Ch 46 ( Quiz 2)

Question 1

Some patients with a terminal illness will continue aggressive medical treatment, hoping for a statistically improbable recovery or attempting to prolong life as much as possible. This is called:

curative care.
hospice care.
investigational care.
palliative care.

Answer 1

curative care.

Question 2

A dialysis patient requires pharmacologically assisted intubation. Which of the following medications should be avoided?

Vecuronium
Midazolam
Etomidate
Succinylcholine

Answer 2

Succinylcholine

Question 3

Which of the following statements regarding paralysis is correct?

• A paralyzed patient has lost the ability to voluntarily move a body part.
• Most patients who are paralyzed have normal sensation or hyperesthesia.
• Injuries to the thoracic or lumbar spine generally result in quadriplegia.
• Paralysis always entails the loss of both sensory and motor functions.

Answer 3

A paralyzed patient has lost the ability to voluntarily move a body part.

Question 4

Upon arriving at the residence of a 27-year-old man who has a tracheostomy tube and is being mechanically ventilated, you note that he is breathing shallowly, is cyanotic, and is diaphoretic. You should:

• disconnect the patient from the mechanical ventilator and begin bag-mask ventilations.
• assess his oxygen saturation level and auscultate his breath sounds to determine if he is moving adequate air.
• remove the ventilator tubing from the tracheostomy tube and suction the tube for 10 to 15 seconds.
• immediately check the settings on the mechanical ventilator to ensure that it is working properly.

Answer 4

disconnect the patient from the mechanical ventilator and begin bag-mask ventilations.

Question 5

What is the pathophysiology of cystic fibrosis?

• Delayed lung growth and development that is typically caused by a variety of congenital cardiovascular defects, most notably a ventriculoseptal defect
• A defective gene that makes it difficult for chloride to move through the cells, which causes unusually high sodium loss and abnormally thick mucous secretions
• An underproduction of pulmonary surfactant, which causes chronic respiratory distress, thick pulmonary secretions, and severe intrapulmonary shunting
• Acquisition of a virus or bacterium that takes residence inside the parenchyma of the lungs, resulting in the production of thin but copious secretions

Answer 5

A defective gene that makes it difficult for chloride to move through the cells, which causes unusually high sodium loss and abnormally thick mucous secretions

Question 6

Which of the following drugs should be avoided in a patient with renal failure?

Succinylcholine
Sodium bicarbonate
Calcium
Albuterol

Answer 6

Succinylcholine

Question 7

When troubleshooting a hearing aid that is not working, you should:

• carefully clean the device with an alcohol prep.
• ensure that the device is set to telephone mode.
• avoid attempting to clean the device.
• soak the device in hydrogen peroxide.

Answer 7

avoid attempting to clean the device.

Question 8

Which of the following statements regarding poliomyelitis (polio) is correct?

• Any warm-blooded animal can serve as a host for the polio virus.
• Polio initially presents with a headache, sore throat, fever, and vomiting.
• Patients with nonparalytic polio usually have permanent neurologic injury.
• Subclinical polio is characterized by symptoms that last less than a month.

Answer 8

Polio initially presents with a headache, sore throat, fever, and vomiting.

Question 9

You would most likely encounter the presence of a ventricular assist device in a patient who:

• has pulmonary hypertension.
• has severe emphysema.
• is awaiting a heart transplant.
• has transient right heart failure

Answer 9

is awaiting a heart transplant.

Question 10

Which of the following interventions is especially important when caring for a patient with a tracheostomy tube?

Head positioning
Suctioning
Hyperventilation
Mask ventilation

Answer 10

Suctioning

Question 11

The outflow catheter of a cerebrospinal fluid shunt is most commonly placed into the patient’s:

peritoneal cavity.
pulmonary cavity.
left ventricle.
right atrium.

Answer 11

peritoneal cavity

Question 12

When treating a dialysis patient, it is especially important to:

• keep the patient in a supine position.
• carefully titrate any IV fluids given.
• treat acidosis with sodium bicarbonate.
• elevate the arm with the AV fistula.

Answer 12

carefully titrate any IV fluids given.

Question 13

Which of the following is a characteristic physical feature of Down syndrome?

Bulging of the nose and face
Excessively long neck
Protruding tongue
Downward-slanting eyes

Answer 13

Protruding tongue

Question 14

Which of the following factors complicates airway management in an obese patient?

Smaller patient head size
Limited neck mobility
Proportionately small tongue
Larger upper airway

Answer 14

Limited neck mobility

Question 15

Which of the following injury patterns is most suggestive of child abuse?

Bruises on the lower leg
Burns with splash marks
Laceration to the chin
Bruises on the abdomen

Answer 15

Bruises on the abdomen

Question 16

The female urinary meatus is located:

• between the vagina and perineum.
• inferior to the vaginal opening.
• just above the vaginal opening.
• superior to the clitoris.

Answer 16

Just above the vaginal opening

Question 17

You respond to a dialysis center for a patient with shortness of breath. When you arrive, you find the patient, an older female, still receiving dialysis. She is conscious and alert and is experiencing mild respiratory distress. As your partner administers oxygen, you should:

• instruct the dialysis technician to remove the patient from the dialysis machine.
• administer a beta-2 agonist medication and contact medical control for guidance.
• start an IV in the arm opposite the AV shunt and set the flow rate to 25 mL/hr.
• ask the dialysis technician how long the patient has been on the dialysis machine.

Answer 17

ask the dialysis technician how long the patient has been on the dialysis machine.

Question 18

Which of the following types of maltreatment is perhaps the most common?

Abandonment
Physical abuse
Sexual abuse
Neglect

Answer 18

Neglect

Question 19

During your assessment of a patient with paraplegia, you touch the patient’s leg and he screams in pain. This is an example of:

parasthesias.
hyperplasia.
hyperesthesia.
hypoplasia.

Answer 19

hyperesthesia.

Question 20

Hydrocephalus may occur if:

• cerebrospinal fluid absorption into the bloodstream is reduced.
• the brain produces less than 500 mL of cerebrospinal fluid per day.
• too much cerebrospinal fluid is forced into the spinal canal.
• bleeding in the brain causes an increase in intracranial pressure.

Answer 20

cerebrospinal fluid absorption into the bloodstream is reduced.

Question 21

The purpose of the wafer that is included in an ostomy kit is to:

• cover the stoma until the bag is attached.
• protect the skin from irritation.
• maintain sterility of the ostomy bag.
• seal the ostomy bag to the skin.

Answer 21

protect the skin from irritation.

Question 22

You are performing an interfacility transfer of a patient who received a cardiac catheterization and has a sheath in his femoral artery. During transport, it is important that the patient:

• remain in a sitting position to prevent an embolism.
• remain in a supine position with his legs straight.
• receive IV fluid boluses to keep the sheath patent.
• be placed onto his left side with his head elevated.

Answer 22

remain in a supine position with his legs straight.

Question 23

Which of the following is a proper technique when accessing an implantable venous access device?

• Stabilize the implantable device and insert the needle at a 45-degree angle to the skin.
• Flush the device with 20 mL of normal saline as soon as you are able to aspirate blood.
• Aspirate 5 mL of blood and then block the flow in the line with the crimping device.
• Remove the syringe from the needle and then block the flow in the line with the crimping device.

Answer 23

Aspirate 5 mL of blood and then block the flow in the line with the crimping device.

Question 24

Prior to replacing an ostomy device in a patient, it is most important to:

• wash the area around the stoma with soap and water.
• wash your hands and apply personal protective equipment.
• ensure that the patient is in a comfortable position.
• use sterile technique when opening the new ostomy kit.

Answer 24

wash your hands and apply personal protective equipment.

Question 25

By placing one hand on your forehead and your other hand over your abdomen, you are asking a hearing-impaired person if they: are in pain. need help. are hurt. feel sick.

Answer 25

feel sick

Question 26

The majority of acquired hearing loss in children and adults is the result of: - frequent middle ear infections. - excessive exposure to loud noise. - long-term use of salicylates. - a tumor on the acoustic nerve.

Answer 26

excessive exposure to loud noise.

Question 27

A person is able to hear, but is unable to interpret speech when other background noises are present. This is consistent with: central auditory processing disorder. conductive hearing loss. auditory neuropathy. sensorineural hearing loss.

Answer 27

central auditory processing disorder

Question 28

While transporting a cancer patient who is receiving chemotherapy, you should recall that: - it is likely that the patient's condition is terminal. - chemotherapy weakens a patient's immune system. - chemotherapy is only used to treat metastatic cancer. - prophylactic antiemetic medications are often needed.

Answer 28

chemotherapy weakens a patient's immune system.

Question 29

Which of the following are often the primary tasks for paramedics who are caring for a patient with a terminal illness? - Pain assessment and management - Airway care and thermal management - Antibiotic and antipyretic therapy - ECG monitoring and antidysrhythmic therapy

Answer 29

Pain assessment and management

Question 30

A 66-year-old man with severe left heart failure is receiving an inotropic medication via an infusion pump. He presents with an altered mental status, increased breathing difficulty, and hypotension. You should: - administer oxygen and discontinue the medication infusion by turning the pump off. - support his breathing, continue his medication infusion, and contact medical control. - administer oxygen, discontinue the medication infusion, and establish a peripheral IV. - assist his breathing, slowly increase the dose of his inotropic medication, and transport.

Answer 30

support his breathing, continue his medication infusion, and contact medical control

Question 31

Spina bifida occurs when: - the fetus's spinal column does not close properly or completely and vertebrae do not develop, leaving a portion of the spinal cord exposed. - trauma during birth causes distracting injuries to the cervical and thoracic vertebrae, resulting in partial or complete paralysis below the injury. - growth of the fetus's spinal column stops at the thoracic vertebrae, which leaves the lumbar portion of the spinal cord completely unprotected. - hydrocephalus causes a significant increase in pressure within the spinal canal, resulting in chronic compression of the spinal cord.

Answer 31

the fetus's spinal column does not close properly or completely and vertebrae do not develop, leaving a portion of the spinal cord exposed.

Question 32

Severe cases of cerebral palsy may present with: acute myocarditis. respiratory failure. cardiovascular disease. seizures.

Answer 32

seizures

Question 33

Sensorineural hearing loss is caused by: - an inability of sound to travel from the outer ear to the inner ear. - decreased sound uptake through tiny hairs within the cochlea. - failure of the brainstem to transmit messages via the acoustic nerve. - destruction of the acoustic nerve from the use of certain drugs.

Answer 33

decreased sound uptake through tiny hairs within the cochlea.

Question 34

Patients with a colostomy: - have a stoma that directs the small intestine to the outside of the abdomen where a collection bag is attached. - have a temporary surgical opening in the abdomen that collects waste material and allows the bowel to rest and heal. - require a collection bag to collect solid fecal material after a section of large intestine is surgically removed. - have had a surgical procedure that directs the large intestine out through a stoma in the anterior abdominal wall.

Answer 34

have had a surgical procedure that directs the large intestine out through a stoma in the anterior abdominal wall.

Question 35

Your assessment of an elderly man gives you reason to suspect that he has been abused. The patient does not appear to have any life-threatening injuries. His son, who is the only family member present at the scene, asks you if he can accompany his father in the back of the ambulance during transport. You should: - remain at the scene until law enforcement arrives and questions the son. - ask the son why he wants to accompany his father in the ambulance. - advise the son to follow the ambulance in his own personal vehicle. - allow the son to accompany his father in the back of the ambulance.

Answer 35

allow the son to accompany his father in the back of the ambulance.

Question 36

A person with amblyopia has: - partial or complete vision loss in one eye. - difficulty visualizing objects that are close. - an area missing from their visual field. - difficulty visualizing object from afar.

Answer 36

partial or complete vision loss in one eye.

Question 37

Dysarthria is: - a speech disorder that primarily affects adults. - caused by damage to the language center of the brain. - the inability to make speech sounds correctly. - the loss of ability to communicate in speech or writing

Answer 37

the inability to make speech sounds correctly.

Question 38

You are assessing a 6-year-old child who presents with a fever. During your assessment, you note red, flat, rounded lesions on the child's torso. This finding is most indicative of: physical abuse. cupping. phytophotodermatitis. coining.

Answer 38

cupping

Question 39

The fistula used for hemodialysis is a surgical connection between: a vein and the peritoneum. two large veins. two large arteries. an artery and a vein

Answer 39

an artery and a vein

Question 40

Adult patients who have a tracheostomy tube in place and are ventilator dependent should receive: - deep tracheal suctioning every other day. - ventilation at a rate of 20 to 24 breaths/min. - humidification and heating of inspired air. - cool, dry air through the ventilator circuit.

Answer 40

humidification and heating of inspired air.

Question 41

Which of the following clinical presentations is most consistent with a malfunctioning cerebrospinal fluid shunt? - Tachypnea, fluid drainage from the ears, and restlessness - Tachycardia, tinnitus, and a narrowing pulse pressure - Hypotension, sudden loss of hearing, and severe nausea - Visual disturbances, headache, and altered mental status

Answer 41

Visual disturbances, headache, and altered mental status

Question 42

You are caring for an elderly woman with terminal sarcoma. She is conscious, extremely weak, and in severe pain. Her son tells you that she has a living will and an out-of-hospital do not resuscitate order, and produces the appropriate documentation. The patient is on home oxygen at 2 L/min via nasal cannula. You should: - administer an appropriate dose of morphine or fentanyl to the patient and provide emotional support to the son. - recognize that the patient's death is imminent and remain at the scene to provide any needed emotional support. - apply high-flow oxygen via nonrebreathing mask, establish vascular access, and transport her to the hospital. - leave the patient on her nasal oxygen, keep her warm, and transport her safely to the hospital for further palliative care.

Answer 42

administer an appropriate dose of morphine or fentanyl to the patient and provide emotional support to the son.

Question 43

Phrenic nerve stimulators function by: - sending electrical impulses to the diaphragm, causing it to contract and passively relax. - sending electrical impulses to the intercostal muscles, causing them to contract and expand the thorax. - sending electrical impulses to the respiratory centers in the brain that stimulate inhalation. - keeping the upper airway patent in patients who experience frequent occurrences of sleep apnea.

Answer 43

sending electrical impulses to the diaphragm, causing it to contract and passively relax.

Question 44

Which of the following statements would be appropriate when documenting a case of suspected abuse? - “The abdominal exam of the patient was within normal limits.” - “The patient's injury is not consistent with an accident.” - “There was a gross discrepancy between the caregivers' stories.” - “The injury was reported to have occurred at 1420 hours.”

Answer 44

“The injury was reported to have occurred at 1420 hours.”

Question 45

When urine becomes evident in the tubing during insertion of an indwelling urinary catheter in a male, you should: - connect the indwelling catheter to the urine drainage system, unclamp the tubing, and allow urine to drain. - continue inserting the catheter until the Y between the drainage port and the balloon port is at the tip of the penis. - inflate the balloon with the prefilled syringe and gently pull back on the catheter until you feel resistance. - insert the catheter approximately 1 inch farther, inflate the balloon, and then pull back on the catheter until you feel resistance.

Answer 45

continue inserting the catheter until the Y between the drainage port and the balloon port is at the tip of the penis.

Question 46

A patient with a long-term vascular access device is in cardiac arrest and requires epinephrine. In order to remove any heparin from the device, the paramedic should: - slowly inject 3 to 5 mL of sodium bicarbonate. - withdraw up to 10 mL of blood and discard it. - follow the epinephrine with a 10-mL saline flush. - briskly flush the device with 20 mL of saline.

Answer 46

withdraw up to 10 mL of blood and discard it.

Question 47

Which of the following vascular access devices is “tunneled” under the skin and placed into the superior vena cava? Midline catheter Double-lumen catheter Dialysis catheter Broviac catheter

Answer 47

Broviac catheter

Question 48

The transducer or drainage system of an intracranial pressure monitor is typically aligned at the same height as the patient's: temporal bone. ear canal. eyebrow. forehead.

Answer 48

ear canal

Question 49

Multiple sclerosis is: - most often secondary to a diffuse axonal brain injury and causes neuromuscular disability due to stretching or tearing of the axons. - a progressive disease in 90% of patients who have it that is characterized by unrelenting pain, weakness, and visual impairment. - chronic in most cases and is the result of degenerative changes in the muscle that results in muscle atrophy and decreased bone density. - a chronic central nervous system disease caused by destruction of the myelin and nerve axons within the brain and spinal cord.

Answer 49

a chronic central nervous system disease caused by destruction of the myelin and nerve axons within the brain and spinal cord.

Question 50

A man leaves his 4-year-old child home alone while he plays golf with his friends. This is an example of: assault. emotional abuse. neglect. abandonment.

Answer 50

abandonment

Question 51

Intellectual disability is defined as: a substandard intelligence quotient secondary to a congenital infection or complications at birth. insufficient development of the brain that results in the inability to learn and socially adapt at the usual rate. the inability to provide adequate self-care because of intense emotional abuse during childhood. a genetic condition in which the patient is unable to interact normally and acts younger than their peers.

Answer 51

insufficient development of the brain that results in the inability to learn and socially adapt at the usual rate.

Question 52

During your assessment of a 4-year-old female, you find injury patterns that are highly suggestive of abuse. The child's mother is present; she is apprehensive and is hesitant to allow you to transport her daughter. You should: ask the mother to leave the room so that you can ask the girl if the injuries that she has were intentionally inflicted by someone else. ask your partner to retrieve an extra set of latex-free gloves from the ambulance, as this will enable them to discreetly call the police. act as though you are not suspicious, but call the child's father and inquire about the relationship between the child and her mother. advise the mother that the child's injuries are inconsistent with accidental trauma and let her know that the child needs to be transported.

Answer 52

ask your partner to retrieve an extra set of latex-free gloves from the ambulance, as this will enable them to discreetly call the police.

Question 53

Triple-lumen central catheters are usually placed in the: • internal carotid artery. • external jugular vein. • subclavian or femoral vein. • antecubital vein in the arm.

Answer 53

Subclavian or femoral vein.

Question 54

When caring for a patient with suspected abuse or neglect, your first priority should be to: • provide an immediate assessment of the patient. • remove the patient from the abusive environment. • take deliberate action to ensure your own safety. • summon law enforcement personnel to the scene.

Answer 54

Take deliberate action to ensure your own safety.