Chapter 8 quiz Flashcards

0
Q

What happens after a cell in anaerobic metabolism breaks down glucose and creates energy in the form of adenosine triphosphate (ATP)?
A) Electrolytes in the cell become balanced.
B) Carbon dioxide and water are formed.
C) Lactic acid is formed.
D) Oxygen and water are created.

A

C) Lactic acid is formed.

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1
Q
The EMT would most likely see a narrowed pulse pressure in a patient who:
A) has an irregular heartbeat. 
B) suffers from diabetes. 
C) is bleeding internally. 
D) has a fever.
A

C) is bleeding internally.

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2
Q
The patient in anaerobic metabolism is deficient of:
A) lactic acid. 
B) protein. 
C) glucose (sugar). 
D) oxygen.
A

D) oxygen.

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3
Q

A patient’s brain cells are undergoing anaerobic metabolism. As a result, those cells:
A) are becoming dysfunctional in a highly acidic environment.
B) have too much adenosine triphosphate (ATP) to function properly.
C) cannot make any energy in the form of ATP.
D) are producing elevated quantities of carbon dioxide (CO2).

A

A) are becoming dysfunctional in a highly acidic environment.

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4
Q
The EMT would best recognize normal cellular metabolism as:
A) oxygenated. 
B) aerobic. 
C) glycolytic. 
D) anaerobic.
A

B) aerobic.

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5
Q
A patient with liver disease suffers from a low platelet count. Which of the following would the EMT directly correlate to this condition?
A) Pale skin color 
B) SpO2 90%
C) Bruising to arms 
D) Heart rate 92
A

C) Bruising to arms

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6
Q

Which one of the following would most likely cause a patient to have a simple episode of syncope (fainting)?
A) Activation of the sympathetic nervous system
B) Sudden release of norepinephrine
C) Parasympathetic stimulation
D) Increase in systemic vascular resistance

A

C) Parasympathetic stimulation

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7
Q

A patient’s lungs are full of fluid and cannot transfer oxygen to the blood. As a result, she is in anaerobic metabolism. She has a decreased level of consciousness with a patent upper airway and inadequate respirations. Her pulse is rapid and weak. Which one of the following prehospital treatments would best address this situation?
A) High-concentration oxygen through a nonrebreather face mask
B) Intravenous (IV) fluids administered by paramedics
C) Insertion of a nasal airway and oxygen through a nasal cannula
D) Positive pressure ventilation with supplemental oxygen

A

D) Positive pressure ventilation with supplemental oxygen

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8
Q
Which of the following would directly compromise the average patient's cardiac output?
A) Heart rate of 170 beats per minute 
B) Blood pressure of 118/52 
C) Circulatory volume of 5 liters 
D) Increased number of circulating WBCs
A

A) Heart rate of 170 beats per minute

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9
Q
A patient with cancer is receiving chemotherapy. As a side effect of the treatment, her white blood cell count is critically low. Given this situation, which sign or symptom should the EMT find particularly concerning?
A) History of diabetes 
B) Complaint of weakness 
C) Oral temperature 102.7°F 
D) Blood pressure of 102/64
A

C) Oral temperature 102.7°F

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10
Q

Question 11
1 / 1 pts
A drop in blood pressure below a critical threshold is a threat to the body because it directly impairs:
A drop in blood pressure below a critical threshold is a threat to the body because it directly impairs:
A) airway patency.
B) anaerobic metabolism.
C) the sympathetic nervous system.

D) cellular perfusion.

A

D) cellular perfusion.

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11
Q

When the cells undergo normal metabolism, which one of the following occurs?
A) Lactic acid is produced and excreted by the kidneys.
B) Decreased amounts of oxygen are required.
C) Adenosine triphosphate (ATP) is produced and excreted by the lungs.
D) Heat, carbon dioxide, and water are produced.

A

D) Heat, carbon dioxide, and water are produced.

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12
Q

You and the critical care transport team are taking a critically ill patient to another hospital. Among many IV infusions and monitors, the patient is also on a ventilator. You note that the FDO2 is set at 0.50. What does this mean?
A) Ventilations are provided when the patient breathes less than 50 times a minute.
B) The patient is being ventilated at a rate pf 50 breaths per minute.
C) Fifty percent of the patient’s respirations are provided by the ventilator.
D) The provided oxygen concentration is set at 50 percent.

A

D) The provided oxygen concentration is set at 50 percent.

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13
Q

You are caring for a 66-year-old male who is severely dehydrated. Given this condition, you would recognize which of the following related to the cardiovascular system?
A) Decreased ability of oxygen to diffuse from the lungs to the blood
B) Difficulty of the hemoglobin in carrying oxygen
C) Decreased production of white blood cells
D) Decreased blood volume available for circulation

A

D) Decreased blood volume available for circulation

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14
Q

Which one of the following best describes the concept of afterload?
A) Ability of the heart to adequately contract and pump blood
B) Amount of blood that a person has in the arteries at any one given moment
C) Amount of blood returned to the lungs for oxygenation
D) Pressure that the left ventricle must pump blood against

A

D) Pressure that the left ventricle must pump blood against

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15
Q

Baroreceptors function in the body by:
A) monitoring the blood pressure.
B) ensuring adequate oxygenation of the red blood cells.
C) monitoring the heart rate.
D) stimulating the production of red blood cells.

A

A) monitoring the blood pressure.

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16
Q

When a healthy person has a sudden increase in blood pressure, which one of the following will occur?
A) Chemoreceptors will increase the rate and depth of breathing.
B) Baroreceptors will directly stimulate the parasympathetic nervous system.
C) The heart rate will increase and blood vessels will constrict.
D) Baroreceptors will signal the brain to decrease the heart rate.

A

D) Baroreceptors will signal the brain to decrease the heart rate.

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17
Q

The body will compensate for a decrease in cardiac output by:
A) dilating to arteries, veins, and capillaries.
B) increasing systemic vascular resistance.
C) increasing the respiratory rate.
D) decreasing the heart rate.

A

B) increasing systemic vascular resistance.

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18
Q
Under normal circumstances, carbon dioxide is excreted from the body through the:
A) sweat ducts. 
B) urinary tract. 
C) kidneys. 
D) lungs.
A

D) lungs.

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19
Q

What is the protective mechanism underlying a narrowed pulse pressure?
A) Stop the loss of blood internally or externally.
B) Maintain an adequate blood pressure for perfusion.
C) Increase the oxygen-carrying capacity of the red blood cells.
D) Increase the amount of oxygen entering the lungs.

A

B) Maintain an adequate blood pressure for perfusion.

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20
Q

Which one of the following would result from increasing a patient’s preload?
A) Decreased myocardial contraction
B) Increased cardiac output
C) Decreased blood pressure
D) Increased oxygen delivery into the lungs

A

B) Increased cardiac output

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21
Q
Paramedics have administered a medication to a patient in heart failure. The medication specifically causes the veins to enlarge, thus decreasing the amount of blood coming back to the heart for pumping. The EMT would recognize this action as:
A) pulse pressure. 
B) preload. 
C) systemic vascular resistance. 
D) afterload.
A

B) preload.

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22
Q

For the patient with a narrowed pulse pressure, which one of the following is occurring?
A) The blood is being pumped more slowly.
B) The veins and arteries are dilating.
C) The heart rate is decreasing.
D) The blood vessels are constricting.

A

D) The blood vessels are constricting.

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23
Q
Which one of the following measurements indicates a narrowed pulse pressure?
A) 210/138 
B) 108/88 
C) 120/76 
D) 116/82
A

B) 108/88

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24
Q

If a patient’s blood pressure cannot be increased by adding volume, then which of the following actions would most likely be successful in increasing it?
A) Vasoconstriction
B) Decreasing the patient’s afterload
C) Blocking beta actions of the sympathetic nervous system
D) Decreasing the patient’s preload

A

A) Vasoconstriction

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25
Q

Which one of the following conditions must be met for carbon dioxide to be moved from the cell to the bloodstream?
A) The blood must be low in carbon dioxide.
B) There must be a high number of red blood cells in the blood.
C) The sodium/potassium pump must be functional.
D) There must be a high amount of oxygen in the blood.

A

A) The blood must be low in carbon dioxide.

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26
Q
A patient with a temperature of 105.4°F is suffering from systemic vasodilation. Which one of the following findings would be consistent with this condition?
A) Slow heart rate 
B) Decreased blood pressure 
C) Elevated afterload 
D) Pale and cool skin
A

B) Decreased blood pressure

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27
Q
A slightly confused but conscious 61-year-old female with generalized weakness has a heart rate of 190 beats a minute. She has a history of high blood pressure and diabetes. Her blood pressure is 78/56 mmHg. Which one of the following would best explain the patient's presentation?
A) Hypoglycemia 
B) Hemorrhage 
C) Hypoxia 
D) Tachycardia
A

D) Tachycardia

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28
Q

Which of the following statements about the ventilation/perfusion (V/Q) ratio in a healthy person is true?
A) The lower portion of the lungs has more oxygen than perfusion.
B) Blood flow and amount of ventilation are equal throughout the lungs.
C) Amount of blood is greater than amount of oxygen in the lungs.
D) The upper portion of the lungs has more ventilation than blood flow.

A

D) The upper portion of the lungs has more ventilation than blood flow.

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29
Q
A patient with high blood pressure takes a medication to slow his heart rate, thus lowering his blood pressure. The EMT would recognize this action as impacting the:
A) systemic vascular resistance. 
B) cardiac output. 
C) preload. 
D) afterload.
A

B) cardiac output.

30
Q

In the hospital, a patient was administered an IV fluid with a high oncotic pressure. Once in the body, the EMT would expect which one of the following actions?
A) Fluid to move evenly from the bloodstream into the cells
B) Fluid from the tissue to move into the bloodstream
C) A dramatic decrease in the patient’s blood pressure
D) Fluid from the IV to move into the cells and rehydrate them

A

B) Fluid from the tissue to move into the bloodstream

31
Q

On scene, a 43-year-old male states that he has a history of liver failure and does not produce enough of the protein albumin. Given this condition, which one of the following would you expect?
A) Elevated temperature and signs of infection
B) Low SpO2 reading from significant edema
C) Decreased heart rate and signs of hypoxia
D) Swelling of the extremities and abdomen

A

D) Swelling of the extremities and abdomen

32
Q
A 100-kilogram patient with a 500-milliliter tidal volume breathing 16 times each minute would have a minute ventilation of how many milliliters?
A) 1,200 
B) 2,400 
C) 8,000 
D) 1,600
A

C) 8,000

33
Q
A patient with severe iron deficiency anemia is hypoxic. What is definitive care for this patient?
A) IV fluids by paramedics 
B) Positive pressure ventilation 
C) Blood transfusion 
D) Supplemental oxygen
A

C) Blood transfusion

34
Q

Which of the following best describes the ventilation/perfusion ratio?
A) The ability of the body to exchange gases across the alveolar capillary membrane
B) The amount of blood and the pressure at which it carries oxygen throughout the body
C) The ability of the red blood cells to offload oxygen to the cells of the body
D) The amount of air that is moved into and out of the lungs in 1 minute

A

A) The ability of the body to exchange gases across the alveolar capillary membrane

35
Q

An unresponsive patient is breathing at a rate of 6 breaths per minute. What intervention would be most beneficial for the patient?
A) Oxygen at 15 liters per minute delivered through a nonrebreather face mask
B) Oral airway and positive pressure ventilation at 40 per minute, supplemental O2, and volume of 100
C) Positive pressure ventilation with O2 a rate of 30 and tidal volume of 200 mL
D) Positive pressure ventilation with a rate of 12 and tidal volume of 500 mL

A

D) Positive pressure ventilation with a rate of 12 and tidal volume of 500 mL

36
Q

Which one of the following is the primary stimulus to breathe in normal human beings?
A) Level of oxygen in the body
B) Amount of oxygen required by the body
C) Amount of nitrogen in air
D) Level of CO2 in the body

A

D) Level of CO2 in the body

37
Q

For a patient reliant on the hypoxic drive to breathe, the respiratory rate will increase when:
A) CO2 levels decrease and O2 levels increase.
B) oxygen and CO2 levels both increase.
C) carbon dioxide levels increase.
D) oxygen levels decrease.

A

D) oxygen levels decrease.

38
Q
Which of the following correctly identifies the primary way in which oxygen is transported to the cells?
A) White blood cell 
B) Plasma 
C) Red blood cell 
D) Plasma proteins
A

C) Red blood cell

39
Q

A patient’s SpO2 increased from 89% to 95% after he received a bronchodilating drug for his asthma. Where did the patient’s problem most likely originate?
A) Minute volume of the V/Q ratio
B) Perfusion portion of the V/Q ratio
C) Cellular perfusion portion of the V/Q ratio
D) Ventilation portion of the V/Q ratio

A

D) Ventilation portion of the V/Q ratio

40
Q

Which of the following will affect the ventilation component of the ventilation/perfusion ratio?
A) Infection and pus in the distal airways and alveoli
B) Decreased amount of hemoglobin in the blood
C) Blood clot in the pulmonary blood vessels
D) Loss of blood plasma from dehydration

A

A) Infection and pus in the distal airways and alveoli

41
Q
Which one of the following conditions is most likely to cause acidosis?
A) Low blood glucose level 
B) Hypothyroidism 
C) Depressed respirations 
D) Irregular heart rhythm
A

C) Depressed respirations

42
Q
Which of the following medical conditions would impair a patient's respiratory status by directly damaging the central chemoreceptors?
A) Aerobic metabolism 
B) Lung cancer 
C) Brainstem stroke 
D) Collapsed lung
A

C) Brainstem stroke

43
Q

Which one of the following best describes minute ventilation?
A) Amount of air moved into and out of the lungs in one minute
B) Total milliliters of air moving into and out of the lungs in one breath
C) Amount of oxygen needed by the body in one minute
D) Number of breaths a patient breathes in one minute

A

A) Amount of air moved into and out of the lungs in one minute

44
Q
A patient with a high fever has an accelerated metabolism and is producing abnormally high amounts of carbon dioxide at the cellular level. To compensate, which one of the following will occur?
A) Increased respiratory rate 
B) Decreased respiratory rate 
C) Decreased depth of breathing 
D) Decreased levels of acid in the blood
A

A) Increased respiratory rate

45
Q

The EMT would document an FDO2 level when she is:
A) inserting a nasopharyngeal airway.
B) assisting breathing with a bag-valve-mask device.
C) providing oxygen at greater than 10 liters per minute.
D) using a nonrebreather face mask with high-concentration O2.

A

B) assisting breathing with a bag-valve-mask device.

46
Q
The EMT is administering oxygen at 95% through a nonrebreathing face mask. He would document this as a FiO2 of:
A) 0.21. 
B) 1.00. 
C) 0.95. 
D) 0.50.
A

C) 0.95.

47
Q

Which of the following statements would be true of a patient who relies on the hypoxic drive to breathe?
A) The central chemoreceptors are the primary influence on the respiratory rate.
B) The respiratory rate is set according to the level of O2 in the body.
C) The peripheral chemoreceptors have become less sensitive to oxygen.
D) The primary gas affecting the respiratory rate is carbon dioxide.

A

B) The respiratory rate is set according to the level of O2 in the body.

48
Q
The best way to decrease a patient's afterload would be to:
A) administer intravenous fluids. 
B) provide supplemental oxygen. 
C) reduce the blood pressure. 
D) slow the heart rate.
A

C) reduce the blood pressure.

49
Q
A chronically elevated afterload increases the patient's chance for developing which one of the following conditions?
A) Heart failure 
B) Diabetes 
C) Liver disease 
D) Hypotension
A

A) Heart failure

50
Q
Which one of the following conditions would most likely account for an elevated carbon dioxide level in a patient's body?
A) Liver injury 
B) Endocrine stem dysfunction 
C) Lung disease 
D) Renal failure
A

C) Lung disease

51
Q
A patient has a blood pressure of 140/98 mmHg. Which one of the following can the EMT ascertain from this reading?
A) The afterload is increased. 
B) The SpO2 level must be abnormal.
C) The preload is diminished. 
D) The pulse pressure is narrowed.
A

A) The afterload is increased.

52
Q
A patient has failure of the left side of his heart. Consequently, the blood is backing up into the pulmonary artery and spilling out into the lung tissue, causing him to be short of breath and moderately hypoxic. The EMT should recognize this condition as a product of:
A) increased hydrostatic pressure. 
B) decreased circulating blood volume. 
C) increased osmotic pressure. 
D) decreased pulmonary perfusion.
A

A) increased hydrostatic pressure.

53
Q

A patient who is weak informs you that she has a history of her “iron being too low.” This should concern the EMT because iron is needed to:
A) make the white blood cells required for fighting infection.
B) maintain an adequate blood pressure in the body.
C) carry oxygen throughout the body.
D) help the blood to clot.

A

C) carry oxygen throughout the body.

54
Q

A 20-year-old female has called 911 for chest pain. On scene you find that she has shallow breathing with an SpO2 reading of 91% on room air. She states she was in a car crash yesterday and diagnosed in the hospital with broken ribs. She says that her pain is right where the ribs are broken and rates it a 10/10. Breath sounds are present bilaterally. In this situation, the EMT should attribute the hypoxia to which one of the following?
A) The fractured ribs have pierced the lung, causing it to collapse.
B) Swelling from the rib fractures has compressed the lung.
C) Pain from rib injury prevents full expansion of the chest cage.
D) The patient is bleeding into the lungs, compressing the alveoli.

A

C) Pain from rib injury prevents full expansion of the chest cage.

55
Q

A confused and lethargic 24-year-old male has intentionally overdosed on a narcotic medication. His vitals signs are: pulse 36, respirations 8, blood pressure 50/20, and SpO2 88% with 15 liters per minute of oxygen. The greatest danger to this patient’s well-being is:
A) increased sympathetic nervous system stimulation.
B) altered mental status.
C) decreased cellular perfusion.
D) left ventricular heart failure.

A

C) decreased cellular perfusion.

56
Q

A 35-year-old male is lethargic and dehydrated after working at a construction site for 12 hours on a very hot day. You obtain the following vital signs: pulse 136, respirations 22, blood pressure 102/88, and SpO2 100% with supplemental oxygen. As a knowledgeable EMT, you would recognize:
A) rapid respirations to decrease CO2 loss.
B) widened pulse pressure to circulate more blood.
C) low blood pressure to conserve the body’s energy.
D) elevated heart rate to increase cardiac output.

A

D) elevated heart rate to increase cardiac output.

57
Q

For a patient who is bleeding, which of the following is the immediate response of the human body?
A) Increased production of red blood cells and hemoglobin
B) Vasoconstriction caused by the sympathetic nervous system
C) increased pulse pressure to promote better circulation of oxygen
D) Vasoconstriction caused by the parasympathetic nervous system

A

B) Vasoconstriction caused by the sympathetic nervous system

58
Q

The EMT would recognize which of the following vital signs as most likely to cause left ventricular failure?
A) Chronically elevated diastolic pressure between 120 and 140 mmHg
B) Chronically decreased diastolic blood pressure between 30 and 50 mmHg
C) Chronically decreased systolic blood pressure between 60 and 80 mmHg
D) Chronically elevated systolic blood pressure between 140 and 160 mmHg

A

A) Chronically elevated diastolic pressure between 120 and 140 mmHg

59
Q

A patient with a severe infection is very sick. Circulating toxins from bacteria in his blood have decreased his systemic vascular resistance (SVR). Which of the following would the EMT correlate to this condition?
A) Systolic blood pressure of 160 mmHg
B) Diastolic blood pressure of >200 mmHg
C) Blood pressure of 174/126 mmHg
D) Blood pressure of 74/26 mmHg

A

D) Blood pressure of 74/26 mmHg

60
Q

A patient has been shot three times in the abdomen and has massive internal hemorrhage and blood loss. What will best give this patient a chance at survival?
A) Stopping the bleeding
B) Positive pressure ventilation
C) High-concentration oxygen
D) Paramedic intervention for pain management

A

A) Stopping the bleeding

61
Q

A patient with asthma is extremely short of breath and hypoxic. Related to the ventilation/perfusion ratio (V/Q), the EMT would recognize the problem lying in:
A) inadequate oxygen in the ambient air.
B) inadequate oxygen in the alveoli.
C) decreased cardiac output to circulate oxygen.
D) decreased blood volume to carry oxygen.

A

B) inadequate oxygen in the alveoli.

62
Q

Which of the following statements about chemoreceptors in the human body is true?
A) The peripheral chemoreceptors are extremely sensitive to oxygen and are located in the brain.
B) The peripheral chemoreceptors are more sensitive to oxygen than carbon dioxide.
C) The central chemoreceptors constantly monitor the oxygen levels in the body and increase the rate when more O2 is needed.
D) The central chemoreceptors are located in the lungs and provide the primary stimulus to breathe.

A

B) The peripheral chemoreceptors are more sensitive to oxygen than carbon dioxide.

63
Q
A patient with a low blood sugar is unresponsive with snoring respirations. His breathing is labored and his pulse is rapid and weak. Examination of the skin reveals it to be cool and diaphoretic. Your partner informs you of the following vital signs: pulse 120, respirations 18, blood pressure 132/60, and SpO2 at 84% on room air. Which one of the following actions would you perform first?
A) Start positive pressure ventilation. 
B) Perform a head-tilt chin-lift. 
C) Provide high-concentration oxygen. 
D) Administer oral glucose.
A

B) Perform a head-tilt chin-lift.

64
Q

Assessment of a hypoxic patient with a history of lung disease reveals him to be using well-developed accessory muscles to exhale. As an EMT, you should recognize that the patient:
A) is using energy to exhale and is in danger of respiratory failure.
B) is inadequately exhaling oxygen from his lungs.
C) has a problem with the red blood cells in transporting oxygen.
D) is adequately compensating for the problem with his breathing.

A

A) is using energy to exhale and is in danger of respiratory failure.

65
Q

A patient who is hypoxic has a pulmonary disease that involves low lung compliance. As such, you realize:
A) ventilation with a bag-valve mask will require more effort.
B) the patient has tremendous swelling to the small airways.
C) oxygen and carbon dioxide cannot be exchanged across the alveolar wall.
D) the lung tissue is easily inflated and can be damaged.

A

A) ventilation with a bag-valve mask will require more effort.

66
Q
For a patient breathing in room air, the EMT would estimate the FiO2 to be:
A) 0.21. 
B) 1.00. 
C) 0.15. 
D) 0.55.
A

A) 0.21.

67
Q

Which of the following is required for normal perfusion to occur?
A) Airway patency, proper amounts of oxygen, adequate glucose levels
B) Adequate breathing, sufficient red blood cells, good heart function
C) Patent airway, sufficient breathing, high amounts of glucose, good heart function
D) Intact breathing, ample red blood cells, body temperature of 98.6°F

A

B) Adequate breathing, sufficient red blood cells, good heart function

68
Q

A young patient is experiencing epiglottitis (swelling of the epiglottis). He is working hard to breathe, has stridorous respirations, and is extremely hypoxic. His skin is cyanotic and pulse rapid but strong. Which of the following is most likely causing the poor delivery of oxygen to the cells?
A) Partial occlusion of the airway
B) Elevation of the heart rate
C) Impaired transfer of O2 between the lungs and blood
D) Poor function of the heart as a pump

A

A) Partial occlusion of the airway

69
Q

Failure of the sodium potassium pump can result in:
A) excess amounts of sodium outside of the cell.
B) large amounts of potassium inside the cell.
C) cellular damage, swelling, and rupture.
D) accumulation of acidic wastes.

A

C) cellular damage, swelling, and rupture.

70
Q

For cells to undergo the process of aerobic metabolism, the cells require:
A) water and oxygen.
B) oxygen and glucose.
C) adenosine triphosphate (ATP) and lactic acid.
D) sugar (glucose) and protein.

A

B) oxygen and glucose.

71
Q

Perfusion is best described as:
A) delivery of essential products and nutrients to the cell for its use.
B) exchange of oxygen and carbon dioxide between the lungs and blood.
C) availability of oxygen to the lungs for placement into the blood.
D) an adequate amount of white blood cells to carry oxygen to the cells.

A

A) delivery of essential products and nutrients to the cell for its use.

72
Q

A patient who has lost 1 liter of blood is conscious with a patent airway, but his extremities are pale and cold to the touch. Vital signs are pulse 130, respirations are 22 and adequate, blood pressure is 74/56, and SpO2 is 95% on room air. Which one of the following is most needed by this patient to increase perfusion to the cells?
A) Increased blood pressure by giving IV fluids
B) Keeping the patient warm
C) Administration of oxygen
D) Increased number of red blood cells and plasma volume

A

D) Increased number of red blood cells and plasma volume

73
Q

A patient is hemorrhaging internally within his colon, therein impairing perfusion to the cells of his body. Aside from the bleeding, the patient has no other problems. In this scenario, the problem impairing adequate perfusion would be:
A) inability to get oxygen to the blood.
B) decreased blood volume.
C) inadequate ventilation to eliminate carbon dioxide.
D) poor myocardial pump function.

A

B) decreased blood volume.