Chapter 46 Flashcards
(50 cards)
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.
ask the dialysis technician how long the patient has been on 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.
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.
have had a surgical procedure that directs the large intestine out through a stoma in the anterior abdominal wall.
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.
When treating a dialysis patient, it is especially important to:
keep the patient in a supine position.
carefully titrate any IV fluids given.
elevate the arm with the AV fistula.
treat acidosis with sodium bicarbonate.
carefully titrate any IV fluids given.
Dysarthria is:
a speech disorder that primarily affects adults.
the inability to make speech sounds correctly.
caused by damage to the language center of the brain.
the loss of ability to communicate in speech or writing.
the inability to make speech sounds correctly.
Which of the following statements regarding paralysis is correct?
A paralyzed patient has lost the ability to voluntarily move a body part.
Injuries to the thoracic or lumbar spine generally result in quadriplegia.
Most patients who are paralyzed have normal sensation or hyperesthesia.
Paralysis always entails the loss of both sensory and motor functions.
A paralyzed patient has lost the ability to voluntarily move a body part.
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:
ask the son why he wants to accompany his father in the ambulance.
remain at the scene until law enforcement arrives and questions the son.
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.
allow the son to accompany his father in the back of the ambulance.
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:
be placed onto his left side with his head elevated.
remain in a supine position with his legs straight.
remain in a sitting position to prevent an embolism.
receive IV fluid boluses to keep the sheath patent.
remain in a supine position with his legs straight.
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:
investigational care.
hospice care.
curative care.
palliative care.
curative care.
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:
assess his oxygen saturation level and auscultate his breath sounds to determine if he is moving adequate air.
disconnect the patient from the mechanical ventilator and begin bag-mask ventilations.
immediately check the settings on the mechanical ventilator to ensure that it is working properly.
remove the ventilator tubing from the tracheostomy tube and suction the tube for 10 to 15 seconds.
disconnect the patient from the mechanical ventilator and begin bag-mask ventilations.
Which of the following interventions is especially important when caring for a patient with a tracheostomy tube?
Suctioning
Mask ventilation
Hyperventilation
Head positioning
Suctioning
While transporting a cancer patient who is receiving chemotherapy, you should recall that:
it is likely that the patient’s condition is terminal.
prophylactic antiemetic medications are often needed.
chemotherapy weakens a patient’s immune system.
chemotherapy is only used to treat metastatic cancer.
chemotherapy weakens a patient’s immune system.
The purpose of the wafer that is included in an ostomy kit is to:
seal the ostomy bag to the skin.
maintain sterility of the ostomy bag.
cover the stoma until the bag is attached.
protect the skin from irritation.
protect the skin from irritation.
The fistula used for hemodialysis is a surgical connection between:
an artery and a vein.
two large veins.
a vein and the peritoneum.
two large arteries.
an artery and a vein.
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
ECG monitoring and antidysrhythmic therapy
Antibiotic and antipyretic therapy
Airway care and thermal management
Pain assessment and management
What is the pathophysiology of cystic fibrosis?
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
Acquisition of a virus or bacterium that takes residence inside the parenchyma of the lungs, resulting in the production of thin but copious secretions
Delayed lung growth and development that is typically caused by a variety of congenital cardiovascular defects, most notably a ventriculoseptal defect
An underproduction of pulmonary surfactant, which causes chronic respiratory distress, thick pulmonary secretions, and severe intrapulmonary shunting
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
Which of the following is a proper technique when accessing an implantable venous access device?
Aspirate 5 mL of blood and then block the flow in the line with the crimping 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.
Remove the syringe from the needle and then block the flow in the line with the crimping device.
Aspirate 5 mL of blood and then block the flow in the line with the crimping device.
A person is able to hear, but is unable to interpret speech when other background noises are present. This is consistent with:
auditory neuropathy.
conductive hearing loss.
sensorineural hearing loss.
central auditory processing disorder.
central auditory processing disorder.
The majority of acquired hearing loss in children and adults is the result of:
frequent middle ear infections.
a tumor on the acoustic nerve.
long-term use of salicylates.
excessive exposure to loud noise.
excessive exposure to loud noise.
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.”
“The injury was reported to have occurred at 1420 hours.”
“There was a gross discrepancy between the caregivers’ stories.”
“The injury was reported to have occurred at 1420 hours.”
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.
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.
recognize that the patient’s death is imminent and remain at the scene to provide any needed emotional support.
administer an appropriate dose of morphine or fentanyl to the patient and provide emotional support to the son.
Spina bifida occurs when:
growth of the fetus’s spinal column stops at the thoracic vertebrae, which leaves the lumbar portion of the spinal cord completely unprotected.
the fetus’s spinal column does not close properly or completely and vertebrae do not develop, leaving a portion of the spinal cord exposed.
hydrocephalus causes a significant increase in pressure within the spinal canal, resulting in chronic compression of the spinal cord.
trauma during birth causes distracting injuries to the cervical and thoracic vertebrae, resulting in partial or complete paralysis below the injury.
the fetus’s spinal column does not close properly or completely and vertebrae do not develop, leaving a portion of the spinal cord exposed.
During your assessment of a patient with paraplegia, you touch the patient’s leg and he screams in pain. This is an example of:
hyperesthesia.
hyperplasia.
hypoplasia.
parasthesias
hyperesthesia.
A dialysis patient requires pharmacologically assisted intubation. Which of the following medications should be avoided?
Succinylcholine
Vecuronium
Midazolam
Etomidate
Succinylcholine
Multiple sclerosis is:
chronic in most cases and is the result of degenerative changes in the muscle that results in muscle atrophy and decreased bone density.
a progressive disease in 90% of patients who have it that is characterized by unrelenting pain, weakness, and visual impairment.
most often secondary to a diffuse axonal brain injury and causes neuromuscular disability due to stretching or tearing of the axons.
a chronic central nervous system disease caused by destruction of the myelin and nerve axons within the brain and spinal cord.
a chronic central nervous system disease caused by destruction of the myelin and nerve axons within the brain and spinal cord.
