Paramedic School FINAL final Flashcards
Dassit!
While starting an IV on a patient complaining of abdominal pain, you inadvertently get stuck with the needle before you can place it in the sharps container. You should:
A) continue with patient care, report the incident to your infection control officer, and schedule an appointment with your physician.
B) complete your care of the patient, wash the affected area as soon as you reach the hospital, and report the incident to your supervisor.
C) ask the driver to pull over, assume the role of driver, continue on to the hospital, and see a physician in the emergency department.
D) immediately clean the affected area with isopropyl alcohol, ask the patient if he has any infectious diseases, and report the incident to your supervisor.
B
A DNR order is MOST accurately defined as a:
A) written order designed to tell health care providers when resuscitation is or is not appropriate.
B) legal document that is executed by the patient while he or she still has decision-making capacity.
C) written or oral directive that stipulates the care that a patient should receive at the end of his or her life.
D) legal document signed by at least two physicians that prohibits resuscitative efforts in terminally ill patients.
A
The husband of a terminally ill woman called 9-1-1 because he thinks his wife is about to die. The patient has a valid living will and an out-of-hospital DNR order. You should:
A) ask the husband why he called EMS if his wife is not to be resuscitated.
B) assume that the husband has revoked the DNR order and begin treatment.
C) contact medical control and request permission to provide emergency care.
D) treat the husband and his wife with respect and provide emotional support.
D
A 77-year-old man with end-stage COPD and renal failure is found unresponsive by his daughter. Your assessment reveals that the patient is apneic and pulseless. The daughter presents you with an out-of-hospital DNR order; however, the document expired 3 months ago. You should:
A) begin CPR only and contact medical control for further guidance.
B) realize that the patient cannot be resuscitated and notify the coroner.
C) begin full resuscitative efforts because the DNR order is no longer valid.
D) confirm that the order has expired before initiating any patient treatment.
A
During the attempted resuscitation of a 79-year-old man in cardiac arrest, a young man arrives at the scene and asks you to cease resuscitative efforts. He further tells you that the patient has entrusted him to make all of his medical decisions. You should:
A) continue full resuscitative efforts and ask the man if the patient has a living will and if he has documentation naming him as the person authorized to make decisions.
B) limit your resuscitative efforts to basic life support only and cease resuscitation altogether if the man can present a valid advance directive.
C) cease all resuscitative efforts, contact medical control, and advise medical control that a surrogate decision maker is present and has requested you to stop.
D) advise the man that, because he does not have valid documentation that he is authorized to make decisions for the patient, you must continue resuscitation.
A
Although the technicalities of EMS DNR orders vary from state to state, they all:
A) are completely irrevocable by the patient’s immediate family members.
B) require the patient to wear a DNR insignia such as a bracelet or necklace.
C) are designed to tell EMS providers when resuscitation is or is not appropriate.
D) must be renewed every 5 years or they will expire and become null and void.
C
You are caring for a 66-year-old man with terminal cancer. He is conscious and alert without evidence of mental incapacitation. You offer him oxygen, but he refuses to accept it, stating “Just let me die with dignity!” You should:
A) tell him that the oxygen is crucial in preventing him from experiencing cardiac arrest.
B) respect the patient’s wishes and ask him if he wants to be transported to the hospital.
C) contact medical control and request permission to treat without the patient’s consent.
D) recognize that patients with terminal illnesses do not have decision-making capacity.
B
Patients with decision-making capacity:
A) cannot refuse EMS treatment and transport after they have given consent for it.
B) have the right to refuse all or part of the emergency medical care offered to them.
C) must agree to EMS transport if they give consent for emergency medical treatment.
D) cannot withdraw consent unless their conditions are deemed to be non-life-threatening.
B
Because minors have no legal status:
A) they can neither consent to nor refuse medical care.
B) you must obtain consent from both parents before treating.
C) they must always be treated under the law of implied consent.
D) you must obtain a court order before you can legally treat them.
A
Because minors have no legal status:
A) they can neither consent to nor refuse medical care.
B) you must obtain consent from both parents before treating.
C) they must always be treated under the law of implied consent.
D) you must obtain a court order before you can legally treat them.
B
If a mentally competent adult refuses emergency medical treatment, your FIRST action should be to:
A) call medical control and seek further guidance.
B) determine if his or her condition is life-threatening.
C) assume the refusal is from fear and begin treatment.
D) try to determine why he or she is refusing treatment.
D
Before asking a patient to sign a refusal form, the paramedic must:
A) ask an impartial observer to sign the refusal form first.
B) tell the patient that he or she will die without treatment.
C) ensure the patient is aware of the risks of his or her refusal.
D) ask a police officer to determine if the patient is competent.
C
Health care powers of attorney are also called “durable” powers of attorney because they:
A) must be in the patient’s possession at all times.
B) can only be revoked by the patient’s personal physician.
C) remain in effect once a patient loses decision-making capacity.
D) do not require anyone to make decisions on the patient’s behalf.
C
When functioning at a crime scene, it is important for the paramedic to:
A) collect and safeguard any and all evidence.
B) carefully question witnesses as to what they saw.
C) use caution and not disturb the scene unnecessarily.
D) avoid performing patient care until cleared by the police.
C
If the paramedic is unable to complete his or her patient care report before departing the emergency department, he or she should:
A) leave, at a minimum, the patient’s name and age, but recognize that the physician will perform his or her own exam.
B) leave an abbreviated form with pertinent data with the receiving provider and complete the patient care report as soon as possible.
C) obtain the emergency department fax number and transmit the completed patient care report within 12 hours after delivering the patient.
D) advise the receiving provider that he or she will return to the emergency department with the completed patient care report within 24 hours.
B
HIPAA mandates that:
A) a patient’s personal information must be shared with the patient’s immediate family members.
B) patient information shall not be shared with entities or persons not involved in the care of the patient.
C) a penalty will be imposed for any release of any portion of a patient’s personal information to any entity.
D) patient information can only be shared with the receiving physician in the emergency department.
B
According to HIPAA, it is acceptable and permissible for hospitals to:
A) disclose information to a patient’s family member, provided the family member has proper identification.
B) release patient information to the public health department, regardless of the patient’s medical condition.
C) share information with the EMS providers about patient outcome for purposes of quality assurance and education.
D) release patient information to the media only if the hospital feels that the patient’s condition may cause an epidemic.
C
The hypoxic drive, a backup system to control breathing, is stimulated when: A) arterial PaO2 levels decrease. B) arterial PaCO2 levels increase. C) arterial PaO2 levels increase. D) arterial PaCO2 levels decrease.
A
What happens when the PaCO2 of the arterial blood increases?
A) pH increases and respirations increase
B) pH decreases and respirations decrease
C) pH increases and respirations decrease
D) pH decreases and respirations increase
D
The primary respiratory stimulus in a healthy adult is a(n):
A) decreased arterial oxygen level.
B) increased arterial carbon dioxide level.
C) increased pH level of the venous blood.
D) decreased venous level of carbon dioxide.
B
What happens when systemic vasoconstriction occurs? A) Preload decreases. B) Afterload increases. C) Afterload and preload increase. D) Afterload and preload decrease.
B
What physiologic reaction occurs when a person’s blood sugar level falls?
A) The pancreas secretes more insulin.
B) More glycogen is stored in the liver.
C) Glucagon production is increased.
D) The pancreatic beta cells become hyperactive.
C
Insulin and glucagon are produced in specialized groups of cells in the pancreas known as the: A) adrenal islets. B) islets of Langerhans. C) medullary cortex. D) adrenal medulla.
B
In response to shock or stress, sympathetic nervous system stimulation causes:
A) vasoconstriction.
B) slowing of the heart rate.
C) increased gastrointestinal function.
D) shunting of blood to the body’s periphery.
A
All of the following are functions of the parasympathetic nervous system, EXCEPT:
A) constriction of the pupils.
B) lowering of the blood pressure.
C) decreased gastrointestinal function.
D) mediating arousal in males and females.
C
During your assessment of a patient, you note that he is bradycardic, hypotensive, and salivating. These clinical findings suggest:
A) sympathetic nervous system stimulation.
B) parasympathetic nervous system stimulation.
C) sympathetic nervous system depression.
D) parasympathetic nervous system depression.
B
Excessive stimulation of the parasympathetic nervous system will result in: A) hypertension. B) bradycardia. C) hyperactivity. D) diaphoresis.
B
Stimulation of alpha receptors of the sympathetic nervous system results in: A) tachycardia. B) bronchodilation. C) peripheral vasodilation. D) peripheral vasoconstriction
D
Which of the following statements regarding type O blood is correct?
A) It contains no surface antigens.
B) It contains type A surface antigens.
C) It contains type B surface antigens.
D) It contains both type A and B surface antigens.
A
A protein of the immune system that recognizes foreign substances is called a(n): A) bilirubin. B) antigen. C) pathogen. D) antibody.
D
Decreases in the PaCO2 result in \_\_\_\_\_\_\_\_\_\_\_\_\_ pH levels in the respiratory center and a(n) \_\_\_\_\_\_\_\_\_\_\_\_\_ in ventilation. A) decreased, decrease B) increased, increase C) decreased, increase D) increased, decrease
D
The primary respiratory stimulus in a healthy adult is a(n):
A) decreased arterial oxygen level.
B) increased arterial carbon dioxide level.
C) increased pH level of the venous blood.
D) decreased venous level of carbon dioxide.
B
What happens when the PaCO2 of the arterial blood increases?
A) pH increases and respirations increase
B) pH decreases and respirations decrease
C) pH increases and respirations decrease
D) pH decreases and respirations increase
D
Oxygen and carbon dioxide pass across the alveolar capillary membrane through a process called: A) diffusion. B) osmosis. C) perfusion. D) metabolism.
A
The movement of a solute from an area of higher concentration to an area of lower concentration is called: A) osmosis. B) endocytosis. C) exocytosis. D) diffusion.
D
Efferent nerves of the peripheral nervous system are responsible for:
A) carrying impulses from the body to the brain.
B) sensations such as pain, temperature, and pressure.
C) involuntary functions such as breathing and heart rate.
D) carrying commands from the brain to the muscles.
D
A loss of normal sympathetic nervous system tone causes: A) neurogenic shock. B) obstructive shock. C) profound vasoconstriction. D) a reduced absolute blood volume.
A
The two MOST common causes of inflammation are: A) fever and phagocytosis. B) infection and injury. C) hypercarbia and hypoxemia. D) immunosuppression and fever.
B
All of the following diseases are autoimmune diseases, EXCEPT: A) rheumatoid arthritis. B) type 1 diabetes. C) HIV infection. D) myasthenia gravis.
C
Baroreceptors, which are located in the carotid artery, aorta, and kidneys, are MOST sensitive to changes in: A) fluid volume. B) blood pressure. C) acid-base balance. D) sodium concentrations.
B
The MOST prevalent cation of the extracellular fluid is: A) sodium. B) chloride. C) potassium. D) bicarbonate.
A
When comparing two solutions, the solution that has a higher solute concentration and a higher osmotic pressure is referred to as a(n) \_\_\_\_\_\_\_\_\_\_ solution. A) isotonic B) hypotonic C) hypertonic D) crystalloid
C
The physiologic effects of nitroglycerin when given to patients with cardiac-related chest pain include:
A) increased myocardial oxygen consumption.
B) decreased preload and coronary vasodilation.
C) coronary vasoconstriction and increased preload.
D) increased afterload and peripheral vasodilation.
B
At 5 to 10 g/kg/min, dopamine:
A) activates beta-1 receptor sites, causing an increased heart rate and increased cardiac contractility.
B) activates dopaminergic receptor sites, causing renal and mesenteric artery vasodilation.
C) no longer activates dopaminergic receptor sites and predominately activates alpha-1 receptor sites.
D) has a negative chronotropic effect on the heart, but an increased inotropic effect.
A
At 15 g/kg/min, dopamine: A) reduces cardiac contractility. B) antagonizes alpha-1 receptors. C) activates beta-2 receptor sites. D) causes vigorous vasoconstriction.
D
Catecholamines and sympathomimetic medications should be administered with caution because they:
A) can increase cardiac workload and myocardial oxygen demand.
B) have an average duration of action of between 24 and 48 hours.
C) are associated with paradoxical bradycardia in younger patients.
D) have a tendency to cause a significant decrease in cardiac output.
A
Under normal conditions, the renin-angiotensin system functions by:
A) dilating the systemic vasculature and reducing cardiac afterload when arterial blood pressure increases.
B) stimulating alpha-1 receptors, thereby increasing the blood pressure in response to acute blood loss.
C) blocking alpha-2 receptors, thereby increasing the release of norepinephrine and raising blood pressure.
D) promoting vasoconstriction and fluid retention in response to hypotension or hypoperfusion
D
The desired clinical effect after administering a beta-2 agonist medication is:
A) dilation of the systemic vasculature.
B) relaxation of bronchiole smooth muscle.
C) increased cardiac contractility
D) contraction of vascular smooth muscle.
B
Beta blockers should be used with extreme caution in patients with reactive airway because:
A) beta-1 receptor antagonism will result in profound bronchoconstriction.
B) beta-2 receptors can potentially be antagonized, resulting in bronchospasm.
C) there are no beta-blockers that selectively target beta-1 receptors only.
D) they inhibit catecholamine release, potentially causing bronchoconstriction.
B
In order to relieve the bronchospasm associated with an acute asthma attack, the paramedic would give a(n): A) alpha-1 agonist. B) beta-2 agonist. C) beta-1 agonist. D) alpha-2 agonist.
B
Compared to succinylcholine, rocuronium:
A) has a rapid (30 to 60 seconds) onset of action and a relatively brief (3 to 8 minutes) duration of action.
B) binds with nicotinic receptors on muscles and causes a brief activation known as fasciculation.
C) has a rapid onset of action, a longer (up to 60 minutes) duration of action, and fewer adverse effects.
D) does not bind with nicotinic receptor sites on muscle cells and does not antagonize acetylcholine.
C
The peak of a medication's effect depends on \_\_\_\_\_\_\_\_\_\_\_\_\_, whereas the duration of effect depends on \_\_\_\_\_\_\_\_\_\_\_\_\_\_. A) distribution, absorption B) absorption, metabolism C) elimination, absorption D) metabolism, distribution
B
In order to relieve the bronchospasm associated with an acute asthma attack, the paramedic would give a(n): A) alpha-1 agonist. B) beta-2 agonist. C) beta-1 agonist. D) alpha-2 agonist.
B
Which of the following statements regarding the endotracheal route of medication administration is correct?
A) If a medication must be given via the endotracheal route, five times the standard IV dose should be given.
B) Evidence has shown that medications given via the endotracheal route quickly achieve a peak plasma level.
C) Medications given via the endotracheal route should be flushed with 20 to 30 mL of sterile water.
D) The endotracheal route is no longer considered a reliable method of medication administration.
D
When a patient needs rapid fluid replacement, you should:
A) use a microdrip administration set because you can deliver more precise volumes of IV fluid.
B) choose an administration set that delivers the least amount of volume per the most number of drops.
C) select an administration set that contains a large opening between the piercing spike and drip chamber.
D) use a microdrip administration set in order to avoid inadvertently overloading the patient with fluid.
C
To administer a drug, you must know the weight of the drug that is present in: A) 1 L. B) 1 mL. C) 100 mL. D) 0.1 mL.
B
If a 10-mL vial contains 1 mg of a drug, how many mg/mL are present? A) 0.1 B) 0.01 C) 0.001 D) 0.0001
A
How many mg/mL are contained in a prefilled syringe of 50% dextrose with a concentration of 25 g/50 mL? A) 100 B) 250 C) 500 D) 1,000
C
A 1% lidocaine (Xylocaine) concentration contains: A) 1 mg/10 mL. B) 100 mg/100 mL. C) 500 mg/50 mL. D) 1,000 mg/100 mL.
D
Your protocols call for you to administer 5 mg of diazepam (Valium) to a patient who is seizing. You have a 10-mL vial of Valium that contains 10 mg. How many milliliters will you give? A) 0.5 mL B) 5 mL C) 0.25 mL D) 10 mL
B
A hypoglycemic patient requires IV dextrose. Medical control orders you to administer 25 mL. You have a prefilled syringe of 50% dextrose that contains 25 g/50 mL. How much dextrose will you give? A) 500 mg B) 12.5 g C) 5,000 mg D) 50 g
B
A 2-year-old girl in cardiac arrest requires epinephrine at a dose of 0.01 mg/kg. The mother tells you that her daughter weighs about 25 lb. How much epinephrine will you administer? A) 0.1 mg B) 0.15 mg C) 0.01 mg D) 0.2 mg
A
Following return of spontaneous circulation, you are ordered to begin a lidocaine infusion at 3 mg/min on your 50-year-old patient. You add 2 g of lidocaine to a 500-mL bag of normal saline and are using a microdrip administration set. At how many drops per minute (gtts/min) will you set the IV flow rate? A) 15 B) 30 C) 45 D) 60
C
A nonhypovolemic patient is severely hypotensive and requires a dopamine infusion at 5 µg/kg/min. The patient's estimated weight is 190 lb. You add 800 mg of dopamine to a 500-mL bag of normal saline and are using a microdrip administration set. At how many drops per minute (gtts/min) will you set the IV flow rate? A) 10 B) 12 C) 14 D) 16
D
Ipratropium (Atrovent) dilates the bronchioles by:
A) inhibiting the interaction of acetylcholine at bronchial smooth muscle receptors.
B) selectively stimulating beta-2 receptors found in the bronchial smooth muscle.
C) competitively binding to beta-2 receptors found in the bronchial smooth muscle.
D) increasing the interaction of acetylcholine at bronchial smooth muscle receptors.
A
Glucagon can be classified as all of the following, EXCEPT as a(n): A) pancreatic hormone. B) hypoglycemic agent. C) insulin antagonist. D) hyperglycemic agent.
B
Glucagon increases the blood glucose level by:
A) stimulating glycogenesis.
B) inhibiting gluconeogenesis.
C) agonizing the effects of insulin.
D) facilitating glucose entry into the cell.
A
Glucagon may be indicated for all of the following conditions, EXCEPT: A) hypoglycemia. B) beta-blocker overdose. C) hyperglycemia. D) calcium channel blocker overdose.
C
Glucagon would be ineffective in patients with: A) significant hypertension. B) low serum glucose levels. C) severe beta-blocker toxicity. D) depleted glycogen stores.
D
Diltiazem is commonly used for patients with: A) rapid atrial fibrillation. B) ventricular tachycardia. C) high-grade AV heart block. D) heart failure and hypotension.
A
If an initial dose of diltiazem is ineffective, a second dose of \_\_\_\_ can be given. A) 5 to 10 mg B) 10 to 20 mg C) 0.25 mg/kg D) 0.35 mg/kg
D
Atropine sulfate is classified as a(n) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ medication. A) adrenergic B) anticholinergic C) sympatholytic D) sympathomimetic
B
Atropine should NOT be given to patients with: A) hypothermic bradycardia. B) nerve agent exposure. C) beta-blocker overdose. D) calcium channel blocker overdose.
A
Atropine should NOT be given to patients with: A) hypothermic bradycardia. B) nerve agent exposure. C) beta-blocker overdose. D) calcium channel blocker overdose.
A
What is the mechanism of action of adenosine (Adenocard)?
A) Inhibits the action of acetylcholine at postganglionic parasympathetic neuroeffector sites; increases heart rate
B) Slows conduction through the AV node; can interrupt re-entrant pathways; slows heart rate by acting directly on sinus pacemaker cells
C) Blocks sodium channels and myocardial potassium channels; delays repolarization; increases the duration of the action potential
D) Decreases heart rate, myocardial contractility, and cardiac output; inhibits dilation of bronchial smooth muscle
B
Adenosine is contraindicated for patients with: A) reentry tachycardia. B) narrow-complex tachycardia. C) wide-complex tachycardia. D) drug-induced tachycardia.
D
If an initial dose of adenosine is ineffective for a 130-pound patient, you should: A) give 6 mg rapid IV/IO push. B) give the second dose more slowly. C) give 12 mg after 1 to 2 minutes. D) give a second dose after 10 minutes.
C
The correct second dose of adenosine for a 50-pound child is: A) 2.3 mg. B) 4.6 mg. C) 6 mg. D) 12 mg.
B
The side effects of adenosine are limited in most patients because:
A) adenosine has such a short half-life.
B) the doses of adenosine are relatively small.
C) patients who receive adenosine are stable.
D) adenosine is subject to first-pass metabolism.
A
The MOST reliable means of attempting to determine an unresponsive medical patient’s problem is:
A) a thorough head-to-toe physical examination.
B) cardiac monitoring and blood glucose assessment.
C) pulse oximetry, capnography, and serial vital signs.
D) information provided by the patient’s family members.
A
Upon completing your rapid exam of an unresponsive trauma patient’s head and neck, you should next:
A) log roll the patient onto a long backboard.
B) assess the integrity of the 12 cranial nerves.
C) ventilate the patient at 12 to 20 breaths/min.
D) apply a properly sized rigid cervical collar.
D
A neighbor finds her elderly female friend unresponsive on her kitchen floor. As you are performing your primary assessment, the neighbor tells you that she does not know what happened to her friend. The patient moans when you speak to her and is breathing at a normal rate with adequate depth. You should:
A) apply a rigid cervical collar, start an IV of normal saline, and perform immediate endotracheal intubation.
B) apply supplemental oxygen via nonrebreathing mask, place her in a lateral recumbent position, and transport.
C) insert an airway adjunct, apply supplemental oxygen, and implement spinal motion restriction precautions.
D) quickly place her on the stretcher, obtain a 12-lead ECG tracing, and perform a detailed physical exam.
C
You are caring for an unresponsive 54-year-old man with an apparent isolated head injury after he fell from a standing position. Your partner is maintaining manual stabilization of the patient’s head while assisting his breathing. Your rapid head-to-toe exam reveals only a large hematoma to the patient’s forehead. Further assessment reveals that the patient is wearing a medical alert bracelet that reads “allergic to codeine.” You should:
A) instruct your partner to ventilate the patient at 24 breaths/min.
B) perform a detailed secondary assessment and transport at once.
C) assess his blood glucose reading and give dextrose if necessary.
D) give epinephrine in case he is experiencing an allergic reaction.
C
You are transporting a conscious middle-aged woman who fell from a second-story balcony while watering her plants. Full spinal motion restriction precautions have been implemented, supplemental oxygen is being administered, and an IV line of normal saline is in place. With a 15-minute estimated time of arrival at the hospital, the patient’s mental status markedly decreases and her respirations become shallow and are making a gurgling sound. Your FIRST action should be to:
A) immediately suction her oropharynx.
B) perform immediate endotracheal intubation.
C) insert a nasal airway and assist ventilations.
D) contact the receiving facility to update them.
A
Which of the following statements regarding the rapid exam of a trauma patient is correct?
A) The rapid exam is used to identify injuries that must be managed before and during packaging and loading the patient for transport.
B) Any trauma patient should receive a rapid head-to-toe exam, even if his or her injury is minor and the mechanism of injury is not significant.
C) The rapid exam is the first assessment you will perform on a trauma patient and is designed to find and treat immediate threats to life.
D) The rapid exam is a detailed exam that should take between 1 and 2 minutes and should primarily focus on the patient’s chief complaint.
A
The rapid exam of a patient is usually performed:
A) as soon as your general impression of the patient suggests that he or she is critically injured.
B) immediately after determining that the patient has experienced a significant mechanism of injury.
C) after all life-threatening conditions have been identified and addressed in the primary assessment.
D) following at least one complete set of vital signs, including assessment of the pupils and blood glucose.
C
The presence of rales during auscultation of the chest indicates all of the following conditions, EXCEPT: A) heart failure. B) bronchospasm. C) toxic inhalation. D) pulmonary edema.
B
When replacing a dislodged tracheostomy tube, it is MOST important that you:
A) insert the tube 2 cm beyond the cuff.
B) take appropriate standard precautions.
C) lubricate the tube before insertion.
D) use a tracheostomy tube of the same size.
B
In order for a tracheostomy tube to be compatible with a mechanical ventilator or bag-mask device:
A) it should have a stylet that can be removed easily.
B) it should have an internal diameter of at least 6.0 mm.
C) the patient’s head must be in a hyperextended position.
D) it must be equipped with a 15/22-mm proximal adaptor.
D
You are dispatched to the residence of a 19-year-old man who has a tracheostomy tube and is on a mechanical ventilator. According to the patient’s mother, he began experiencing difficulty breathing about 30 minutes ago. Auscultation of his lungs reveals bilaterally diminished breath sounds, and his oxygen saturation is 90%. You disconnect the patient from the mechanical ventilator and begin bag-mask ventilations; however, you meet significant resistance. You should:
A) suspect that he has bilateral pneumothoraces.
B) ventilate with a demand valve and transport at once.
C) remove the bag-mask and suction his tracheostomy tube.
D) remove his tracheostomy tube and replace it with a new one.
C
Before intubating a patient who has been chemically sedated and paralyzed, it is MOST important for the paramedic to:
A) administer 0.5 mg of atropine sulfate.
B) hyperventilate the patient at 24 breaths/min.
C) adequately preoxygenate with 100% oxygen.
D) suction the oropharynx to clear any secretions.
C
You are assessing a young woman who was struck in the head with a baseball bat. The patient is semiconscious and has slow, irregular respirations. Further assessment reveals CSF drainage from her nose and periorbital ecchymosis. She has blood in her mouth, but clenches her teeth and becomes combative when you attempt to suction her oropharynx. The MOST appropriate airway management for this patient involves:
A) sedating her with a benzodiazepine, chemically paralyzing her with a neuromuscular blocker, and intubating her trachea.
B) suctioning along the inside of her cheek with a whistle-tip catheter and then performing blind nasotracheal intubation.
C) opening her mouth with a dental prod, suctioning her oropharynx for 15 seconds, and intubating her trachea via direct laryngoscopy.
D) inserting a nasopharyngeal airway, administering supplemental oxygen via nonrebreathing mask, and continuing suction attempts.
A
If the patient’s oxygen saturation drops at any point during rapid-sequence intubation, you should:
A) stop and hyperventilate the patient at a rate of 24 breaths/min.
B) abort the intubation attempt and ventilate with a bag-mask device.
C) apply posterior cricoid pressure and continue the intubation attempt.
D) continue the intubation attempt and monitor the cardiac rhythm closely.
B
You are caring for a 69-year-old man with congestive heart failure. His breathing is profoundly labored, his oxygen saturation reads 79% on oxygen via nonrebreathing mask, and he is showing signs of physical exhaustion. Considering that your protocols do not allow you to perform rapid-sequence intubation, you should:
A) insert an oral airway, assist ventilations with a bag-mask device, and transport at once.
B) preoxygenate him with a bag-mask device and then perform blind nasotracheal intubation.
C) give him Valium for sedation, perform orotracheal intubation, and transport to the hospital at once.
D) insert a nasopharyngeal airway and ensure that the nonrebreathing mask is tightly secured to his face.
B
After inserting the Combitube to the proper depth, you should next:
A) inflate the distal cuff with 5 mL of air.
B) ventilate through the pharyngeal tube.
C) inflate the pharyngeal cuff with 100 mL of air.
D) apply a cervical collar to minimize head movement.
C
You have just inserted a Combitube in a 59-year-old cardiac arrest patient. You attach the bag-mask device to the pharyngeal (blue) tube, begin ventilations, and note the presence of bilaterally equal breath sounds, absent epigastric sounds, and visible chest rise. You should:
A) perform laryngoscopy to visualize placement of the Combitube.
B) continue to ventilate and use additional confirmation techniques.
C) continue ventilating the patient at a rate of 10 to 12 breaths/min.
D) ventilate through the clear tube and auscultate all four lung fields.
B
When intubating a 3-year-old child, you would MOST likely use a: A) size 2 straight blade. B) 6.5-mm uncuffed ET tube. C) 5.0-mm cuffed ET tube. D) size 1 curved blade.
A
When intubating a 3-year-old child, you should insert the ET tube until:
A) the distal cuff is 1 to 2 cm beyond the vocal cords.
B) you meet resistance, and then withdraw the tube 2 cm.
C) the vocal cord mark is 2 to 3 cm beyond the vocal cords.
D) the cm marking on the tube reads 15 cm at the child’s lips.
C
The MOST effective way to minimize the risk of hypoxia while intubating a child is to:
A) limit your intubation attempt to 20 seconds.
B) monitor the child’s cardiac rhythm at all times.
C) premedicate the child with 0.02 mg/kg of atropine.
D) not allow the oxygen saturation to fall below 100%.
A
