CH 19

Question 1

You are dispatched to a local pharmacy, where a 24-year-old woman experienced an apparent seizure. During your assessment, you note that the patient is conscious but combative. The patient’s supervisor states that she has a history of seizures and takes Tegretol. The patient’s blood pressure is 146/90 mm Hg, pulse rate is 110 beats/min and regular, and respirations are 24 breaths/min with adequate depth. The most appropriate treatment for this patient includes:
establishing vascular access, administering diazepam or lorazepam to reduce her combativeness, and transporting to the closest hospital.
giving her high-flow oxygen, inserting an IO catheter in her proximal tibia, transporting, and observing for further seizure activity.
administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren.
administering oxygen, restraining her to protect her from further injury, placing a bite block in her mouth in case she seizes again, and transporting.

Answer 1

Administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren.

Question 2

A rhythmic contraction and relaxation of muscle groups that is commonly observed during a seizure indicates which type of activity?
Tonic
Hypertonic
Myoclonic
Clonic

Answer 2

Clonic

Question 3

Which of the following is an example of receptive aphasia?

A patient with slurred speech is able to tell you their name.
A patient responds with “no” when asked if they have hypertension.
You hand a patient a pencil and they try to cut paper with it.
You ask a patient who the president is, and they say “January.”

Answer 3

You ask a patient who the president is, and they say “January.”

Question 4

You are dispatched to a residence for a 44-year-old woman with a severe headache. You arrive to find the patient lying on her sofa with a wet washcloth on her forehead. She tells you that she has a history of migraine headaches and that this is one of her “typical” headaches. She also complains of nausea and photophobia. Her blood pressure is 170/94 mm Hg, pulse rate is 120 beats/min and regular, and respirations are 22 breaths/min with adequate depth. The most appropriate treatment for this patient includes:
administering high-flow oxygen, establishing vascular access, and administering nitroglycerin to lower her blood pressure.
carefully assessing her pupils, administering oxygen, starting an IV and giving her morphine, and transporting.
oxygen as tolerated, starting an IV line and administering ondansetron, and transporting without lights or siren.
placing her in a Fowler position, administering oxygen, and transporting her to the hospital for definitive care.

Answer 4

oxygen as tolerated, starting an IV line and administering ondansetron, and transporting without lights or siren.

Question 5

An autoimmune disorder in which the body attacks the myelin of the brain and spinal cord is called:

a dystonic reaction.
Guillain-Barre syndrome.
muscular dystrophy.
multiple sclerosis.

Answer 5

multiple sclerosis.

Question 6

Which of the following cranial nerves regulates movement of the head and shoulders?

Hypoglossal
Accessory
Abducens
Trigeminal

Answer 6

Accessory

Question 7

What type of tremor occurs when a body part is placed in a particular position and required to maintain that position for a long period of time?

Postural
Jacksonian
Intention
Rest

Answer 7

Postural

Question 8

A 29-year-old man, who was recently prescribed an antipsychotic medication, presents with an acute onset of bizarre contortions of the face. Treatment should include:
ondansetron, 4 mg.
promethazine, 25 mg.
diphenhydramine, 25 mg.
diazepam, 5 mg.

Answer 8

diphenhydramine, 25 mg.

Question 9

When performing the arm drift test on a patient with a suspected stroke, a positive finding is characterized by:

both arms moving downward more than 3 inches in 30 seconds when the patient’s eyes are open.
one arm drifting downward and turning away from the body when the patient’s eyes are closed.
one arm drifting downward and turning away from the body when the patient’s eyes are open.
one arm drifting downward and turning toward the body when the patient’s eyes are closed.

Answer 9

one arm drifting downward and turning toward the body when the patient’s eyes are closed.

Question 10

In contrast to a patient in shock, you would expect a patient with increased intracranial pressure to present with:

hypotension.
tachycardia.
a widened pulse pressure.
a narrow pulse pressure.

Answer 10

a widened pulse pressure.

Question 11

A stroke to the right cerebral hemisphere would likely cause:

right-sided weakness and right-sided facial droop.
right-sided weakness and left-sided visual field loss.
left-sided weakness and right-sided visual field loss.
left-sided weakness and an absence of facial droop.

Answer 11

left-sided weakness and right-sided visual field loss.

Question 12

What portion of the brainstem regulates respiratory pattern and depth?

Pons
Basal nuclei
Medulla
Midbrain

Answer 12

Pons

Question 13

Which of the following cranial nerves is responsible for airway control?

Abducens
Oculomotor
Trochlear
Trigeminal

Answer 13

Trigeminal

Question 14

A woman brings her 18-year-old son to your EMS station. The patient is actively seizing and, according to the mother, has been seizing for the past 10 minutes. She states that her son has a history of seizures and takes Depakote. The patient is cyanotic, is breathing erratically, and has generalized muscle twitching to all extremities. You should:
open his airway and begin assisting his ventilations, establish an IV or IO line, and administer diazepam.
hyperventilate him with a bag-mask device to eliminate excess carbon dioxide, establish vascular access, and give lorazepam.
place a bite block between his molars to prevent oral trauma, administer high-flow oxygen, and give lorazepam IM.
protect him from further injury by restraining him, attempt orotracheal intubation, establish an IV, and give Valium.

Answer 14

open his airway and begin assisting his ventilations, establish an IV or IO line, and administer diazepam.

Question 15

You arrive at the scene shortly after a 7-year-old girl experienced a seizure. According to the child’s mother, she was sitting at the dinner table and then suddenly stopped speaking and started blinking her eyes very rapidly. The episode lasted less than 1 minute, after which the child’s condition rapidly improved. This clinical presentation is consistent with which type of seizure?

Complex partial
Absence
Simple partial
Tonic-clonic

Answer 15

Absence

Question 16

You are dispatched to a residence for a middle-aged woman with generalized weakness of approximately 18 hours duration. Your primary assessment reveals right-sided hemiparesis, a left-sided facial droop, and bilaterally equal and reactive pupils. Further assessment reveals that her blood glucose level is 70 mg/dL. En route to the hospital, you note increased movement of her right arm. You are monitoring her vital signs and IV access has been established. Which of the following statements regarding this scenario is correct?

Although the patient is likely experiencing a TIA, you should treat her as though she is experiencing a stroke.
The patient’s signs and symptoms are likely the result of her blood sugar and will resolve with dextrose.
The patient will likely receive fibrinolytic therapy in the emergency department if no contraindications exist.
You should administer nitroglycerin or labetalol if her systolic blood pressure is greater than 150 mm Hg.

Answer 16

Although the patient is likely experiencing a TIA, you should treat her as though she is experiencing a stroke.

Question 17

Tremors that increase as the patient’s hand gets closer to an object that they are trying to grab are what type of tremors?

Clonic
Intention
Postural
Rest

Answer 17

Intention

Question 18

Which of the following is an example of an acute cerebrovascular emergency?

Embolic blockage of a cerebral artery
Accumulation of atherosclerotic plaque
Frontal headache with sensitivity to light
Numbness and tingling in the extremities

Answer 18

Embolic blockage of a cerebral artery

Question 19

A staggering gait is most suggestive of damage to the:

cerebrum.
medulla.
cerebellum.
brainstem.

Answer 19

Cerebellum

Question 20

Which of the following disease processes is characterized by an abnormal gait in which the patient places his or her feet very close together and shuffles while walking?

Alzheimer disease
Cerebral palsy
Parkinson disease
Multiple sclerosis

Answer 20

Parkinson disease

Question 21

A patient with multiple sclerosis may present with:

anisocoria.
nystagmus.
dysphagia.
hyperopia.

Answer 21

Nystagmus

Question 22

Which of the following assessment findings would indicate dysfunction of the trigeminal nerve?

Inability to move the eyes up, down, and laterally
The tongue deviating to one direction or the other
Inability to feel the part of the face you are touching
Inability to shrug the shoulders against resistance

Answer 22

Inability to feel the part of the face you are touching

Question 23

An elderly man who is a resident of a skilled nursing facility is found unresponsive by a staff nurse. When you and your partner arrive, you assess the patient and note that his respirations are slow and shallow; his heart rate is slow, weak, and irregular; and his skin is cool and clammy. You should:

apply oxygen via nonrebreathing mask and apply the ECG.
assess his blood glucose level and give high-flow oxygen.
assist his ventilations and assess his oxygen saturation.
obtain a 12-lead ECG tracing and assess his pupils.

Answer 23

assist his ventilations and assess his oxygen saturation.

Question 24

Components of the diencephalon include the:

pons and medulla.
brainstem and midbrain.
thalamus and hypothalamus.
cerebellum and cerebral cortex.

Answer 24

thalamus and hypothalamus.

Question 25

Which of the following causes of altered mental status is a gradual process? Uremia Epilepsy Acidosis Psychosis

Answer 25

Uremia

Question 26

Patients with trismus often require: immediate tracheal intubation before the airway swells shut. premedication with lidocaine before being intubated. sedation or chemical paralysis to facilitate airway control. hyperventilation to reduce severe intracranial pressure.

Answer 26

sedation or chemical paralysis to facilitate airway control.

Question 27

What is the cerebral perfusion pressure of a patient with a mean arterial pressure of 80 mm Hg and an intracranial pressure of 5 mm Hg? 95 mm Hg 75 mm Hg 85 mm Hg 65 mm Hg

Answer 27

75 mm Hg

Question 28

An elderly man presents with slurred speech, confusion, and unilateral facial droop. When asked to squeeze your hands, the strength in his left hand is markedly less than the strength in his right hand. The patient's wife tells you that her husband has type 2 diabetes and hypertension. On the basis of your clinical findings, you should: suspect that he is experiencing a hemorrhagic stroke, begin immediate transport, and start an IV en route. rule out hypoglycemia by assessing his blood sugar, but suspect a right-sided ischemic stroke. consider him a candidate for fibrinolytic therapy if his symptoms began less than 12 hours ago. start an IV and administer crystalloid fluid boluses if his systolic blood pressure is less than 110 mm Hg.

Answer 28

rule out hypoglycemia by assessing his blood sugar, but suspect a right-sided ischemic stroke.

Question 29

A patient with a head injury is found lying supine. The patient's feet are extended with the toes pointed, and the arms extended with the hands pronated. This indicates: decorticate posturing. low intracranial pressure. brainstem injury. spinal cord injury.

Answer 29

Brainstem injury

Question 30

Prehospital treatment for a patient with a suspected stroke who recently had a seizure may include which of the following? 60-degree elevation of the head Vigorously airway suctioning Diazepam or lorazepam Up to 325 mg of aspirin

Answer 30

Diazepam or lorazepam

Question 31

An idiopathic seizure is one in which: the cause is not known. a part of the brain is affected. the entire brain is affected. a postictal phase is not present.

Answer 31

the cause is not known.

Question 32

A 59-year-old woman presents with acute onset of confusion, left-sided hemiparesis, and a right-sided facial droop. Her airway is patent and she is breathing adequately. Her blood pressure is 150/100 mm Hg and her pulse is 70 beats/min. The cardiac monitor displays atrial fibrillation with a variable rate of 60 to 90 beats/min. When obtaining the patient's medical history from her husband, the most important question to ask him is: “Is your wife allergic to aspirin or contrast dye?” “When did your wife last see her physician?” “Does your wife have a history of diabetes?” “When did you first notice your wife's symptoms?”

Answer 32

“When did you first notice your wife's symptoms?”

Question 33

During a generalized tonic-clonic seizure, the patient is rigid and his back is arched. This represents which phase of the seizure? Hypertonic Tonic Clonic Postictal

Answer 33

Hypertonic

Question 34

Chemicals that relay electrically conducted signals from one neuron to another are called: catecholamines. endorphins. neurotransmitters. hormones.

Answer 34

Neurotransmitters

Question 35

Which of the following is a term used to describe changes in a person's ability to perform coordinated motions, such as walking? Myoclonus Bradykinesia Ataxia Decussation

Answer 35

Ataxia

Question 36

Which of the following is a common cause of trismus in an unresponsive patient? Cushing reflex Cerebral hypoxia Opiate toxicity Hypoglycemia

Answer 36

Cerebral hypoxia

Question 37

Hyperventilating a patient who has increased intracranial pressure (ICP) will: increase the carbon dioxide levels in the brain through vasodilation. decrease ICP and maintain adequate cerebral perfusion. constrict the cerebral vasculature and decrease cerebral perfusion. dilate the cerebral vasculature and cause further increases in ICP.

Answer 37

constrict the cerebral vasculature and decrease cerebral perfusion.

Question 38

Emotions such as rage and anger are generated in the: diencephalon. thalamus. limbic system. hypothalamus.

Answer 38

limbic system.

Question 39

When assessing a patient's respiratory pattern, you notice that inspiration and expiration are equal. This indicates which pattern of breathing? Eupnea Apnea Bradypnea Tachypnea

Answer 39

Eupnea

Question 40

Which of the following would have the most negative effect on the outcome of a patient with an intracranial hemorrhage? Hypertension Hypotension Tachycardia Hypothermia

Answer 40

Hypotension

Question 41

Spasmodic torticollis is characterized by: neck muscle contraction, which twists the head to one side. involuntary unilateral myoclonic contractions of the face. sustained and painful contraction of the eyelids. severe stabbing pain, usually to one side of the face.

Answer 41

neck muscle contraction, which twists the head to one side.

Question 42

A 51-year-old man complains of chronic headaches that have worsened progressively over the past 3 months. Today, he called 9-1-1 because his headache is severe and he is nauseated. His vital signs are stable and he is breathing adequately. The patient denies any medical problems and states that he has been taking acetaminophen for the headaches. You should be most suspicious of: an intracranial neoplasm. acute hemorrhagic stroke. acute sinusitis. a ruptured cerebral artery.

Answer 42

an intracranial neoplasm.

Question 43

Which of the following cranial nerves are assessed when you ask a patient to follow your finger as you move it in an “H” shape? Facial, accessory, glossopharyngeal Accessory, olfactory, hypoglossal Trochlear, oculomotor, abducens Optic, trigeminal, glossopharyngeal

Answer 43

Trochlear, oculomotor, abducens

Question 44

According to the Los Angeles Prehospital Stroke Screen, the possibility of a stroke is increased if: the patient is younger than 45 years of age. at baseline, the patient is normally bedridden. a bilateral facial droop is present during the exam. the blood glucose is between 60 and 400 mg/dL.

Answer 44

the blood glucose is between 60 and 400 mg/dL.

Question 45

When assessing a patient's response to pain, you notice that the patient is not responding to stimuli. What should you do first? Perform tracheal intubation. Provide hyperventilation. Carefully assess the airway. Give a sedative medication.

Answer 45

Carefully assess the airway.

Question 46

A 19-year-old man presents with a decreased level of consciousness. According to his girlfriend, he has no known medical problems and takes no medications. Initial treatment for this patient involves: administering oxygen via nonrebreathing mask. performing a rapid check of his blood glucose level. evaluating his cardiac rhythm with the ECG monitor. ensuring airway patency and adequate breathing.

Answer 46

ensuring airway patency and adequate breathing.

Question 47

Management for a patient with a neurologic emergency begins by: taking deliberate actions to ensure personal safety. determining the degree of neurologic impairment. protecting the patient from further injury or harm. ensuring that the patient's airway remains patent.

Answer 47

taking deliberate actions to ensure personal safety.

Question 48

When neurons are deprived of oxygen and glucose: the process of neuronal regeneration begins. they produce alkalotic waste products. they convert to anaerobic metabolism. spontaneous intracerebral bleeding occurs.

Answer 48

they convert to anaerobic metabolism.

Question 49

Which of the following signs or symptoms are consistent with meningitis in an infant? High fever, drooling, and tachycardia Kehr sign, vomiting, and poor skin turgor Low-grade fever and depressed fontanelles High-pitched cry and bulging fontanelles

Answer 49

High-pitched cry and bulging fontanelles

Question 50

Pupils that differ in size by less than 1 mm: are a sign of optic nerve compression. are a sign of methamphetamine abuse. may be a normal variant in some patients. indicate increased intracranial pressure.

Answer 50

may be a normal variant in some patients.