NREMT Practice Test Bank - Multiple Choice Answered with rationales.

NREMT Test Bank - Multiple Choice,2022 Hypoglycemia and acute ischemic stroke can present similarly because: • A:both oxygen and glucose are needed for brain function. • B:the majority of stroke patients have a hi ...

NREMT Test Bank - Multiple Choice,2022 Hypoglycemia and acute ischemic stroke can present similarly because: • A:both oxygen and glucose are needed for brain function. • B:the majority of stroke patients have a history of diabetes. • C:the most common cause of a stroke is hypoglycemia. • D:they are both caused by low levels of glucose in the blood. *correct ANS*- • A:both oxygen and glucose are needed for brain function. Reason: Although stroke and hypoglycemia are two distinctly different conditions, their signs and symptoms are often similar. This is because the brain requires both oxygen and glucose to function normally. An acute ischemic stroke is caused by a lack of oxygen to a part of the brain due to a blocked cerebral artery, whereas hypoglycemia (low blood glucose level) deprives the entire brain of glucose. In either case, the patient presents with signs of impaired brain function (ie, slurred speech, weakness, altered mental status). Both conditions may lead to permanent brain damage or death if not treated promptly. When dealing with an emotionally disturbed patient, you should be MOST concerned with: • A:gathering all of the patient's medications. • B:safely transporting to the hospital. • C:whether the patient could harm you. • D:obtaining a complete medical history. *correct ANS*- You selected C; This is correct! Reason: When managing any patient with an emotional or psychiatric crisis, your primary concern is your own safety. Safely transporting the patient to the hospital is your ultimate goal. If possible, you should attempt to obtain a medical history and should take any of the patient's prescribed medications to the hospital. However, this should not supercede your own safety or interfere with safely transporting the patient. You are at the scene where a man panicked while swimming in a small lake. Your initial attempt to rescue him should include: • A:rowing a small raft to the victim. • B:reaching for the victim with a long stick. • C:throwing a rope to the victim. • D:swimming to the victim to rescue him. *correct ANS*- You selected B; This is correct! Reason: General rules to follow when attempting to rescue a patient from the water include "reach, throw, row, and then go." In this case, you should attempt to reach the victim by having him grab hold of a large stick or similar object. If this is unsuccessful, throw the victim a rope or flotation device (if available). If these are not available, row to the patient in a small raft (if available). Going into the water to retrieve the victim is a last resort. The rescuer must be a strong swimmer because patients who are in danger of drowning are in a state of blind panic and will make every attempt to keep themselves afloat, even if it means forcing the rescuer underwater. How should you classify a patient's nature of illness if he or she has a low blood glucose level, bizarre behavior, and shallow breathing? • A:Behavioral emergency • B:Altered mental status • C:Respiratory emergency • D:Cardiac compromise *correct ANS*- The correct answer is B; Reason: The nature of illness (NOI) is the medical equivalent to mechanism of injury (MOI). Altered mental status should be the suspected NOI in any patient with any fluctuation in level of consciousness, which can range from bizarre behavior to complete unresponsiveness. Causes of an altered mental status include hypo- or hyperglycemia, head trauma, stroke, behavioral crises, drug overdose, and shock, among others. A young female is unresponsive after overdosing on an unknown type of drug. Her respirations are slow and shallow and her pulse is slow and weak. Which of the following drugs is the LEAST likely cause of her condition? • A:Seconal • B:Heroin • C:Cocaine • D:Valium *correct ANS*- The correct answer is C; Reason: Of the drugs listed, cocaine would be the least likely cause of the patient's condition. Cocaine is a central nervous system (CNS) stimulant; you would expect her to be hypertensive, tachycardic, tachypneic, and perhaps even violent. Heroin, Valium, and Seconal are all CNS depressants and could explain her condition. Heroin is an illegal narcotic (opiate), Valium is a benzodiazepine sedative-hypnotic drug, and Seconal is a barbiturate. Narcotics, benzodiazepines, and barbiturates are all CNS depressants. When taken in excess, they cause a decreased level of consciousness, respiratory depression, bradycardia, and hypotension. Activated charcoal is contraindicated for a patient who is: • A:conscious and alert and has ingested a large amount of Motrin. • B:emotionally upset and has ingested two bottles of aspirin. • C:agitated and claims to have ingested a bottle of Tylenol. • D:awake and alert and has swallowed a commercial drain cleaner. *correct ANS*- You selected D; This is correct! Reason:Activated charcoal adsorbs (sticks to) many ingested substances, preventing them from being absorbed into the body by the stomach or intestines. In some cases, you may give activated charcoal to patients who have ingested certain substances, if approved by medical control or local protocol. Activated charcoal is contraindicated for patients who have ingested an acid or alkali (ie, drain cleaner) or a petroleum product (ie, gasoline), who have a decreased level of consciousness and cannot protect their own airway, or who are unable to swallow. The MOST obvious way to reduce heat loss from radiation and convection is to: • A:move away from a cold object. • B:increase metabolism by shivering. • C:wear a thick wind-proof jacket. • D:move to a warmer environment. *correct ANS*- you selected D; This is correct! Reason:In a cold environment, the body has two ways of staying warm: generating heat (thermogenesis) and reducing heat loss. Radiation is the transfer of heat by radiant energy. The body can lose heat by radiation, such as when a person stands in a cold room. Convection occurs when heat is transferred to circulating air, as when cool air moves across the body's surface. A person standing in windy cold weather, wearing lightweight clothing, is losing heat to the environment mostly by convection. The quickest and most obvious way to decrease heat loss from radiation and convection is to move out of the cold environment and seek shelter from wind. Shivering increases the body's metabolism and is a mechanism for generating heat, not reducing heat loss. Layers of clothing trap air and provide excellent insulation; thus, layered clothing decreases heat loss better than a single, thick jacket. Conduction is the direct transfer of heat from a part of the body to a colder object by direct contact, as when a warm hand touches cold metal or ice. The most obvious way to decrease heat loss by conduction is to remove your hand from the cold object. A near-drowning is MOST accurately defined as: • A:complications within 24 hours following submersion in water. • B:immediate death due to prolonged submersion in water. • C:survival for at least 24 hours following submersion in water. • D:death greater than 24 hours following submersion in water. *correct ANS*- You selected C; This is correct! Reason:Collectively, drowning and near-drowning are referred to as submersion injuries. Drowning is defined as death after submersion in a liquid medium, usually water. In a drowning, death is either immediate or occurs within 24 hours following submersion. Near-drowning is defined as survival, at least temporarily (24 hours), after submersion. It should be noted, however, that complications such as pneumonia and pulmonary edema can cause death greater than 24 hours following submersion. For this reason, all patients with a submersion injury should be transported to the hospital, even if they appear fine at the scene. A young woman reports significant weight loss over the last month, persistent fever, and night sweats. When you assess her, you note the presence of dark purple lesions covering her trunk and upper extremities. You should suspect: • A:end-stage cancer. • B:HIV/AIDS. • C:tuberculosis. • D:rheumatic fever. *correct ANS*- You selected B; This is correct! Reason:Weight loss, fever, and night sweats could indicate tuberculosis or HIV/AIDS; however, the dark purple lesions on the skin, which are called Kaposi's sarcoma, are malignant skin tumors and are a classic finding in patients in the later stages of AIDS. A 48-year-old male became acutely hypoxic, experienced a seizure, and is now postictal. The MOST effective way to prevent another seizure is to: • A:dim the lights in the back of the ambulance. • B:place him in the recovery position. • C:administer high-flow supplemental oxygen. • D:give him oral glucose if he can swallow. *correct ANS*- You selected C; This is correct! Reason:You should administer high-flow oxygen to all patients who are actively seizing and to patients who experienced a seizure and are postictal. This is especially true if the seizure was caused by hypoxia. Increasing the oxygen content of the blood, which minimizes hypoxia, may prevent another seizure. The recovery position is appropriate for uninjured patients with a decreased level of consciousness and adequate breathing; it will help maintain the airway and facilitate drainage of secretions from the mouth, but will not prevent another seizure. Oral glucose may prevent another seizure if hypoglycemia was the cause of the seizure. You should dim the lights in the back of the ambulance to help prevent any seizure, not just those that are caused by hypoxia. Which of the following conditions would be the LEAST likely to be present in a patient who was submerged in water? • A:Spinal injury • B:Gastric distention • C:Hyperglycemia • D:Laryngospasm *correct ANS*- You selected C; This is correct! Reason: Many factors can contribute to or result from a submersion injury (eg, drowning, near-drowning). It is not uncommon for a person to experience a spinal injury after diving head first into shallow water, especially if he or she is under the influence of alcohol. When a swimmer panics, he or she initially swallows large amounts of water, resulting in gastric distention. Gastric distention can cause aspiration if the patient regurgitates water during rescue breathing; protect the airway! During the panic phase, the victim expends a tremendous amount of energy (and glucose) from flailing around in the water, possibly resulting in hypoglycemia. Inhaling even a small amount of fresh or salt water can severely irritate the larynx, which sends the muscles of the larynx and vocal cords into spasm (laryngospasm), resulting in airway blockage and hypoxia. A 42-year-old male presents with fever, a severe headache, and a stiff neck. He is conscious, but confused. His wife tells you that he does not have any medical problems and does not take any medications. You should be MOST suspicious for: • A:acute stroke. • B:influenza. • C:meningitis. • D:tuberculosis. ( *correct ANS*- You selected C; This is correct! Reason:Meningitis is an inflammation of the protective coverings of the brain and spinal cord (meninges). Common signs and symptoms of meningitis include fever, headache, neck stiffness (nuchal rigidity), and vomiting. An altered mental status is common in severe cases. Meningococcal meningitis, caused by a bacterium, is the most contagious and potentially fatal type of meningitis. The patient's signs and symptoms are not consistent with acute stroke, tuberculosis (TB), or influenza (the flu). Although fever is common with both TB and the flu, neither causes neck stiffness. Acute stroke may be associated with a headache, especially a hemorrhagic stroke; however, stroke patients typically do not have a fever. All of the following are signs of gastrointestinal bleeding, EXCEPT: • A:melena. • B:hematemesis. • C:tachycardia. • D:hemoptysis. *correct ANS*- You selected D; This is correct! Reason:Signs and symptoms of gastrointestinal (GI) bleeding include abdominal pain; vomiting blood (hematemesis); the passage of dark, tarry stools (melena); and bright red rectal bleeding (hematochezia). If blood loss is significant, the patient may have signs of shock (eg, tachycardia, diaphoresis, tachypnea, hypotension). Hemoptysis (coughing up blood) is a sign of a pulmonary injury, not GI bleeding. A 24-year-old female presents with a rash to her left leg and swollen, painful knee joints. She tells you that she and her friends returned from a hiking trip in the mountains a week ago. She is conscious and alert with a blood pressure of 112/62 mm Hg, a pulse of 84 beats/min, and respirations of 14 breaths/min. Her symptoms are MOST likely the result of: • A:Rocky Mountain spotted fever. • B:tetanus. • C:Lyme disease. • D:a localized allergic reaction. *correct ANS*- You selected C; This is correct! Reason:The patient's symptoms and her history of a recent hiking trip are consistent with Lyme disease, which was the result of a tick bite. Ticks can carry two infectious diseases: Lyme disease and Rocky Mountain spotted fever. Both are spread through the tick's saliva, which is injected into the skin when the tick attaches itself. The first symptom of Lyme disease, a rash that may spread to several parts of the body, begins about 3 days after the bite of an infected tick. The rash may eventually resemble a target bull's-eye pattern in one third of patients. After a few more days or weeks, painful swelling of the joints, particularly the knees, occurs. If recognized and treated promptly with antibiotics, many patients recover completely. Rocky Mountain spotted fever, which is not limited to the Rocky Mountains, occurs within 7 to 10 days after being bitten by an infected tick. Its symptoms include nausea, vomiting, headache, weakness, paralysis, and possibly cardiopulmonary failure. A 50-year-old woman who is conscious and alert complains of a severe migraine headache. When caring for her, you should generally avoid: • A:transporting her in a supine position. • B:shining a light into her pupils. • C:dimming the lights in the ambulance. • D:applying ice packs to her forehead. *correct ANS*- You selected B; This is correct! Reason:Patients with migraine or cluster headaches typically have photophobia (light sensitivity). Any type of bright light, especially if shone directly into the eyes, will cause the patient with a headache unnecessary severe pain. Dimming the lights in the ambulance and making the patient as comfortable as possible are the treatments of choice for a patient with a headache. Some patients benefit from ice packs applied to the forehead; just be sure to wrap the ice pack with roller gauze. Oxygen also should be administered as needed. Typically, the patient will prefer to lie supine or on the side A patient who overdosed on heroin would be expected to present with: • A:tachycardia. • B:hyperpnea. • C:hypotension. • D:dilated pupils. *correct ANS*- The correct answer is C; Reason:Heroin is a Schedule I (illegal) narcotic that is typically injected. As with all narcotics, legal or illegal, overdose causes depression of the central nervous system (CNS), resulting in a decreased level of consciousness; bradycardia; hypotension; and slow, shallow (reduced tidal volume) breathing. Hyperpnea (deep breathing) would not be present in a patient who overdosed on a narcotic. In a narcotic overdose, the pupils are typically constricted (miosis). Barbiturates, such as phenobarbital, are also CNS depressants and cause the same symptoms seen with narcotic overdose. The patient's pupils, however, are typically dilated (mydriasis), not constricted. When caring for any patient with a decreased level of consciousness, your primary concern should be the: • A:potential for airway compromise. • B:patient's blood glucose level. • C:possibility of a spinal injury. • D:possibility of a drug overdose. *correct ANS*- You selected A; This is correct! Reason:Altered mental status could be caused by a high or low blood glucose level, drug overdose, or head injury, among other causes. Furthermore, the possibility of a spinal injury should be considered if the patient was injured. However, your primary concern should be the status of the patient's airway. Patients with a decreased level of consciousness are at risk for aspiration if vomiting occurs. Unless spinal trauma is present or the patient is breathing inadequately (eg, fast or slow rate, shallow breathing [reduced tidal volume]), place him or her in the recovery position to facilitate drainage if vomiting occurs. Remember this: no airway, no patient! A 16-year-old, 125-pound male ingested a bottle of aspirin approximately 20 minutes ago. Medical control orders you to administer activated charcoal in a dose of 1 g/kg. How much activated charcoal should you administer? • A:54 g • B:60 g • C:51 g • D:57 g *correct ANS*- You selected D; This is correct! Reason: First, you must determine the patient's weight in kilograms (kg). Either of the following formulae can be used to convert pounds to kilograms: Formula 1: weight (in pounds) ÷ 2.2 = weight in kg. Formula 2: weight (in pounds) ÷ 2 - 10% = weight in kg. On the basis of the above formulae, a 125-pound patient weighs 57 kg. Using formula 1, the equation is as follows: 125 (weight in pounds) ÷ 2.2 = 56.81 (57 [rounded to the nearest tenth]). Using formula 2, the equation is as follows: 125 (weight in pounds) ÷ 2 = 62.5 (63 [rounded to the nearest tenth] - 6.3 (10% of 63) = 56.7 (57 [rounded to the nearest tenth]). Since the drug order is for 1 g/kg, you should administer 57 g of activated charcoal to your 125-pound patient. Which of the following is the MOST significant finding in a patient with a severe headache? • A:Pain in both legs • B:Chest discomfort • C:Unilateral weakness • D:Abdominal tenderness *correct ANS*- You selected C; This is correct! Reason: Unilateral weakness (weakness on one side of the body) is a clinically significant finding in a patient with a headache because it could indicate a stroke (ischemic or hemorrhagic). Abdominal, chest, and leg pain are not common complaints associated with a headache, although they should be noted and investigated if they are present. When caring for a patient with severe hypothermia who is in cardiac arrest, you should: • A:perform rescue breathing only. • B:perform BLS and transport. • C:avoid using the AED. • D:hyperventilate the patient. *correct ANS*- The correct answer is B; Reason:Patients with severe hypothermia (core body temperature < 86°F) who are in cardiac arrest should be managed with basic life support (chest compressions and ventilations), passive external rewarming (ie, removal of wet clothing, applying warm blankets) and rapid transport to the hospital where they can be actively rewarmed. Because cold muscle is a poor conductor of electricity, defibrillation, if indicated, should be limited to 1 attempt until the patient's body temperature has been increased. Cardiac arrest patients with severe hypothermia generally do not respond to defibrillation. Hyperventilation should be avoided as this may increase intrathoracic pressure and impair blood flow back to the heart. You should not attempt to actively rewarm a patient with moderate or severe hypothermia in the field because: • A:rewarming too quickly can cause a fatal cardiac dysrhythmia. • B:the risk of inadvertently inducing hyperthermia is too high. • C:it is painful for the patient and you cannot give analgesic drugs. • D:active rewarming has been shown to cause severe hypertension. *correct ANS*- You selected A; This is correct! Reason:When caring for a patient with hypothermia, your goal is to prevent further heat loss; this involves removing wet clothing, applying warm blankets, and allowing the patient's body temperature to rise gradually and naturally (passive rewarming). If the patient is moderately or severely hypothermic, you should not try to rewarm him or her actively (placing heat on or into the body). Rewarming too quickly may cause a fatal cardiac dysrhythmia, such as ventricular fibrillation (V-Fib). Active rewarming may also cause rewarming shock, a condition in which the blood vessels dilate when heat is applied to the body, resulting in significant hypotension. For these reasons, active rewarming should only be performed in the controlled setting of a hospital. You respond to a grocery store where a 39-year-old man reportedly experienced a seizure. When you arrive at the scene, a clerk begins to escort you to the patient. She tells you that the man stopped seizing about 5 minutes ago. If the patient truly experienced a seizure, you will MOST likely find that he: • A:has a slow heart rate. • B:is fully conscious and alert. • C:is not breathing and is cyanotic. • D:is confused and disoriented. *correct ANS*- You selected D; This is correct! Reason: Most seizures are followed by a postictal phase, in which the patient is unresponsive at first and then gradually regains consciousness. In most cases, the postictal patient appears dazed, confused, or disoriented; in some cases, he or she is combative. The postictal phase typically lasts from 5 to 30 minutes. During the seizure, the patient is often not breathing or is breathing inadequately; however, when the seizure stops, breathing usually resumes. You will also find that most postictal patients are tachycardic; this is the result of an adrenalin surge that occurs during the tonic-clonic phase of the seizure. You are called to a local park for an ill person. It is a hot day and the humidity is high. When you arrive, a bystander directs you to the patient, a young male who is semiconscious. His skin is flushed, hot, and moist. Your FIRST action in the management of this patient should be to: • A:begin rapid cooling measures. • B:ensure an open airway. • C:administer high-flow oxygen. • D:move him to a cool area. *correct ANS*- You selected D; This is correct! Reason:Your first action in a heat-related emergency is to move the patient to a cooler environment. Once you have moved the patient to a cooler place, you should begin your assessment and treat the patient accordingly. Remember, you must FIRST prevent further harm to the patient. A known diabetic female is found unresponsive. Her respirations are rapid and shallow; her skin is cool, clammy, and pale; and her pulse is rapid and weak. Which of the following would BEST explain the likely cause of her condition? • A:Failure to take insulin • B:Insulin overdose • C:Excessive eating • D:High blood sugar *correct ANS*- The correct answer is B; Reason:The patient has classic signs of insulin shock, a condition caused by a low blood glucose level (hypoglycemia). Common causes of insulin shock include insulin overdose (accidental or intentional), failure to eat (or not eating enough), and excessive exertion. The patient's symptoms are not consistent with diabetic ketoacidosis (DKA), a condition that results from a high blood glucose level (hyperglycemia). Signs of DKA include deep, rapid breathing with a fruity or acetone breath odor (Kussmaul respirations), and warm, dry skin. Unlike insulin shock, which can result from an insulin overdose, DKA can occur if a patient fails to take his or her insulin or takes too little. You are dispatched to a residence for a 20-year-old male with respiratory distress. When you arrive, you find that the patient has a tracheostomy tube and is ventilator dependent. His mother tells you that he was doing fine, but then suddenly began experiencing breathing difficulty. You should: • A:detach the ventilator, suction the tracheostomy tube, and reassess the patient. • B:remove the ventilator tubing and place an oxygen mask over the tracheostomy tube. • C:remove him from the mechanical ventilator and ventilate him manually. • D:check the settings on the ventilator to ensure that it is functioning properly. *correct ANS*- you selected C; This is correct! Reason:If a ventilator-dependent patient experiences a sudden onset of respiratory distress, you should first remove him or her from the mechanical ventilator and begin manual ventilation with a bag-mask device; if the patient improves, you will know that the problem was a malfunction with the mechanical ventilator. If the patient does not improve, the tracheostomy tube is likely plugged with thick mucus secretions and requires suctioning. Unless you are familiar with the mechanical ventilator (most EMTs are not), do not attempt to troubleshoot the device by checking the settings; this only wastes time. A middle-aged man was found floating facedown in a small pond. When you arrive at the scene, bystanders are present, but nobody has removed him from the water because they thought he was dead. After reaching the victim, you should: • A:float a buoyant backboard under him, remove him from the pond, and begin rescue breathing. • B:move him to a supine position by rotating the entire upper half of his body as a single unit. • C:stabilize his head as you remove it from the water and open his airway by tilting his head back. • D:grab him by his clothing, remove him from the pond, and assess for breathing and a pulse. *correct ANS*- The correct answer is B; Reason:After safely reaching a drowning victim, you should first turn him to a supine position by rotating the entire upper half of the body as a single unit; protect the cervical spine as you do this because a spinal injury cannot be ruled out. Open the patient's airway, without manipulating the neck, and begin rescue breathing while still in the water. Float a buoyant backboard under the patient, secure him to it, and remove him from the water. After removing the victim from the water, assess for a pulse. If the victim is pulseless, begin CPR, dry him off, and apply the AED as soon as possible. Which of the following patients with diabetes is the BEST candidate for oral glucose? • A:A confused patient who has cool, clammy skin • B:A semiconscious patient with pale, clammy skin • C:An unresponsive patient who took too much insulin • D:A confused patient with suspected hyperglycemia *correct ANS*- You selected A; This is correct! Reason:Oral glucose is indicated for patients with diabetes who are in insulin shock (hypoglycemic crisis), or for any patient with symptomatic hypoglycemia (as documented by glucometer). The patient must be conscious and alert enough to be able to swallow the glucose, which comes in a tube of gel. If the patient is unresponsive or otherwise unable to swallow the glucose, you should provide rapid transport, providing the appropriate airway management en route, and consider an ALS intercept. A 40-year-old woman presents with widespread hives that she noticed about 45 minutes after taking penicillin. She is conscious and alert and denies difficulty breathing. Her breath sounds are clear to auscultation bilaterally, her vital signs are stable, and her oxygen saturation is 94%. She tells you she is allergic to wasps and has an epinephrine auto-injector. You should: • A:assist her in administering epinephrine via her auto-injector. • B:give high-flow oxygen and administer 100 mg of Benadryl. • C:give supplemental oxygen and transport her to the hospital. • D:advise her that she can probably drive herself to the hospital. *correct ANS*- You selected C; This is correct! Reason:The patient is experiencing an allergic reaction, but she is not in anaphylactic shock. Urticaria (hives) is common to all allergic reactions, regardless of severity; however, wheezing and hypotension, which she does not have, are specific to anaphylaxis. Although she carries an epinephrine auto-injector for her allergy to wasps, she was not stung by a wasp. Furthermore, the absence of wheezing and hypotension negates epinephrine administration. Give supplemental oxygen (in a concentration sufficient to maintain an SpO2 of greater than 94%) and transport her to the hospital. Because it can take up to an hour for signs of a severe allergic reaction to manifest, the patient should not drive herself. Diphenhydramine (Benadryl), an antihistamine, is an appropriate drug based on her presentation; however, it is not typically carried on a BLS unit. Furthermore, the correct dose is 25 to 50 mg. Immediately following a generalized motor seizure, most patients are: • A:hyperactive. • B:confused. • C:apneic. • D:awake and alert. *correct ANS*- You selected B; This is correct! Reason:After a generalized (grand mal) motor seizure, the patient typically will be confused, sleepy, or in some cases, combative. This is referred to as the postictal phase. The patient's level of consciousness typically improves within 30 minutes. In many cases, the patient's respirations will be fast (tachypnea) following a seizure; this is the body's attempt to eliminate excess carbon dioxide that accumulated in the blood during the seizure. When assessing a conscious patient who overdosed on a drug, you should FIRST determine: • A:if there is a history of prior overdose. • B:the patient's weight in kilograms. • C:the type of medication ingested. • D:when the medication was ingested. *correct ANS*- You selected C; This is correct! Reason: When assessing a patient who has overdosed on a drug, you should first determine what was ingested, which will provide you with immediate information about whether or not the substance is toxic. You should then find out when the medication was ingested. This information will provide medical control (or poison control) with the information needed to direct the most appropriate treatment. The patient's weight also should be estimated in kilograms in the event that an antidote is required. Information regarding prior drug overdoses would normally be obtained during the SAMPLE history. Which of the following actions should be carried out during the primary assessment of an unresponsive patient? • A:Assessing the skin • B:Obtaining a blood pressure • C:Palpating the cranium • D:Auscultating the lungs *correct ANS*- You selected A; This is correct! Reason:Components of the primary assessment for both responsive and unresponsive patients include assessing and managing the airway and assessing and managing circulation, which includes controlling any major bleeding; assessing the rate, regularity, and quality of the pulse; and assessing the color, condition, and temperature of the skin. When restraining a violent patient, you should make sure that: • A:the patient is restrained using maximal force. • B:at least two EMTs restrain the patient. • C:consent for restraint has been obtained from a family member. • D:someone talks to the patient during the process. *correct ANS*- You selected D; This is correct! Reason:If a violent patient needs to be restrained, you must ensure the presence of at least four people (one per extremity). One of the EMTs should continuously talk to the patient to explain what is happening, even if the patient is not listening. Restraint is a last resort used to protect the EMT as well as the patient. Consent is not needed from a family member prior to restraining the patient. Just enough force to effectively restrain the patient is all that is required to prevent causing unnecessary injury. Immediately following a generalized seizure involving tonic-clonic activity, most patients: • A:have a slow heart rate because of cardiac depression during the seizure. • B:are unresponsive but gradually regain consciousness. • C:experience prolonged apnea and require positive-pressure ventilations. • D:return to a normal level of consciousness but cannot recall the event. *correct ANS*- You selected B; This is correct! Reason:Most generalized (grand mal) seizures last 3 to 5 minutes and are followed by a lengthy (5 to 30 minutes) period called the postictal phase, in which the patient is unresponsive at first but gradually regains consciousness. During the seizure itself, the nervous system releases excess adrenaline (epinephrine); therefore, tachycardia, even after the seizure has stopped, is common. Apnea is common during a seizure; however, breathing usually resumes after the seizure has stopped. Many patients are tachypneic following a seizure; this is the body's attempt to eliminate excess carbon dioxide that accumulated in the blood during the seizure. Unlike grand mal seizures, petit mal seizures (also called absence seizures) can last for just a fraction of a minute, after which the patient fully recovers immediately with only a brief lapse of memory of the event. Which of the following organs are contained within the right upper quadrant of the abdomen? • A:Liver and gallbladder • B:Stomach and gallbladder • C:Liver and spleen • D:Liver and stomach *correct ANS*- You selected A; This is correct! Reason:The liver and gallbladder lie within the right upper quadrant of the abdomen. Most of the stomach is within the left upper quadrant, as is the entire spleen. You respond to a baseball field for a person who was struck by lightning. When you arrive, you see one patient who appears confused and is ambulatory; a second patient who is conscious, sitting on the ground, and holding his arm; and a third patient who is supine and motionless. After requesting additional responders, you should: • A:assess the motionless victim and perform CPR and defibrillation if necessary. • B:assess and begin treating the sitting patient first because he is obviously injured. • C:treat the conscious patients because the motionless patient is likely deceased. • D:proceed to the ambulatory patient, sit him down, and assess his mental status. *correct ANS*- You selected D; The correct answer is A; Reason:The process of triaging multiple victims of a lightning strike is different than the conventional triage methods used during a mass-casualty incident. When a person is struck by lightning, respiratory or cardiac arrest, if it occurs, usually occurs immediately. Those who are conscious following a lightning strike are much less likely to develop delayed respiratory or cardiac arrest; they usually survive. Therefore, you should focus your efforts on those who are in respiratory or cardiac arrest. This process, called reverse triage, differs from conventional triage, where such patients would ordinarily be classified as deceased. A 32-year-old man who was stung by a bee has diffuse hives, facial swelling, and difficulty breathing. When he breathes, you hear audible stridor. What does this indicate? • A:Narrowing of the two mainstem bronchi • B:Swelling of the upper airway structures • C:Narrowing of the bronchioles in the lungs • D:Swelling of the lower airway structures *correct ANS*- You selected B; This is correct! Reason:This patient is experiencing a severe allergic reaction (anaphylaxis). Stridor, which is a high-pitched sound heard on inhalation, indicates swelling of the structures and tissues of the upper airway. If not promptly treated, the patient's airway may close completely, resulting in respiratory arrest. Narrowing of the bronchioles in the lungs causes wheezing, a whistling sound that may be heard during inhalation, exhalation, or both. A behavioral crisis is MOST accurately defined as: • A:any reaction to an event that interferes with the activities of daily living or has become unacceptable to the patient, family, or community. • B:an acute psychiatric emergency characterized by violent behavior, mood swings, and a loss of connection to reality. • C:a persistent feeling of sadness, despair, or hopelessness that incapacitates the patient and prevents him or her from interacting socially. • D:a chronic mental health problem in which the patient experiences frequent thoughts of suicide or other self-destructive behavior. *correct ANS*- You selected A; This is correct! Reason:The definition of a behavioral crisis or emergency is any reaction to an event that interferes with the activities of daily living (eg, bathing, dressing, eating) or has become unacceptable to the patient, his or her family, or the general community. Some patients react to an event with violent behavior or suicidal thoughts; others react with depression. Regardless of the reaction, it significantly interferes with the patient's life or is unacceptable to his or her family and/or the community You are called to an assisted living center where an attendant found a 72-year-old man unresponsive. The patient had recent hip surgery and has been taking Vicodin for pain. His respirations are slow and shallow and his pulse is slow and weak. You should: • A:apply the AED in case he develops cardiac arrest. • B:request an ALS ambulance to respond to the scene. • C:begin ventilation assistance with a bag-mask device. • D:apply high-flow oxygen via a nonrebreathing mask. *correct ANS*- You selected C; This is correct! Reason:Vicodin is a combination of hydrocodone and acetaminophen (APAP), the active ingredient in Tylenol. Hydrocodone is a potent narcotic analgesic. When taken in excess, it can suppress the central nervous system and cause respiratory depression, bradycardia, and hypotension. Initial management of any patient who has overdosed on a medication of this type is to ensure a patent airway and support breathing. Because the patient is breathing inadequately (slow and shallow), immediate ventilation assistance is needed. Consider requesting an ALS ambulance if transport time to the nearest hospital will be lengthy. Paramedics can administer a drug called naloxone (Narcan) to reverse the effects of narcotic drugs. The AED is not indicated for this patient; it is only applied to patients in cardiac arrest. In the patient with diabetes, insulin shock typically presents with: • A:clammy skin and a rapid onset. • B:dry skin and a slow onset. • C:dry skin and a rapid onset. • D:clammy skin and a slow onset. *correct ANS*- The correct answer is A; Reason:In the patient with diabetes, insulin shock (hypoglycemic crisis) presents with cool, clammy skin and a rapid onset. The brain is critically dependent on glucose and responds quickly when the body is in short supply. Diabetic coma (hyperglycemic crisis) typically presents with warm, dry skin and a slow onset, sometimes occurring over a period of days. Your FIRST action in managing a patient with an altered mental status should be to: • A:determine if the patient is breathing adequately. • B:administer one tube of oral glucose. • C:administer high-flow supplemental oxygen. • D:ask a family member how the patient normally acts. *correct ANS*- You selected A; This is correct! Reason:When treating a patient with an altered mental status, you must first ensure a patent airway and determine if the patient is breathing adequately. If the patient is breathing adequately, administer supplemental oxygen and continue your assessment. If the patient is not breathing adequately (ie, fast or slow rate, shallow breathing [reduced tidal volume]), assist his or her ventilations. It is important to ask a family member, if available, how the patient normally acts; this will help establish a baseline. Before administering oral glucose, you should assess the patient's blood glucose level to determine if hypoglycemia is the cause of his or her problem and then decide if the patient is able to swallow the glucose, if indicated. If the patient is unable to swallow, do not administer oral glucose, even if he or she is hypoglycemic. Request a paramedic ambulance if possible so the patient can receive intravenous glucose. A patient who overdosed on methamphetamine would be expected to have all of the following clinical signs, EXCEPT: • A:agitation. • B:hypertension. • C:dilated pupils. • D:bradycardia. *correct ANS*- You selected C; The correct answer is D; Reason:Methamphetamine, an upper, stimulates the central nervous system, causing it to release excessive amounts of adrenaline (epinephrine). Epinephrine increases heart rate and blood pressure; therefore, the patient would experience tachycardia and hypertension. Other signs of methamphetamine overdose, which also indicate an adrenaline surge, include pupillary dilation, agitation, and hyperthermia. Bradycardia would be expected in patients who have overdosed on drugs that suppress, not stimulate, the central nervous system (eg, narcotics, benzodiazepines, barbiturates). A 50-year-old woman with a history of epilepsy is actively seizing. Care for this patient should focus primarily on: • A:protecting her from injury and ensuring adequate ventilation. • B:administering high-flow oxygen and requesting an ALS ambulance. • C:frequently suctioning her airway and carefully restraining her. • D:placing a bite block in between her molars and giving her oxygen. *correct ANS*- You selected A; This is correct! Reason:Seizure deaths are most frequently the result of hypoxia. When a person is actively seizing, he or she is not breathing adequately. Your primary focus when treating a seizure patient is to protect him or her from injury and to ensure adequate ventilation and oxygenation. Many seizing patients require assisted ventilation. Suction the oropharynx only if the patient has secretions in his or her mouth. Do NOT insert anything into the mouth of a seizing patient; doing so may cause an airway obstruction