Quiz 15 - Medical & Hematologic Flashcards Preview

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Flashcards in Quiz 15 - Medical & Hematologic Deck (30):
1

You are transporting a 55-year-old woman to the hospital. The patient has lymphoma and complains of generalized, severe pain. She is receiving supplemental oxygen and has an IV line of normal saline established. Her blood pressure is 110/64 mm Hg, pulse rate is 104 beats/min and regular, and respirations are 22 breaths/min and adequate. You should:

A. administer narcotic analgesia as needed while closely monitoring her blood pressure.

B. give her 2 to 5 mg of a benzodiazepine sedative and provide constant reassurance.

C. provide emotional support, but refrain from analgesia as this may cause hypotension.

D. ensure that she is in a comfortable position and administer a 250-mL saline bolus.

A. administer narcotic analgesia as needed while closely monitoring her bloodpressure.

2

As multiple myeloma progresses, the patient would MOST likely experience:

A. acute intracranial bleeding.

B. frequent nosebleeds.

C. spontaneous fractures.

D. atrophy of large muscle groups.

C. spontaneous fractures.

3

You receive a call to a residence for a patient who is “sick.” Upon arriving at the scene, you find the patient, a 39-year-old woman, lying on the couch with a wet washcloth on her forehead. She is conscious and alert, and tells you that she has had several episodes of diarrhea and noticed bright red blood in her stool. Her pulse rate is rapid and weak, her skin is cool and clammy, and her blood pressure is 98/58 mm Hg. Her medical history is significant for hemophilia, for which she is receiving factor VIII therapy. As you pull out a non rebreathing mask, she tells you that her husband will be home in a few hours and that he will take herto the hospital. You should:

A. notify her husband, explain the situation to him, and advise him that you will be transporting his wife to the hospital.

B. advise her that her condition dictates immediate transport to the hospital and that delaying transport could result in death.

C. ask her to sign a refusal of EMS transport form, have a neighbor sit with her until her husband gets home, and then return to service.

D. tell her that her condition is critical and that you are legally required to transport her to the closest appropriate medical facility.

B. advise her that her condition dictates immediate transport to the hospital and that delaying transport could result in death.

4

Why are children more prone to croup when they acquire a viral infection that adults are when infected with the same virus?

a. Adults were vaccinated against the virus that causes croup, and children have not been.

b. The virus that causes croup replicates far more aggressively in children that it does in adults.

c. A child's airway is narrower than an adults and even minor swelling can result in obstruction.

d. children's immune systems are not as developed as adults, so they are more prone to infection

c. A child's airway is narrower than an adults and even minor swelling can result in obstruction.

5

The _________ cartilage forms a complete ring and maintains the trachea in an open position.

A. thyroid

B. arytenoid

C. cricoid

D. laryngeal

C. cricoid

6

Regulatory functions of blood include:

A. carrying antibodies that protect against foreign organisms.

B. transporting oxygen from the lungs to the tissues.

C. carrying nutrients throughout the body.

D. transporting hormones to their target organs

D. transporting hormones to their target organs

7

Anemia would result from all of the following conditions, EXCEPT:

A. an increase in iron.

B. erythrocyte hemolysis.

C. chronic hemorrhage.

D. acute blood loss.

A. an increase in iron.

8

A 23-year-old woman with sickle cell disease presents with severe joint pain and a fever of 102.5°F. She is conscious and alert, and tells you that her symptoms began yesterday and suddenly worsened today. Her blood pressure is 118/76 mm Hg, pulse rate is 120 beats/min and regular, and respirations are 24 breaths/min with adequate depth. After applying high-flow oxygen and initiating transport, you should:

A. obtain a 12-lead ECG tracing, start a large-bore IV line, administer a 20-mL/kg normal saline bolus, and reassess her blood pressure.

B. establish vascular access, administer 2 to 5 mg of midazolam, monitor her cardiac rhythm, and notify the receiving facility as soon as possible.

C. ensure that she is in a comfortable position, cover her with a blanket, start an IV line at a keep-vein-open rate, and monitor her throughout transport.

D. monitor her oxygen saturation and cardiac rhythm, start an IV line with normal saline, administer 1 μg/kg of fentanyl, and reassess her vital signs.

D. monitor her oxygen saturation and cardiac rhythm, start an IV line with normal saline, administer 1 μg/kg of fentanyl, and reassess her vital signs.

9

The barrel-chest appearance classically seen in emphysemic patients is secondary to:

A. air trapping in the lungs.

B. widespread atelectasis.

C. carbon dioxide retention.

D. chest wall hypertrophy.

A. air trapping in the lungs.

10

Most of the blood's formed elements are:

A. leukocytes.

B. platelets.

C. erythrocytes.

D. electrolytes.

C. erythrocytes.

11

One of the hallmarks of a pulmonary embolism is:

A. the disappearance of radial pulses during inhalation.

B. pleuritic chest pain that occurs after a strong cough.

C. jugular venous distention while in a supine position.

D. cyanosis that does not resolve with oxygen therapy.

D. cyanosis that does not resolve with oxygen therapy.

12

Which of the following statements regarding epiglottitis is correct?

A. Most cases of epiglottitis are progressive in their onset and result in severe swelling of the larynx, trachea, and bronchi.

B. Unlike croup, epiglottitis most commonly occurs in the middle of the night, when the outside temperature is cool.

C. Characteristic signs of epiglottitis include a low-grade fever, a seal-like barking cough, and varying degrees of respiratory distress.

D. Epiglottitis has become relatively rare in children due to vaccinations against the Haemophilus influenzae type b bacterium.

D. Epiglottitis has become relatively rare in children due to vaccinations against the Haemophilus influenzae type b bacterium.

13

Which of the following statements regarding leukemia is correct?

A. Leukemia may cause leukocytosis, a low white blood cell count.

B. Leukemia is the result of abnormal white blood cell development.

C. Most patients with leukemia have a normal white blood cell count.

D. A hallmark of leukemia is an excess production of platelets.

B. Leukemia is the result of abnormal white blood cell development.

14

Common effects of gag reflex stimulation include all of the following, EXCEPT:

A. increased intracranial pressure.

B. tachycardia.

C. vomiting.

D. bradycardia.

B. tachycardia.

15

Approximately one third of the body's platelets:

A. are produced by the liver.

B. circulate in the bloodstream.

C. have a life span of 72 hours.

D. are stored in the spleen.

D. are stored in the spleen.

16

Red blood cell production is stimulated by erythropoietin, which is secreted by the:

A. spleen.

B. bone marrow.

C. liver.

D. kidneys.

D. kidneys.

17

You are transferring a 60-year-old man with COPD from a community hospital to a metropolitan hospital. The patient is mildly dyspneic, but is otherwise stable. He is receiving oxygen via nasal cannula, has an IV line of normal saline in place, and has an ECG applied. When reading his chart, you note that he has polycythemia, a history of a prior stroke, and hypertension. The patient tells you that he feels a fluttering sensation in his chest. You glance at the cardiac monitor and see a narrow complex tachycardia at a rate of 160 beats/min. The patient's blood pressure is 116/70 mm Hg and he remains conscious and alert. You should:

A. carefully auscultate his lung sounds and then administer a 500-mL bolus of normal saline solution.

B. administer 5 mg of midazolam, perform synchronized cardioversion with 50 joules, and reassess his cardiac rhythm.

C. place the patient supine, elevate his legs 6 to 12 inches, and administer 150 mg of amiodarone over 10 minutes.

D. ensure adequate oxygenation and ventilation, administer 6 mg of adenosine, and reassess his cardiac rhythm.

D. ensure adequate oxygenation and ventilation, administer 6 mg of adenosine, and reassess his cardiac rhythm.

18

Digital clubbing is most indicative of:

a. peripheral vascular disease

b. acute hypoxemia

c. chronic hypoxia

d. right heart failure

c. chronic hypoxia

19

The MOST clinically significant finding when questioning a patient with a chronic respiratory disease is:

A. prior intubation for the same problem.

B. a recent emergency department visit.

C. a recent medication regimen change.

D. medication use prior to your arrival.

A. prior intubation for the same problem.

20

Common signs and symptoms of lymphoma include:

A. an increased appetite.

B. night sweats and chills.

C. irritability and a skin rash.

D. weight gain and nausea.

B. night sweats and chills.

21

If the amount of pulmonary surfactant is decreased:

A. diffuse alveolar hyperinflation occurs.

B. alveolar surface tension increases.

C. alveoli are able to expand more easily.

D. pulmonary gas exchange is enhanced

B. alveolar surface tension increases.

22

A patient with thrombocytopenia:

A. is at high risk for a pulmonary embolism.

B. is severely anemic.

C. has blood that clots rapidly.

D. has a decreased platelet count.

D. has a decreased platelet count.

23

A patient who is experiencing an allergic reaction states that his tongue “feels thick” and speaks at a low volume. You should immediately evaluate for:

A. adventitious breath sounds.

B. a gag reflex.

C. hypotension.

D. angioedema.

D. angioedema

24

Patients with type A hemophilia:

A. require infusions of factor IX.

B. bleed due to thrombocytopenia.

C. have a deficiency of factor VIII.

D. have a low platelet count.

C. have a deficiency of factor VIII.

25

Use of a spacer device in conjunction with a metered-dose inhaler:

A. requires the patient to time his or her inhalation to coincide with the discharge of the metered-dose inhaler.

B. collects medication as it is released from the canister, allowing more to be delivered to the lungs and less to be lost to the environment.

C. may be required when assisting a patient who is breathing inadequately, but generally results in less medication delivery to the lungs.

D. is only indicated in children under 6 years of age, who are generally not able to use the inhaler effectively.

B. collects medication as it is released from the canister, allowing more to be delivered to the lungs and less to be lost to the environment.

26

Which of the following is NOT typically associated with leukemia?

A. Absence of fever

B. Bruising from minor trauma

C. Chronic infections

D. Frequent bleeding

A. Absence of fever

27

When present at low levels, oxygen binds easily to hemoglobin molecules, resulting in:

A. small changes in oxygen saturation when small changes in PaO2 occur.

B. small changes in oxygen saturation when large changes in PaO2 occur.

C. large changes in oxygen saturation when large changes in PaO2 occur.

D. large changes in oxygen saturation when small changes in PaO2 occur.

D. large changes in oxygen saturation when small changes in PaO2 occur.

28

During your primary assessment of a patient with a hematologic disorder, your priority should be to:

A. apply a cardiac monitor to detect the presence of lethal cardiac dysrhythmias.

B. note any signs and symptoms that may be immediately life threatening.

C. specifically inquire if the patient complains of dyspnea or chest pressure.

D. perform a rapid head-to-toe exam to look for spontaneous hemorrhage.

B. note any signs and symptoms that may be immediately life threatening.

29

A patient who presents with petechiae is MOST likely:

A. anemic.

B. polycythemic.

C. thrombocytopenic.

D. leukopenic.

C. thrombocytopenic.

30

During the second stage of disseminated intravascular coagulopathy:

A. large quantities of platelets aggregate and cause the blood to clot.

B. decreased clotting factors cause uncontrolled hemorrhage.

C. free thrombin and fibrin deposits increase in the bloodstream.

D. the coagulation and fibrinolytic systems become overwhelmed

B. decreased clotting factors cause uncontrolled hemorrhage.