Test 3 Flashcards by Ernest Just

Wheezing is resolved with medications that:
A) dry up secretions in the lower airway.
B) reduce soft tissue swelling in the larynx.
C) relax the smooth muscle of the bronchioles.
D) cause bronchoconstriction and improved airflow

How well did you know this?

Not at all

Perfectly

Unlike bronchodilator therapy, corticosteroid therapy:
A) causes immediate improvement in breathing.
B) takes a few hours to reduce bronchial edema.
C) is administered exclusively in a hospital setting.
D) is the primary treatment for acute bronchospasm.

How well did you know this?

Not at all

Perfectly

A 76-year-old woman with emphysema presents with respiratory distress that has worsened progressively over the past 2 days. She is breathing through pursed lips and has a prolonged expiratory phase and an oxygen saturation of 76%. She is on home oxygen at 2 L/min. Your initial action should be to:
A) increase her oxygen flow rate to 6 L/min.
B) administer a beta-2 agonist via nebulizer.
C) place her in a position that facilitates breathing.
D) auscultate her lungs for adventitious breath sounds.

How well did you know this?

Not at all

Perfectly

You are transporting a patient with a long history of emphysema. The patient called 9-1-1 because his shortness of breath has worsened progressively over the past few days. He is on high-flow oxygen via nonrebreathing mask and has an IV of normal saline in place. The cardiac monitor shows sinus tachycardia and the pulse oximeter reads 89%. When you reassess the patient, you note that his respiratory rate and depth have decreased. You should:
A) remove the nonrebreathing mask and apply a nasal cannula.
B) administer a sedative and a paralytic and then intubate his trachea.
C) begin assisting his ventilations with a bag-mask and 100% oxygen.
D) insert a nasal airway, apply a CPAP unit, and notify medical control.

How well did you know this?

Not at all

Perfectly

Emphysema is caused by:
A) an abundance of pulmonary surfactant.
B) chronic destruction of the alveolar walls.
C) excessive mucus production in the bronchi.
D) progressive weakening of the lung parenchyma.

How well did you know this?

Not at all

Perfectly

Know dose(s) of albuterol

5 mg nebulized

2.5 mg when mixed with Atrovent

How well did you know this?

Not at all

Perfectly

Cor pulmonale is defined as:
A) increased preload caused by severe hypertension.
B) left heart failure secondary to mitral valve damage.
C) rupture of the alveoli due to increased surface tension.
D) right heart failure secondary to chronic lung disease.

How well did you know this?

Not at all

Perfectly

You are transporting a middle-aged man on a CPAP unit for severe pulmonary edema. An IV line of normal saline is in place. Prior to applying the CPAP device, the patient was tachypneic and had an oxygen saturation of 90%. When you reassess him, you note that his respirations have increased and his oxygen saturation has dropped to 84%. You should:
A) continue the CPAP treatment and administer a diuretic to remove fluids from his lungs quickly.
B) remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him.
C) suspect that he has developed a pneumothorax and prepare to perform a needle chest decompression.
D) decrease the amount of positive-end expiratory pressure that you are delivering and reassess.

How well did you know this?

Not at all

Perfectly

What function do the nasal turbinates serve?
A) Separating the left and right nostrils
B) Warming and humidifying inhaled air
C) Decreasing the surface area of the nasopharynx
D) Secreting mucus that traps viruses and bacteria

How well did you know this?

Not at all

Perfectly

COPD is characterized by:
A) narrowing of the smaller airways that is often reversible with prompt treatment.
B) changes in pulmonary structure and function that are progressive and irreversible.
C) small airway spasms during the inhalation phase, resulting in progressive hypoxia.
D) widespread alveolar collapse due to increased pressure during the exhalation phase.

How well did you know this?

Not at all

Perfectly

You respond to the residence of an elderly man with severe COPD. You recognize the address because you have responded there numerous times in the recent past. You find the patient, who is clearly emaciated, seated in his recliner. He is on oxygen via nasal cannula, is semiconscious, and is breathing inadequately. The patient’s daughter tells you that her father has an out-of-hospital DNR order, for which she is frantically looking. You should:
A) apply a nonrebreathing mask, assess his oxygen saturation level, and prepare for immediate transport.
B) provide aggressive airway management unless the daughter can produce a valid DNR order.
C) intubate him at once, begin transport, and advise the daughter to notify the hospital when she finds the DNR order.
D) recognize that he is experiencing end-stage COPD, begin assisting his ventilations, and contact medical control as needed.

How well did you know this?

Not at all

Perfectly

Bedridden patients with excessive pulmonary secretions are MOST prone to developing:
A)  pneumonia.
B)  bronchospasm.
C)  a pneumothorax.
D)  a pulmonary embolism.

How well did you know this?

Not at all

Perfectly

A patient with orthopnea:
A) seeks a sitting position when short of breath.
B) is awakened from sleep with severe dyspnea.
C) prefers to lie flat in order to facilitate breathing.
D) generally has a slow, shallow respiratory pattern.

How well did you know this?

Not at all

Perfectly

Which of the following medications is a parasympathetic bronchodilator?
A)  Alupent
B)  Albuterol
C)  Bronkosol
D)  Ipratropium

How well did you know this?

Not at all

Perfectly

Abnormal breath sounds associated with pneumonia and congestive heart failure are MOST often heard in the:
A)  right middle lobe.
B)  bases of the lungs.
C)  apices of the lungs.
D)  midaxillary line.

How well did you know this?

Not at all

Perfectly

Patients with pneumonia often experience a coughing fit when they roll from one side to the other because:
A) movement loosens pulmonary secretions and stimulates coughing.
B) most cases of pneumonia occur in conjunction with bronchospasm.
C) the secretions in their lungs suddenly disperse and impair breathing.
D) pneumonia often occurs in the lung bases, typically on only one side.

How well did you know this?

Not at all

Perfectly

A 29-year-old woman is experiencing a severe asthma attack. Her husband reports that she was admitted to an intensive care unit about 6 months ago, and had a breathing tube in place. Prior to your arrival, the patient took 3 puffs of her rescue inhaler without effect. She is anxious and restless, is tachypneic, and has audible wheezing. You should:
A) apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital.
B) begin assisting her ventilations with a bag-mask device and 100% oxygen and prepare to intubate her trachea.
C) start an IV of normal saline, administer methylprednisolone via IV push, and transport as soon as possible.
D) attempt to slow her breathing with respiratory coaching, administer a nebulized bronchodilator, and transport.

How well did you know this?

Not at all

Perfectly

A 36-year-old man with a history of asthma presents with severe respiratory distress. You attempt to administer a nebulized beta-2 agonist, but his poor respiratory effort is inhibiting effective drug delivery via the nebulizer and his mental status is deteriorating. You should:
A) assist his ventilations and establish vascular access.
B) start an IV of normal saline and administer a steroid.
C) apply high-flow oxygen via a nonrebreathing mask.
D) assist him with a metered-dose inhaler bronchodilator.

How well did you know this?

Not at all

Perfectly

Review Solumedrol and its effects

Classification: 
Glucocorticoid 
Description
Naturally occurring steroid that suppresses acute and chronic inflammation. 
Potentiates vascular smooth muscle relaxation by beta adrenergic agonists, and may alter air-
way hyperactivity. 
Indications 
Anaphylaxis /  Allergic states
Inhalation of Hot Smoke and Gases
Bronchodilator
unresponsive asthma COPD
Shock /  (controversial)
Acute spinal cord injury / (controversial
Onset
1
-
2 hours
Contraindications 
Use with caution in patients with GI bleeding
Adverse Reactions
Few short term
Headache 
Hypertension 
Sodium and water retention
Dose
125 mg IV 
Spinal Cord injury
initial dose is 30 mg/kg IV bolus followed by an infusion of 5.4 mg/kg/hr for 23 hours

How well did you know this?

Not at all

Perfectly

Retractions of the sternum or ribs during inhalation:
A) are common in patients with emphysema.
B) are signs of acute respiratory failure in adults.
C) occur when soft tissue is pulled in around the bones.
D) are especially common in infants and small children.

How well did you know this?

Not at all

Perfectly

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) cyanosis that does not resolve with oxygen therapy.
D) jugular venous distention while in a supine position

How well did you know this?

Not at all

Perfectly

You are dispatched to a residence for a young woman with difficulty breathing. When you arrive, you find the patient sitting in a tripod position, noticeably dyspneic and tachypneic. She tells you that she experienced a sudden sharp pain to the left side of her chest and then started having trouble breathing. She denies any past medical history and states that she only takes birth control pills. Based on this patient's clinical presentation, you should be MOST suspicious for:
A)  a pleural effusion.
B)  spontaneous pneumothorax.
C)  acute pulmonary embolism
D)  hyperventilation syndrome.

How well did you know this?

Not at all

Perfectly

The presence of diffuse rhonchi (low-pitched crackles) in the lungs indicates:
A) right-sided congestive heart failure.
B) isolated consolidation of secretions.
C) thick secretions in the large airways.
D) air being forced through narrowed airways.

How well did you know this?

Not at all

Perfectly

\_\_\_\_\_\_\_\_\_\_\_ respirations are characterized by a grossly irregular pattern of breathing that may be accompanied by lengthy periods of apnea.
A)  Biot
B)  Agonal
C)  Eupneic
D)  Cheyne-Stokes

How well did you know this?

Not at all

Perfectly

``` An unresponsive patient who overdosed on a central nervous system depressant drug would be expected to have __________ respirations. A) eupneic B) hyperpneic C) bradypneic D) Kussmaul ```

A known heroin abuser is found unconscious on a park bench. Your assessment reveals that his respirations are slow and shallow, and his pulse is slow and weak. You should: A) suction his oropharynx, perform intubation, and then administer naloxone via slow IV push. B) preoxygenate him with a bag-mask device for 2 to 3 minutes and then intubate his trachea. C) apply oxygen via nonrebreathing mask, administer naloxone, and be prepared to assist ventilations. D) assist ventilations with a bag-mask device, administer naloxone, and reassess his ventilatory status.

``` The barrel-chest appearance classically seen in emphysemic patients is secondary to: A) widespread atelectasis. B) chest wall hypertrophy. C) air trapping in the lungs. D) carbon dioxide retention. ```

``` Which of the following clinical findings is MOST suggestive of pneumonia in a patient with COPD? A) Nonproductive cough B) White sputum and rales C) Fever and localized crackles D) Dyspnea and diffuse wheezing ```

``` In a person who is not bedridden, most pulmonary infections occur in the: A) middle lobes of the lungs. B) bases of the lungs. C) apices of the lungs. D) upper portion of the lungs. ```

``` Hypoventilating patients: A) eliminate too much carbon dioxide. B) become hypercapneic and acidotic. C) experience an increase in blood pH. D) typically do not have an open airway. ```

``` Respiratory alkalosis is the result of: A) carbon dioxide retention. B) slow and shallow respirations. C) increased hydrogen ion production. D) excess carbon dioxide elimination. ```

When auscultating the lungs of a patient with early pulmonary edema, you will MOST likely hear: A) inspiratory rhonchi to the bilateral apices of the lungs. B) crackles in the bases of the lungs at the end of inspiration. C) faint rhonchi to all lung fields on inspiration and expiration. D) coarse crackles to the bases of the lungs during inspiration.

``` The most obvious external landmark of the larynx is the: A) cricoid cartilage. B) hyoid bone. C) arytenoid cartilage. D) thyroid cartilage. ```

``` Stretch receptors in the lungs are responsible for the ____________ reflex, which causes you to cough if you take too deep a breath. A) Cushing B) Hering-Breuer C) pneumotaxic D) yawning ```

With regard to pulse oximetry, the more hypoxic a patient becomes: A) the slower his or her PaO2 will fall. B) the faster he or she will desaturate. C) the slower he or she will desaturate. D) the less reliable the pulse oximeter is.

Reactive airway disease is characterized by: A) bronchospasm, edema, and mucus production. B) chronic bronchoconstriction of varying severity. C) acute, reversible swelling of the laryngeal muscles. D) excessive mucus production and a chronic cough.

The hypoxic drive is a phenomenon in which: A) a chronically hypoxic patient's primary respiratory drive is stimulated by increased levels of carbon dioxide in the arterial blood. B) a relatively large percentage of patients with COPD become acutely apneic after receiving high-flow oxygen. C) high levels of oxygen rapidly depress a COPD patient's respiratory rate and depth, leading to worsened hypoxia and severe acidosis. D) bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance.

• What patients should not receive diuretics

Do not give diuretics to patients with pneumonia or to those who are already dehydrated; reserve them for pts who clearly have pulmonary edema

Condition with reversible narrowing of the airways

asthma

clinches jaws also known as

tristas

flank bruising indicates retroperitoneal hemorrhage

grey turner sign

persons ability to perform coordinated functions

ataxia

wave like muscular contraction moves food inferiorly toward the stomach

peristalsis

starting flowing rate when administering cpap

5cm H20

reabsorption of water and sodium occur in the kidneys

Loop of henley

term of right sided heart failure due to COPD

corpulmonale

term used for large amounts of uring output

polyurea

during this period of neurologic distress you will notice patient has an arched back and becomes rigid?

hypertonic

what is the dose of nalbuphine?

10 mg

medical term for weakness on one side of body

hemiperisis

structure and functional units that form urine

nephril

name of the stretch receptors in the lungs

Herring Brewer

dialysis blood through a machine

hemodialysis

most of the digestion happens here

small intestine

pain thats hard to locate and radiates

visceral

``` You would MOST likely observe a grossly low respiratory rate and volume in a patient who overdosed on: A) LSD. B) ibuprofen. C) Prozac. D) heroin. ```

You respond to the residence of an elderly man with severe COPD. You recognize the address because you have responded there numerous times in the recent past. You find the patient, who is clearly emaciated, seated in his recliner. He is on oxygen via nasal cannula, is semiconscious, and is breathing inadequately. The patient's daughter tells you that her father has an out-of-hospital DNR order, for which she is frantically looking. You should: A) apply a nonrebreathing mask, assess his oxygen saturation level, and prepare for immediate transport. B) provide aggressive airway management unless the daughter can produce a valid DNR order. C) intubate him at once, begin transport, and advise the daughter to notify the hospital when she finds the DNR order. D) recognize that he is experiencing end-stage COPD, begin assisting his ventilations, and contact medical control as needed.

``` An idiopathic seizure is one in which: A) the cause is not known. B) the entire brain is affected. C) a part of the brain is affected. D) a postictal phase is not present. ```

You are dispatched to a residence for a middle-aged woman with generalized weakness of approximately 18 hours' duration. Your primary assessment reveals right-sided hemiparesis, a left-sided facial droop, and bilaterally equal and reactive pupils. Further assessment reveals that her blood glucose level is 70 mg/dL. En route to the hospital, you note increased movement of her right arm. She is receiving oxygen via nasal cannula and has a patent IV line in place. Which of the following statements regarding this scenario is correct? A) You should administer nitroglycerin or labetalol if her systolic blood pressure is greater than 150 mm Hg. B) The patient will likely receive fibrinolytic therapy in the emergency department if no contraindications exist. C) Although the patient is likely experiencing a TIA, you should treat her as though she is experiencing a stroke. D) The patient's signs and symptoms are likely the result of her blood sugar and will resolve with dextrose.

``` Prehospital treatment for a patient with a suspected stroke may include all of the following, EXCEPT: A) 30° elevation of the head. B) diazepam or lorazepam. C) up to 325 mg of aspirin. D) crystalloid fluid boluses. ```

A 39-year-old woman presents with signs and symptoms of an acute hemorrhagic stroke. She is responsive to deep painful stimuli only and has bilaterally dilated and sluggishly reactive pupils. Her respirations are slow and irregular, blood pressure is 80/50 mm Hg, and pulse is 40 and bounding. Initial treatment for this patient involves: A) positive-pressure ventilatory support. B) rapid infusion of a crystalloid solution. C) high-flow oxygen via nonrebreathing mask. D) immediate transcutaneous cardiac pacing.

Decerebrate posturing: A) is characterized by abnormal flexion of the arms and extension of the lower extremities. B) is considered less severe than decorticate posturing, because it indicates that the brainstem is intact. C) is an early clinical finding, because it occurs with minimal increases in intracranial pressure. D) is a more severe finding than decorticate posturing, as it indicates damage in or near the brainstem.

``` A rhythmic contraction and relaxation of muscle groups that is commonly observed during a seizure is called __________ activity. A) tonic B) clonic C) hypertonic D) myoclonic ```

``` During a generalized tonic/clonic seizure, the patient is rigid and his back is arched. This represents the _________ phase of the seizure. A) tonic B) clonic C) hypertonic D) postictal ```

When performing the arm drift test on a patient with a suspected stroke, a positive finding is characterized by: A) one arm drifting downward and turning away from the body when the patient's eyes are closed. B) one arm drifting downward and turning toward the body when the patient's eyes are closed. C) one arm drifting downward and turning away from the body when the patient's eyes are open. D) both arms moving downward more than 3 inches in 30 seconds when the patient's eyes are open.

An elderly man presents with slurred speech, confusion, and unilateral facial asymmetry. When asked to squeeze your hands, the strength in his left hand is markedly less than the strength in his right hand. The patient's wife tells you that her husband has type 2 diabetes and hypertension. On the basis of your clinical findings, you should: A) consider him a candidate for fibrinolytic therapy if his symptoms began less than 12 hours ago. B) rule out hypoglycemia by assessing his blood sugar, but suspect a right-sided ischemic stroke. C) start an IV and administer crystalloid fluid boluses if his systolic blood pressure is less than 110 mm Hg. D) suspect that he is experiencing a hemorrhagic stroke, begin immediate transport, and start an IV en route.

``` The MOST immediate and significant complication associated with a hemorrhagic stroke is: A) acute hypovolemic shock. B) hypertension and bradycardia. C) mean arterial pressure increase. D) increased intracranial pressure. ```

A patient with a unilateral eyelid droop when smiling: A) has a condition called miosis. B) may be experiencing Bell palsy. C) likely has an intracerebral hemorrhage. D) is experiencing transient cerebral ischemia.

A high level of oxygen to the brain of a patient with a hemorrhagic stroke and increased intracranial pressure: A) dilates the blood vessels and can cause brain herniation. B) lowers intracranial pressure and oxygenates the brain. C) increases intracranial pressure, but oxygenates the brain. D) causes vasoconstriction and can impair brain perfusion.

A 59-year-old woman presents with acute onset of confusion, left-sided hemiparesis, and a right-sided facial droop. Her airway is patent and she is breathing adequately. Her blood pressure is 150/100 mm Hg and her pulse is 70 beats/min. The cardiac monitor displays atrial fibrillation with a variable rate of 60 to 90 beats/min. When obtaining the patient's medical history from her husband, the MOST important question to ask him is: A) “Does your wife have a history of diabetes?” B) “Is your wife allergic to aspirin or contrast dye?” C) “When did your wife last see her physician?” D) “When did you first notice your wife's symptoms?”

``` A loss of balance and equilibrium suggests injury to the: A) midbrain. B) cerebrum. C) thalamus. D) cerebellum. ```

``` Chemicals that relay electrically conducted signals from one neuron to another are called: A) hormones. B) endorphins. C) catecholamines. D) neurotransmitters. ```

Know dose of Valium and Versed

``` 5 mg over 2 min IV every 10 – 15 min prn. Premedication for Cardioversion or TCP 5 to 15 mg IV, 5 - 10 minutes prior to procedure ```

``` __________ is a term used to describe changes in a person's ability to perform coordinated motions, such as walking. A) Ataxia B) Myoclonus C) Bradykinesia D) Decussation ```

Hyperventilating a patient who has increased intracranial pressure (ICP) will: A) dilate the cerebral vasculature and cause further increases in ICP. B) constrict the cerebral vasculature and decrease cerebral perfusion. C) increase the carbon dioxide levels in the brain through vasodilation. D) decrease ICP and maintain adequate cerebral perfusion.

``` A 33-year-old woman had an apparent syncopal episode. According to her husband, she complained of dizziness shortly before the episode. He further states that he caught her before she fell to the ground. Upon your arrival, the patient is conscious but confused and is sitting in a chair. Her blood pressure is 90/60 mm Hg, pulse rate is 110 beats/min and weak, and respirations are 22 breaths/min and regular. Her blood glucose level is 74 mg/dL. The MOST likely cause of her syncopal episode is: A) a seizure. B) dehydration. C) a vasovagal response. D) acute hypoglycemia. ```

Because the facial nerve does not decussate, a stroke to the right cerebral hemisphere would MOST likely cause: A) left-sided weakness and a left-sided facial droop. B) left-sided weakness and a right-sided facial droop. C) right-sided weakness and a left-sided facial droop. D) right-sided weakness and a right-sided facial droop

``` The _______, also called the eyeball, is a spherical structure measuring about 1 inch in diameter. A) iris B) globe C) retina D) cornea ```

``` The anterior chamber is the portion of the globe between the _____ and the _____, and is filled with _____ humor. A) iris, lens, vitreous B) cornea, iris, aqueous C) lens, iris, vitreous D) lens, cornea, aqueous ```

Which of the following statements regarding vitreous humor is correct? A) Vitreous humor can be replenished, but it takes many years. B) Vitreous humor is contained within the posterior chamber of the eye. C) Vitreous humor is a jelly-like substance that maintains the shape of the globe. D) Vitreous humor is a clear fluid that is responsible for tear production.

Which of the following statements regarding vitreous humor is correct? A) Vitreous humor is a jelly-like substance that is replenished if lost. B) Vitreous humor fills the posterior chamber and maintains the shape of the globe. C) Vitreous humor is a clear watery fluid that fills the anterior chamber. D) The most significant risk caused by a loss of vitreous humor is infection.

``` What part of the eye is MOST commonly injured following a thermal burn? A) Globe B) Retina C) Cornea D) Eyelids ```

``` In dark-skinned patients, cyanosis can be detected in the: A) sclera. B) iris. C) cornea. D) conjunctiva. ```

``` The __________ are cone-shaped fossae that enclose and protect the eyes. A) zygomas B) orbits C) condyles D) crista galli ```

``` In which of the following situations is the Morgan lens NOT appropriate to use? A) Eye burn from a strong alkali B) An object impaled in the eye C) Eye burn from a strong acid D) Any foreign body in the eye ```

``` Common causes of a ruptured tympanic membrane include all of the following, EXCEPT: A) diving injuries. B) otitis externa. C) foreign bodies. D) blast injuries. ```

``` Signs or symptoms of otitis media include: A) hypersensitivity to sound. B) bilateral chronic tinnitus. C) bulging tympanic membrane. D) vertigo and violent vomiting. ```

Signs and symptoms of a ruptured tympanic membrane include: A) permanent deafness and a unilateral headache. B) CSF leakage from the ear and severe tinnitus. C) a low-grade fever and fullness in the ear. D) hearing loss and blood drainage from the ear.

``` Glaucoma is a condition caused by: A) a loss of peripheral vision. B) retinal artery occlusion. C) increased intraocular pressure. D) decreased vitreous humor. ```

``` Alkali or strong acid burns to the eye should be irrigated for at least ____ minutes. A) 10 B) 15 C) 20 D) 30 ```

In contrast to the oculomotor nerve, the optic nerve: A) is the second cranial nerve and provides the sense of vision. B) carries parasympathetic nerve fibers that constrict the pupil. C) is the third cranial nerve and regulates movement of the eyes. D) innervates the muscles that cause motion of the upper eyelids.

The middle ear consists of the: A) cochlea and semicircular canals. B) organ of Corti and the external auditory canal. C) inner portion of the tympanic membrane and the ossicles. D) pinna and the exterior portion of the tympanic membrane.

``` Which of the following is NOT an inner ear structure? A) Cochlea B) Oval window C) Eustachian tube D) Semicircular canal ```

``` Paralysis of cranial nerve ____ can cause unilateral facial and gag reflex paralysis. A) V B) VI C) VII D) X ```

``` Which of the following is a complication associated with dysfunction of cranial nerves VI, VII, IX, and XII? A) Hearing impairment B) Acute ischemic stroke C) Aspiration pneumonia D) Upper airway obstruction ```

``` Which cranial nerve provides taste sensation to the posterior portions of the tongue and carries parasympathetic fibers to the salivary glands? A) Vagus B) Glossopharyngeal C) Hypoglossal D) Vestibulocochlear ```

``` Which cranial nerve innervates the muscles that cause motion of the eyeballs and upper eyelids? A) Optic B) Trigeminal C) Oculomotor D) Hypoglossal ```

``` Peristalsis is defined as: A) the churning of food. B) rhythmic contraction. C) turbulent blood flow. D) passive regurgitation. ```

Bile is stored in the _________ and is released into the __________, where it helps to _______. A) liver, gallbladder, break down fats B) duodenum, gallbladder, digest food C) gallbladder, duodenum, emulsify fats D) liver, gallbladder, metabolize proteins

Which of the following is NOT a function of the liver? A) Storage of bile B) Drug detoxification C) Storage of vitamins and minerals D) Completion of red and white blood cell breakdown

``` Which of the following conditions would be the LEAST likely to result in peritonitis? A) Stomach rupture B) Splenic laceration C) Acute appendicitis D) Bowel perforation ```

``` A protuberant abdomen would MOST likely be encountered in a patient with: A) an abdominal evisceration. B) peritoneal fluid accumulation. C) decreased abdominal volume. D) an acutely inflamed appendix. ```

``` In contrast to somatic pain, visceral pain: A) is well localized. B) indicates peritonitis. C) is difficult to localize. D) increases with movement. ```

``` . Irritation or injury to abdominal tissue, causing activation of peripheral nerve tracts, would MOST likely result in ___________ pain. A) visceral B) somatic C) rebound D) parietal ```

``` A 52-year-old man complains of severe abdominal pain but denies nausea or vomiting. He is conscious and alert, has a blood pressure of 130/70 mm Hg, a heart rate of 120 beats/min and strong, and respirations of 20 breaths/min and regular. In addition to providing supplemental oxygen, you should start an IV line and give: A) ondansetron, 4 mg. B) a 20-mL/kg fluid bolus. C) diphenhydramine, 25 mg. D) nalbuphine, 10 mg. ```

You are caring for a middle-aged man with severe abdominal pain and dark, tarry stools. He is conscious but very restless. His blood pressure is 78/52 mm Hg, pulse rate is 130 beats/min and weak, and respirations are 24 breaths/min and shallow. Further assessment reveals that his skin is cool and clammy and his radial pulses are weakly present. You should: A) apply a nasal cannula in case he vomits, start at least one large-bore IV line, and administer up to 3 liters of normal saline solution. B) administer high-flow oxygen, start two large-bore IV lines, and administer 20-mL/kg normal saline boluses until his radial pulses strengthen. C) apply supplemental oxygen, establish vascular access, and give isotonic crystalloid boluses until his systolic BP is at least 110 mm Hg. D) administer high-flow oxygen, start a large-bore IV line, administer a 20-mL/kg normal saline bolus, and give 1 µg/kg of fentanyl for pain.

A 38-year-old man presents with an acute onset of severe right upper quadrant abdominal pain, pain to his right shoulder, and nausea. He is conscious and alert, but is restless from the pain. His blood pressure is 150/86 mm Hg, pulse rate is 120 beats/min and strong, and respirations are 22 breaths/min and regular. In addition to administering supplemental oxygen, you should: A) start an IV with normal saline and set it to keep the vein open, place him in a position of comfort, and administer 4 mg of morphine and 12.5 mg of promethazine. B) encourage him to remain supine to relieve his pain, monitor his oxygen saturation level, and administer 10 to 20 mg of Nubain via the IM route. C) establish vascular access with a large-bore catheter, administer a 500-mL normal saline bolus, and avoid analgesics due to the potential for intra-abdominal bleeding. D) perform a comprehensive abdominal exam, start at least one large-bore IV line, infuse normal saline at 125 mL/hr, and consider giving him an antiemetic medication.

``` Angiotensin II: A) relaxes smooth muscle. B) decreases sodium reabsorption. C) decreases blood pressure. D) is a potent vasoconstrictor. ```

Furosemide (Lasix) causes diuresis by: A) increasing circulating blood glucose. B) converting angiotensin I to angiotensin II. C) inhibiting sodium reabsorption in the kidneys. D) inhibiting the production of antidiuretic hormone.

The pain associated with a kidney stone MOST often: A) is described by the patient as a dull ache. B) begins as a sharp pain in the right upper quadrant. C) radiates from the umbilicus to the pubic symphysis. D) begins in the flank region and radiates to the groin

Which of the following statements regarding peritoneal dialysis is correct? A) Because of the high risk of peritonitis, peritoneal dialysis can only be performed in a hospital or specialized dialysis center. B) In peritoneal dialysis, large amounts of specially formulated dialysis fluid are infused into the abdominal cavity and left for 1 to 2 hours. C) Peritoneal dialysis involves the surgical placement of an arteriovenous shunt in the vasculature of the abdominal cavity. D) Peritoneal dialysis is the least-preferred method of dialyzing a patient and is only used in extreme emergency situations.

Unlike peritoneal dialysis, hemodialysis: A) is associated with a higher risk of peritonitis. B) filters nitrogenous waste products from the blood. C) involves the circulation of blood through a machine. D) is only used for patients experiencing acute renal failure.

``` Bradycardia and hypotension following an overaggressive dialysis treatment are MOST indicative of: A) hypovolemia. B) hypokalemia. C) hyperkalemia. D) air embolism. ```

``` A 59-year-old woman with chronic renal failure presents with an acute onset of dyspnea while undergoing a hemodialysis treatment. She is conscious but in obvious respiratory distress. Further assessment reveals perioral cyanosis and a blood pressure of 96/56 mm Hg. Based on this patient's medical history and clinical presentation, which of the following interventions is likely NOT indicated? A) IV crystalloid fluid boluses B) Left lateral recumbent position C) Rapid transport to the hospital D) Ventilation assistance as needed ```

``` A patient with prerenal acute renal failure would MOST likely present with: A) confusion and hypertension. B) joint pain and bladder distention. C) hypotension and tachycardia. D) peripheral edema and hematuria. ```

``` A common cause of intrarenal acute renal failure is: A) hypovolemia. B) type 1 diabetes. C) a renal calculus. D) myocardial infarction. ```

Which of the following statements regarding postrenal acute renal failure (ARF) is correct? A) Patients with postrenal ARF typically develop severe hypokalemia. B) Postrenal ARF involves damage to the renal parenchyma or tubules. C) Postrenal ARF typically results in decreased pressure on the nephrons. D) Postrenal ARF is caused by obstruction of urine flow from the kidneys.

``` The skin of a patient with chronic renal failure is MOST often: A) flushed. B) jaundiced. C) cyanotic. D) cool and dry. ```

``` Patients with chronic renal failure may present with uremic frost, especially: A) in the urine. B) during emesis. C) to the flank area. D) around the face. ```

It is important for the paramedic to consult with medical control prior to administering analgesia to a patient with severe flank pain and suspected acute renal failure because: A) patients with renal failure often require high doses of analgesia. B) renal failure may cause analgesics to accumulate to toxic levels. C) most patients who are given analgesia will experience hypotension. D) analgesia will mask the patient's pain and skew further examination