Module 9 Exam

Question 1

Uterine inversion occurs when:

A) the musculature of the uterine fundus is inherently weak, causing the uterus to prolapse.
B) the placenta fails to detach properly and adheres to the uterine wall when it is expelled.
C) postpartum bleeding is improperly managed with inadequate massage of the uterine fundus.
D) excessive postpartum hemorrhage causes uterine ischemia and subsequent expulsion from the vagina.

Answer 1

B) the placenta fails to detach properly and adheres to the uterine wall when it is expelled.

Question 2

What is the corpus luteum?

A) The by-product of the release of progesterone
B) The thickened inner lining of the uterine wall
C) A hormone that is excreted throughout the ovarian cycle
D) Remnants of the follicle after the egg has been released

Answer 2

D) Remnants of the follicle after the egg has been released

Question 3

Common signs of gestational diabetes include:
A) confusion.
B) diaphoresis.
C) polydipsia.
D) tachycardia.

Answer 3

C) polydipsia.

Question 4

Tetralogy of Fallot is a combination of four heart defects, including:

A) atrial septal defect.
B) coarctation of the aorta.
C) tricuspid atresia.
D) right ventricular hypertrophy

Answer 4

D) right ventricular hypertrophy

Question 5

Total anomalous pulmonary venous return is a rare congenital defect in which:

A) pressure in the lungs causes pulmonary hypertension.
B) the four pulmonary veins connect to the right atrium.
C) venous blood mixes with arterial blood in the heart.
D) blood returns to the lungs after being reoxygenated

Answer 5

B) the four pulmonary veins connect to the right atrium.

Question 6

Cervical spondylosis is a degenerative change in the cervical spine that causes:

A) destruction of the intervertebral discs and vertebral fractures.
B) narrowing of the spinal canal and pressure on the spinal cord.
C) lateral curvature of the cervical spine with cord impingement.
D) fracture of the odontoid process of the second cervical vertebra.

Answer 6

B) narrowing of the spinal canal and pressure on the spinal cord.

Question 7

Delirium is MOST accurately defined as:

A) an acute alteration in mentation that indicates an underlying condition.
B) any alteration in cognitive function that may or may not be reversible.
C) a pattern of disorganized thinking that progresses over several weeks.
D) an altered mental status that is caused by structural damage to the brain

Answer 7

A) an acute alteration in mentation that indicates an underlying condition.

Question 8

In contrast to delirium, dementia is:

A) often caused by conditions such as poisonings and infection.
B) an acute state of confusion that may last for up to 1 week.
C) often reversible if the underlying cause is identified rapidly.
D) a progressive disease that produces irreversible brain failure.

Answer 8

D) a progressive disease that produces irreversible brain failure.

Question 9

Polypharmacy is MOST accurately defined as:

A) a harmful interaction when several drugs are taken together.
B) the prescribing of multiple drugs to treat multiple conditions.
C) unnecessarily prescribing numerous drugs to prevent a disease.
D) the unintentional ingestion of multiple doses of the same drug.

Answer 9

B) the prescribing of multiple drugs to treat multiple conditions.

Question 10

Spina bifida occurs when:

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

Answer 10

B) 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 11

The female urinary meatus is located:

A) superior to the clitoris.
B) just above the vaginal opening.
C) inferior to the vaginal opening.
D) between the vagina and perineum.

Answer 11

B) just above the vaginal opening.

Question 12

The MOST important prehospital intervention for a footling breech or transverse presentation of the baby is:

A) maternal vascular access.
B) keeping the mother warm.
C) delivery of high-flow oxygen.
D) rapid transport to the hospital.

Answer 12

D) rapid transport to the hospital.

Question 13

The risk of aspiration in the pregnant woman is increased significantly because:

A) decreased digestion causes a delay in gastric emptying.
B) pregnancy hormones often cause nausea and vomiting.
C) increased tidal volume causes air to enter the stomach.
D) the gastric lining is extremely irritable during pregnancy.

Answer 13

A) decreased digestion causes a delay in gastric emptying.

Question 14

There is a higher incidence of abdominal injuries in association with chest trauma in pregnant women because:

A) seat belts are usually not worn.
B) the peritoneum is maximally stretched.
C) the diaphragm is elevated nearly 2 inches.
D) the abdomen is large and protuberant.

Answer 14

C) the diaphragm is elevated nearly 2 inches.

Question 15

When assessing the abdomen of a woman who is 36 weeks pregnant, you should expect it to be:

A) rigid and distended.
B) firm and nontender.
C) enlarged and tender.
D) distended and guarded.

Answer 15

B) firm and nontender.

Question 16

When caring for a prolapsed umbilical cord, you should:

A) position the mother in a left lateral recumbent position with her knees flexed into her abdomen.
B) keep the presenting part of the baby off the umbilical cord during rapid transport to the hospital.
C) have your partner cover the exposed portion of the umbilical cord with dry, sterile dressings.
D) instruct the mother to push during each contraction to facilitate passage of the baby past the cord.

Answer 16

B) keep the presenting part of the baby off the umbilical cord during rapid transport to the hospital.

Question 17

When caring for a woman with an inevitable or incomplete abortion, you should be MOST concerned with:

A) bleeding and shock.
B) severe maternal infection.
C) maternal emotional trauma.
D) the risk of airway compromise.

Answer 17

A) bleeding and shock.

Question 18

When delivering multiple babies, you should clamp and cut the umbilical cord:

A) after the placenta has delivered.
B) only after the first baby delivers.
C) following delivery of each baby.
D) after all the babies have delivered.

Answer 18

C) following delivery of each baby.

Question 19

Which of the following changes occurs in the respiratory system of a pregnant woman?

A) Progesterone increases the threshold of the medullary respiratory center to carbon dioxide.
B) Minute ventilation increases by as much as 50%, which causes the PaCO2 to drop by about 5 mm Hg.
C) Oxygen consumption decreases by approximately 20%, causing a 40% decrease in tidal volume.
D) An increase in blood bicarbonate levels causes a slight decrease in the pH level of the blood.

Answer 19

B) Minute ventilation increases by as much as 50%, which causes the PaCO2 to drop by about 5 mm H

Question 20

During the second stage of labor:

A) amniotic fluid typically gushes out of the vagina.
B) the baby’s head begins to bulge through the cervix.
C) delivery in a multiparous woman occurs in a few hours.
D) contractions become more intense and more frequent.

Answer 20

D) contractions become more intense and more frequent.

Question 21

A woman is in the second stage of labor when:

A) she feels a strong urge to move her bowels.
B) the cervix is fully effaced and partially dilated.
C) a gush of amniotic fluid pours from the vagina.
D) contractions occur in 5- to 10-minute intervals

Answer 21

A) she feels a strong urge to move her bowels.

Question 22

Which of the following events occur during the third stage of labor?

A) Crowning
B) Placental delivery
C) Delivery of the baby
D) Mucous plug expulsion

Answer 22

B) Placental delivery

Question 23

Average blood loss during the third stage of labor is approximately:

A) 150 mL.
B) 250 mL.
C) 400 mL.
D) 500 mL.

Answer 23

A) 150 mL.

Question 24

Common signs of gestational diabetes include:

A) confusion.
B) diaphoresis.
C) polydipsia.
D) tachycardia.

Answer 24

C) polydipsia.

Question 25

Which of the following is NOT a function of the placenta?

A) Synthesis of glycogen and cholesterol
B) Fetal protection against all harmful substances
C) Antibody production that protects the fetus
D) Excretion of wastes in the maternal circulation

Answer 25

B) Fetal protection against all harmful substances

Question 26

In pregnancy, magnesium sulfate is used principally for:

A) eclamptic seizures.
B) tocolytic therapy.
C) ventricular dysrhythmias.
D) hyperemesis gravidarum.

Answer 26

A) eclamptic seizures.

Question 27

All of the following processes take place in the uterus, EXCEPT:

A) fertilization.
B) implantation.
C) the act of labor.
D) fetal development.

Answer 27

A) fertilization.

Question 28

The ____________of the uterus is composed of three layers of muscle fibers that contract and help expel the fetus during childbirth.

A) cervix
B) endometrium
C) myometrium
D) perimetrium

Answer 28

C) myometrium

Question 29

Which of the following statements regarding abdominal trauma during pregnancy is correct?

A) Use of a lap belt increases the risk of uterine injury.
B) Deceleration injuries often result in placenta previa.
C) Uterine trauma is common during the first trimester.
D) The pubic bone protects the bladder in late pregnancy.

Answer 29

A) Use of a lap belt increases the risk of uterine injury.

Question 30

Which of the following statements regarding Rh disease during pregnancy is correct?

A) Isoimmunization occurs when an Rh-positive woman becomes pregnant by an Rh-negative man.
B) Rh disease is a problem during the first pregnancy and occurs when the mother’s blood is Rh positive.
C) If the fetus inherits Rh-positive blood, it will create antibodies that can result in maternal hemolysis.
D) During subsequent pregnancies, the Rh antibody will cross the placental barrier and attack the fetal red blood cells.

Answer 30

D) During subsequent pregnancies, the Rh antibody will cross the placental barrier and attack the fetal red blood cells.

Question 31

Which of the following statements regarding the amniotic sac and fluid is correct?

A) In the latter stages of pregnancy, the fetus swallows amniotic fluid and passes wastes out into the fluid.
B) The volume of amniotic fluid reaches about 500 mL by the end of pregnancy and nourishes the fetus.
C) Amniotic fluid serves no real physiologic purpose and the fetus could easily survive in utero without it.
D) The amniotic sac is composed of a tough, fibrous membrane that generally does not rupture until birth.

Answer 31

A) In the latter stages of pregnancy, the fetus swallows amniotic fluid and passes wastes out into the fluid.

Question 32

The uterine fundus is measured:

A) horizontally from one side of the uterus to the other side.
B) vertically from the top of the pubic bone to the top of the fundus.
C) from just below the umbilicus to the inferior part of the sternum.
D) vertically from the top of the fundus to just below the umbilicus.

Answer 32

B) vertically from the top of the pubic bone to the top of the fundus.

Question 33

Respiratory distress in a premature infant is MOST often the result of:

A) a pneumothorax.
B) surfactant deficiency.
C) pneumonia at birth.
D) intracranial hemorrhage

Answer 33

B) surfactant deficiency.

Question 34

The MOST common reasons for ineffective bag-mask ventilations in the newborn are:

A) equipment malfunction and a ventilation rate that is too rapid.
B) inadequate mask-to-face seal and incorrect head position.
C) hyperflexion of the newborn’s head and thick mucous plugs.
D) pneumothorax and a face mask that is too large for the infant.

Answer 34

B) inadequate mask-to-face seal and incorrect head position.

Question 35

The quickest way to prevent newborn hypothermia involves:

A) administering warmed IV fluids.
B) thoroughly drying the newborn after birth.
C) applying a hot water bottle to the groin area.
D) administering warmed, humidified oxygen.

Answer 35

B) thoroughly drying the newborn after birth.

Question 36

The single MOST common cause of seizures in both term and preterm infants is:

A) intracranial hemorrhaging.
B) hypoxic ischemic encephalopathy.
C) congenital or developmental defects.
D) a severe derangement in electrolytes.

Answer 36

B) hypoxic ischemic encephalopathy.

Question 37

Which of the following statements regarding the Apgar score is correct?

A) If resuscitation is necessary, the Apgar score is completed to determine the result of the resuscitation.
B) The Apgar score is determined on the basis of the newborn’s condition at 2 and 10 minutes after birth.
C) If resuscitation is needed, it should commence immediately after you obtain the 1-minute Apgar score.
D) A newborn with a heart rate of greater than 80 beats/min would be assigned a score of 2 on the Apgar score.

Answer 37

A) If resuscitation is necessary, the Apgar score is completed to determine the result of the resuscitation.

Question 38

According to the Apgar score, a newborn with a heart rate of 80 beats/min and slow, irregular breathing should receive a combined score of:

A) 2.
B) 3.
C) 4.
D) 5.

Answer 38

A) 2.

Question 39

An infant born with a pink body and blue extremities, a pulse rate of 90 beats/min, a strong cry, and active movement should be assigned an initial Apgar score of:

A) 5.
B) 6.
C) 7.
D) 8.

Answer 39

D) 8.

Question 40

What size and type of laryngoscope blade is recommended for use in a full-term newborn?

A) No. 1, straight
B) No. 2, straight
C) No. 1, curved
D) No. 2, curved

Answer 40

A) No. 1, straight

Question 41

Chest compressions are indicated in the newborn if its heart rate remains less than ____ beats/min despite effective positive-pressure ventilations for ____ seconds.

A) 80, 30
B) 60, 30
C) 60, 60
D) 80, 60

Answer 41

B) 60, 30

Question 42

When performing chest compressions on a newborn, you should:

A) compress the chest one third the anteroposterior depth of the chest.
B) use the two-finger compression technique if two rescuers are present.
C) reassess the newborn’s heart rate after every 60 seconds of compressions.
D) deliver 120 compressions and 40 ventilations during any 60-second period.

Answer 42

A) compress the chest one third the anteroposterior depth of the chest.

Question 43

Which of the following disorders or conditions is related to decreased glycogen stores in the newborn?

A) Large for gestational age
B) Hypoxia or hypothermia
C) Small for gestational age
D) Maternal diabetes mellitus

Answer 43

C) Small for gestational age

Question 44

Which of the following events is a critical part of fetal transition?

A) Diversion of blood flow to the fetus’s lungs
B) An acute increase in intrapulmonary pressure
C) Fetal lung expansion within 5 minutes after birth
D) Blood flow diversion across the ductus arteriosus

Answer 44

A) Diversion of blood flow to the fetus’s lungs

Question 45

Which of the following factors is associated with the HIGHEST risk of newborn hypoglycemia?

A) Neonatal polycythemia
B) Morbid obesity in the mother
C) The larger of discordant twins
D) 5-minute Apgar score of less than 7

Answer 45

B) Morbid obesity in the mother

Question 46

Signs of hypovolemia in the newborn include all of the following, EXCEPT:

A) persistent pallor.
B) weak central pulses.
C) persistent acrocyanosis.
D) persistent bradycardia.

Answer 46

C) persistent acrocyanosis.

Question 47

Signs of a diaphragmatic hernia include all of the following, EXCEPT:

A) a scaphoid or concave abdomen.
B) bilaterally absent breath sounds.
C) noted increased work of breathing.
D) audible bowel sounds in the chest.

Answer 47

B) bilaterally absent breath sounds.

Question 48

While preparing equipment for newborn resuscitation, which of the following items is/are NOT considered optional?

A) Pulse oximeter
B) Cardiac monitor
C) Endotracheal tubes
D) Laryngeal mask airway

Answer 48

C) Endotracheal tubes

Question 49

When fever is suspected in the newborn, you should:

A) observe for the presence of a rash.
B) assist ventilations with a bag-mask device.
C) administer acetaminophen or ibuprofen.
D) quickly lower the newborn’s body temperature.

Answer 49

A) observe for the presence of a rash.

Question 50

Which of the following statements regarding fever in the newborn is correct?

A) Fever in newborns is defined as a rectal temperature greater than 99.0°F.
B) The ability of the newborn to dissipate heat through sweating is prominent.
C) Fever may not always be a presenting feature in newborns with an infection.
D) Because of their active immune systems, newborns commonly experience fever.

Answer 50

C) Fever may not always be a presenting feature in newborns with an infection.

Question 51

A 12-year-old boy presents with marked respiratory distress; hot, moist skin; and anxiety. He is sitting with his chin thrust forward and has inspiratory stridor. According to the child’s grandmother, his symptoms began suddenly about 30 minutes ago. You should be MOST suspicious for:

A) acute viral croup.
B) bacterial epiglottitis.
C) subglottic narrowing.
D) laryngotracheobronchitis.

Answer 51

B) bacterial epiglottitis.

Question 52

A 13-year-old, 40-pound girl is experiencing an acute asthma attack that has been unresponsive to 3 puffs of her albuterol inhaler. She is conscious and alert, but is notably dyspneic and has diffuse wheezing. In addition to administering supplemental oxygen, you should:

A) give 0.35 mg of epinephrine 1:1,000 SQ.
B) give 0.5 mg of nebulized ipratropium.
C) administer another 2.5-mg dose of albuterol.
D) assist her ventilations with a bag-mask device

Answer 52

B) give 0.5 mg of nebulized ipratropium.

Question 53

A 6-year-old girl who has been running a fever for the past 2 days presents with lethargy and tachycardia. Her heart rate is 170 beats/min and varies with activity. Her skin is cool and clammy, and her capillary refill time is 4 seconds. The cardiac monitor reveals a narrow complex tachycardia with a rate that varies between 150 and 170 beats/min. After applying high-flow oxygen, you should:

A) apply chemical ice packs to the child’s face to try to slow her heart rate.
B) establish vascular access and administer a 20-mL/kg normal saline bolus.
C) start an IV line and give adenosine while monitoring her cardiac rhythm.
D) transport immediately and establish vascular access en route to the hospital.

Answer 53

B) establish vascular access and administer a 20-mL/kg normal saline bolus.

Question 54

A 2-year-old girl fell approximately 12 feet from a second-story window, landing on her head. Your primary assessment reveals that she is unresponsive; has slow, irregular respirations; and has blood draining from her mouth and nose. A rapid scan of her body does not reveal any gross injuries or bleeding. You should:

A) manually stabilize her head and neck in a neutral position, insert a nasal airway, and hyperventilate her at a rate of 35 breaths/min.
B) suction her mouth and nose for no longer than 15 seconds, insert an oral airway, and apply high-flow oxygen with a pediatric nonrebreathing mask.
C) open her airway with the jaw-thrust maneuver, suction her mouth and nose, insert an oral airway, and assist her ventilations with a bag-mask device.
D) insert an oral airway, apply a cervical collar, preoxygenate her with a bag-mask device and 100% oxygen for 30 seconds, and intubate her trachea.

Answer 54

C) open her airway with the jaw-thrust maneuver, suction her mouth and nose, insert an oral airway, and assist her ventilations with a bag-mask device.

Question 55

A 4-year-old boy is found unresponsive by his mother. When you begin your assessment, the child’s mother tells you that her son apparently ingested some of her antihypertensive medication. The child has poor perfusion and is breathing poorly. As you are assisting the child’s ventilations with high-flow oxygen, your partner informs you that the child’s heart rate is 50 beats/min and weak and that the cardiac monitor reveals sinus bradycardia. You should:

A) ask your partner to insert an IO catheter and administer epinephrine 1:10,000.
B) attempt immediate transcutaneous pacing while continuing ventilation assistance.
C) establish immediate vascular access and administer 0.02 mg/kg of atropine sulfate.
D) initiate one-rescuer CPR while your partner attempts to establish vascular access.

Answer 55

D) initiate one-rescuer CPR while your partner attempts to establish vascular access.

Question 56

Upon arriving at the scene of a 4-year-old girl who is ill, you assess her and note that she is tachypneic and tachycardic. Her skin is warm and moist, and there are no signs of increased work of breathing. The child’s mother denies any vomiting or diarrhea. This child’s tachycardia and tachypnea are MOST likely the result of:

A) fever and anxiety.
B) early hypoxemia.
C) a cardiac problem.
D) moderate dehydration.

Answer 56

A) fever and anxiety.

Question 57

A 7-year-old conscious boy presents with marked respiratory distress. Your assessment reveals the presence of intercostal and supraclavicular retractions and nasal flaring. His oxygen saturation is 93% on room air, and his heart rate is rapid. The MOST appropriate initial treatment for this child involves:

A) administering high-flow oxygen as tolerated, auscultating his lung sounds, and being prepared to assist his ventilations.
B) conducting a focused history and physical exam and allowing him to breathe room air to see if his oxygen saturation falls.
C) recognizing that the child is in respiratory failure and making immediate preparations to perform endotracheal intubation.
D) assisting his ventilations with a bag-mask device and determining if his tachycardia is ventricular or supraventricular in origin.

Answer 57

A) administering high-flow oxygen as tolerated, auscultating his lung sounds, and being prepared to assist his ventilations.

Question 58

A 9-year-old who fell off his bike has an isolated deformity to his forearm and is in significant pain. The child is conscious and alert, his vital signs are stable, and his mother is present. Your initial effort to relieve this child’s pain should involve:

A) encouraging the child to breathe high-flow oxygen.
B) not allowing the child to visualize his deformed arm.
C) providing calm reassurance to both mother and child.
D) administering morphine or fentanyl via slow IV push.

Answer 58

C) providing calm reassurance to both mother and child.

Question 59

A child in decompensated shock with hypotension should:

A) be intubated to protect his or her airway.
B) receive initial fluid resuscitation at the scene.
C) be given 25% dextrose to prevent hypoglycemia.
D) receive volume expansion with 5% dextrose in water.

Answer 59

B) receive initial fluid resuscitation at the scene.

Question 60

A child who is experiencing a moderate asthma attack would MOST likely present with:

A) a markedly prolonged expiratory phase.
B) wheezing during inspiration and expiration.
C) an inability to speak in complete sentences.
D) an oxygen saturation between 80% and 90%.

Answer 60

B) wheezing during inspiration and expiration.

Question 61

Early hypoxia in a child would MOST likely present with:

A) tachycardia.
B) bradypnea.
C) mottled skin.
D) bradycardia.

Answer 61

A) tachycardia.

Question 62

A conscious child who is in the sniffing position:

A) is trying to align the axes of the airway to improve ventilation.
B) is clearly experiencing a lower airway obstruction.
C) will refuse to lie down and leans forward on outstretched arms.
D) assumes a physical position that optimizes accessory muscle use.

Answer 62

A) is trying to align the axes of the airway to improve ventilation.

Question 63

A normal respiratory rate in a child:

A) may be observed if the child has been breathing rapidly with increased work of breathing and is becoming fatigued.
B) generally ranges between 15 and 20 breaths per minute and is influenced easily by factors such as excitement, fear, or fever.
C) cannot be established accurately because a toddler’s respirations generally are grossly irregular and extremely difficult to count.
D) is a sign of impending respiratory failure if it is observed in conjunction with a room air oxygen saturation reading of less than 96%.

Answer 63

A) may be observed if the child has been breathing rapidly with increased work of breathing and is becoming fatigued.

Question 64

A sick or injured child’s general appearance is MOST reflective of:

A) the etiology of the problem.
B) his or her cardiovascular status.
C) his or her central nervous system function.
D) his or her ability to be consoled.

Answer 64

C) his or her central nervous system function.

Question 65

A young child with marked respiratory distress who is agitated and thrashing about should receive oxygen via:

A) nonrebreathing mask because agitation indicates cerebral ischemia.
B) the blow-by technique while he or she sits on the lap of a caregiver.
C) positive-pressure ventilation after he or she has been properly sedated.
D) a method that minimizes metabolic demand and oxygen consumption.

Answer 65

D) a method that minimizes metabolic demand and oxygen consumption.

Question 66

After falls, _______________ is/are the second leading cause of accidental death among elderly people.

A) thermal burns
B) drug interactions
C) submersion injury
D) motor vehicle accidents

Answer 66

D) motor vehicle accidents

Question 67

After obtaining an elderly patient’s chief complaint, gathering additional information about the history of present illness would MOST likely be complicated because:

A) the patient may ask you to repeat your questions.
B) chronic problems may affect the acute problem.
C) most elderly patients take numerous medications.
D) the aging process causes difficulty in understanding.

Answer 67

B) chronic problems may affect the acute problem.

Question 68

Aging brings a widespread decrease in bone mass, especially:

A) in postmenopausal women.
B) in men over 50 years of age.
C) if the person falls frequently.
D) in the presence of hypertension.

Answer 68

A) in postmenopausal women.

Question 69

Aging kidneys have a decreased glomerular filtration rate, which predisposes an older person to all of the following conditions, EXCEPT:

A) hyperkalemia.
B) hypernatremia.
C) profound dehydration.
D) acute volume overload.

Answer 69

C) profound dehydration.

Question 70

An 82-year-old man presents with confusion that has worsened progressively over the past 2 weeks. Because of his confusion and the fact that he is hearing impaired, you obtain the majority of your medical history information from his daughter. She tells you that her father has high blood pressure but refuses to take medication for it. She also tells you that she thinks he fell about 3 weeks ago, although he denies falling. The patient’s blood pressure is 168/98 mm Hg, pulse rate is 60 beats/min and occasionally irregular, and respirations are 22 breaths/min and regular. This patient MOST likely:

A) has an acute onset of dementia.
B) is experiencing a subdural hematoma.
C) had a stroke secondary to atrial fibrillation.
D) has normal age-related physiologic changes.

Answer 70

B) is experiencing a subdural hematoma.

Question 71

An elderly person is at increased risk for aspiration, primarily from:

A) atrophy of the epiglottis.
B) a decreased ability to swallow.
C) slowing of the ciliary mechanisms.
D) decreased cough and gag reflexes.

Answer 71

D) decreased cough and gag reflexes.

Question 72

An elderly person is more likely to sustain serious injury following trauma due to:

A) brittle, demineralized bone.
B) ineffective vasoconstriction.
C) chronic renal hypertrophy.
D) decreased respiratory function.

Answer 72

A) brittle, demineralized bone.

Question 73

An increase in blood pressure that commonly occurs with aging is physiologically exacerbated by:

A) a compensatory increase in preload and cardiac ejection fraction.
B) a decrease in stroke volume due to age-induced cardiomyopathy.
C) an overproduction of collagen and decreased quantities of elastin.
D) the patient’s noncompliance with his or her antihypertensive drugs.

Answer 73

C) an overproduction of collagen and decreased quantities of elastin.

Question 74

Decreased elasticity of the lungs and calcification of the costochondral cartilage results in:

A) an increase in residual lung volume.
B) a significant increase in vital capacity.
C) a decrease in airway size and resistance.
D) a decrease in the total amount of air in the lungs.

Answer 74

A) an increase in residual lung volume.

Question 75

Failure of the heart’s primary pacemaker and the development of alternate pacemakers in the atria would MOST likely result in:
A) junctional rhythms.
B) atrioventricular block.
C) ventricular ectopy.
D) atrial fibrillation.

Answer 75

D) atrial fibrillation.

Question 76

Following retirement, many older people:

A) experience a rapid decline in their underlying health and become incapacitated within 12 months.
B) often experience an improvement in their overall health because the stress of working has been eliminated.
C) return to work within 6 months because their retirement pension does not support them adequately.
D) commonly experience decreased self-esteem because they no longer feel useful or productive in society.

Answer 76

D) commonly experience decreased self-esteem because they no longer feel useful or productive in society.

Question 77

Heat gain or loss in response to environmental changes is delayed in elderly people for all of the following reasons, EXCEPT:

A) impaired circulation.
B) chronic hyperthyroidism.
C) atherosclerotic vessels.
D) decreased sweat production

Answer 77

B) chronic hyperthyroidism.

Question 78

Hypotension and orthostatic vital sign changes would MOST likely occur in elderly people who take:

A) diuretics.
B) beta blockers.
C) antidepressants.
D) ACE inhibitors.

Answer 78

A) diuretics.

Question 79

In contrast to a 30-year-old man, if a 70-year-old were to consume an excessive amount of alcohol:

A) he would experience a lower blood alcohol concentration secondary to a decrease in total body water.
B) the alcohol would be eliminated from his body much faster unless he is taking an antihypertensive drug.
C) it would take longer for him to develop alcohol toxicity secondary to decreased metabolism in the liver.
D) he would experience a higher blood alcohol concentration due to decreases in body mass and total body water.

Answer 79

D) he would experience a higher blood alcohol concentration due to decreases in body mass and total body water.

Question 80

MOST age-related visual disturbances are the result of:

A) diabetic retinopathy.
B) cataracts or glaucoma.
C) macular degeneration.
D) retinal artery occlusion.

Answer 80

B) cataracts or glaucoma.

Question 81

The fistula used for hemodialysis is a surgical connection between:

A) two large veins.
B) an artery and a vein.
C) two large arteries.
D) a vein and the peritoneum.

Answer 81

B) an artery and a vein.

Question 82

Physiologic age-related decreases in skin elasticity are the result of:

A) decreased collagen and elastin production.
B) chronic use of corticosteroid medications.
C) slower replenishment of epidermal cells.
D) frequent fungal or viral skin infections.

Answer 82

A) decreased collagen and elastin production.

Question 83

The majority of acquired hearing loss in children and adults is the result of:

A) a tumor on the acoustic nerve.
B) frequent middle ear infections.
C) excessive exposure to loud noise.
D) long-term use of salicylates.

Answer 83

C) excessive exposure to loud noise.

Question 84

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

A) right atrium.
B) pulmonary cavity.
C) peritoneal cavity.
D) left ventricle.

Answer 84

C) peritoneal cavity.

Question 85

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

A) protect the skin from irritation.
B) seal the ostomy bag to the skin.
C) maintain sterility of the ostomy bag.
D) cover the stoma until the bag is attached.

Answer 85

A) protect the skin from irritation.

Question 86

The transducer or drainage system of an intracranial pressure monitor is typically aligned at the same height as the patient’s:

A) forehead.
B) ear canal.
C) eyebrow.
D) temporal bone.

Answer 86

B) ear canal.

Question 87

Triple lumen central catheters are usually placed in the:

A) external jugular vein.
B) internal carotid artery.
C) antecubital vein in the arm.
D) subclavian or femoral vein.

Answer 87

D) subclavian or femoral vein.

Question 88

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:

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

Answer 88

B) immediately check the settings on the mechanical ventilator to ensure that it is working properly.

Question 89

What is the pathophysiology of cystic fibrosis?

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

Answer 89

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

Question 90

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

A) keep the patient in a supine position.
B) elevate the arm with the AV fistula.
C) carefully titrate any IV fluids given.
D) treat acidosis with sodium bicarbonate.

Answer 90

C) carefully titrate any IV fluids given.

Question 91

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

A) avoid attempting to clean the device.
B) soak the device in hydrogen peroxide.
C) ensure the device is set to telephone mode.
D) carefully clean the device with an alcohol prep.

Answer 91

A) avoid attempting to clean the device.

Question 92

When urine becomes evident in the tubing during insertion of an indwelling urinary catheter in a male, you should:

A) connect the indwelling catheter to the urine drainage system, unclamp the tubing, and allow urine to drain.
B) inflate the balloon with the prefilled syringe and gently pull back on the catheter until you feel resistance.
C) continue inserting the catheter until the Y between the drainage port and the balloon port is at the tip of the penis.
D) insert the catheter approximately 1 inch farther, inflate the balloon, and then pull back on the catheter until you feel resistance.

Answer 92

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

Question 93

Which of the following are often the primary tasks for paramedics who are caring for a patient with a terminal illness?

A) Airway care and thermal management
B) ECG monitoring and antidysrhythmic therapy
C) Antibiotic and antipyretic therapy
D) Pain assessment and management

Answer 93

D) Pain assessment and management

Question 94

Which of the following clinical presentations is MOST consistent with a malfunctioning cerebrospinal fluid shunt?

A) Tachycardia, tinnitus, and a narrowing pulse pressure
B) Visual disturbances, headache, and altered mental status
C) Hypotension, sudden loss of hearing, and severe nausea
D) Tachypnea, fluid drainage from the ears, and restlessness

Answer 94

B) Visual disturbances, headache, and altered mental status

Question 95

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

A) Midazolam
B) Etomidate
C) Vecuronium
D) Succinylcholine

Answer 95

D) Succinylcholine

Question 96

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

A) Larger upper airway
B) Limited neck mobility
C) Smaller patient head size
D) Proportionately small tongue

Answer 96

B) Limited neck mobility

Question 97

Bag-mask ventilation of the obese patient would MOST likely be ineffective when the patient is:

A) supine.
B) apneic.
C) semisitting.
D) in reverse Trendelenburg.

Answer 97

A) supine.

Question 98

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

A) Burns with splash marks
B) Bruises on the abdomen
C) Bruises on the lower leg
D) Laceration to the chin

Answer 98

B) Bruises on the abdomen

Question 99

Adult patients who have a tracheostomy tube in place and are ventilator-dependent should receive:

A) cool, dry air through the ventilator circuit.
B) deep tracheal suctioning every other day.
C) humidification and heating of inspired air.
D) ventilation at a rate of 20 to 24 breaths/min.

Answer 99

C) humidification and heating of inspired air.

Question 100

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

A) Suctioning
B) Mask ventilation
C) Hyperventilation
D) Head positioning

Answer 100

A) Suctioning

Question 101

When suctioning and cleaning the tracheostomy of a ventilator-dependent patient, it is MOST important to:

A) keep the patient well oxygenated.
B) have a new tube readily available.
C) suction for no longer than 5 seconds.
D) soak the inner cannula in sterile water.

Answer 101

A) keep the patient well oxygenated.

Question 102

Several attempts to clear a plugged tracheostomy tube with suction have failed. The patient, who is on a mechanical ventilator, has a pulse rate of 150 beats/min and is making exaggerated attempts to breathe. You should:

A) remove the tracheostomy tube, place a mask over the stoma, and ventilate with a bag-mask device.
B) deflate the cuff of the tracheostomy tube and ventilate the patient in the usual fashion with a bag-mask device.
C) administer high-flow oxygen via nonrebreathing mask as you prepare to replace the tracheostomy tube.
D) provide free-flow oxygen as you remove the tracheostomy tube and replace it with a similarly sized endotracheal tube.

Answer 102

B) deflate the cuff of the tracheostomy tube and ventilate the patient in the usual fashion with a bag-mask device.