart ventricles.

A

left ventricular assist device

58
Q

When caring for a patient with a previous head injury, you should:

A. Never consider returning the patient

B. Watch the patient for signs of anxiety

C. Expect the patient to be able to walk

E. Speak in a loud, commanding tone e

A

B. Watch the patient for signs of anxiety

59
Q

Which of the following statements is NOT true regarding the care of a patient with cerebral palsy?

A. Be prepared to care for a seizure if one occurs

B. Do not assume these patients are mentally disabled

C. Walkers or wheelchairs are not to be taken in the ambulance

D. Limbs are often underdeveloped and are prone to injury

A

C. Walkers or wheelchairs are not to be taken in the ambulance

60
Q

When assessing or providing care to a patient with an intellectual disability, you should:

A. Explain procedures while in the process of performing them

B. Move swiftly and deliberately to quickly accomplish the task

C. Be observant for signs of fear or reluctance from the patient

D. Frequently reassure him or her that everything will be okay

A

C. Be observant for signs of fear or reluctance from the patient

61
Q

Cerebral palsy is a condition that results from damage or injury to the:

A. Spinal cord knew the

B. Peripheral nervous system

C. Voluntary muscles

D. Brain

A

D. Brain

62
Q

General care for a patient with a tracheostomy tube includes all of the following, EXCEPT:

A. Maintaining the patient in a position of comfort when possible new

B. Removing the tube if the area around it appears to be infected

C. Suctioning the tube as needed to clear a thick mucous plug

D. Ensuring adequate oxygenation and ventilation at all times

A

B. Removing the tube if the area around it appears to be infected

63
Q

By placing one hand on your head and the other hand over your abdomen, you are asking a hearing-impaired patient if he or she:

A. Needs help

B. Is sick

C. His nauseated new

D. His heart

A

B. Is sick

64
Q

When enlisting the help of an interpreter who signs, it is important for you to ask the interpreter to:

A. Report exactly what the patient signs and not to add any commentary

B. Voice what he or she is signing while communicating with the patient

C. Avoid any kind of lip movement while he or she is signing with patient

D. Document the answers to the questions that the patient has responded to

A

A. Report exactly what the patient signs and not to add any commentary