AMLS - STUDY GUIDE QUESTIONS WITH 100% CORRECT ANSWERS 2023\2024, Exams of Nursing

Download AMLS - STUDY GUIDE QUESTIONS WITH 100% CORRECT ANSWERS 2023\2024 and more Exams Nursing in PDF only on Docsity! AMLS - STUDY GUIDE QUESTIONS WITH 100% CORRECT ANSWERS 2022\2023 List 7 Red Flags for Breathing - ANSWER-1. Reduced consciousness 2. Cyanosis 3. SpO2 29 5. Asymmetrical movement 6. Tracheal deviation and distress 7. Inability to count to five in a single breath List 7 Red Flags for Circulatory Problems - ANSWER-1. Reduced consciousness 2. Profound pallor 3. Marked sweating 4. Systolic BP 140 6. Skin mottling 7. Dysrhythmia & hypotension List 5 Red Flags for Airway Assessment - ANSWER-1. Reduced consciousness 2. Stridor 3. Snoring 4. Voice change 5. Tongue swelling List 5 Red Flags of Disability Assessment - ANSWER-1. Hypoglycaemia 2. Reducing level of consciousness 3. Persistent fitting 4. Progression of signs (e.g. headache, lateralization) 5. P,U or not localizing pain List 3 Red Flags on General Assessment - ANSWER-1. Purpuric rash 2. Erythrodermia 3. Core temperature 40deg List 11 immediately life-threatening causes of airway obstruction - ANSWER-1. Tongue swelling (pharynx) 2. Swelling of the epiglottis or soft tissues (pharynx) 3. Oedema of the larynx 4. Laryngospasm (spasm of the vocal cords) 5. Foreign body in larynx 6. Laryngeal trauma 7. Subglottic secretions or foreign body 8. Subglottic swelling 9. Bronchial aspiration 10. Tension pneumothorax 11. Bronchial foreign body List 7 immediately life-threatening causes of breathlessness - ANSWER-1. Airway obstruction 2. Acute severe asthma 3. Acute exacerbation of COPD 4. Pulmonary oedema 5. Tension pneumothorax 6. Critical oxygen desaturation 7. Circulatory shock List 5 Life-threatening conditions that present with cutaneous manifestations - ANSWER-1. Anaphylaxis 2. Angio-oedema A 45 year old patient is found supine on the floor of the Triage area. Healthcare providers note pinpoint pupils, shallow respirations and vomitus in and around the mouth. What course of action should be implemented next? - ANSWER-Supplemental oxygen and suction Patients with a history of chronic bronchitis that present with shortness of breath are likely to have which condition? - ANSWER-Pulmonary embolism Acute Respiratory Distress Syndrome (ARDS) is characterized by what pathological change? - ANSWER-Breakdown of the alveolar-capillary membrane An anxious male complains of a sore throat, fever, chills, dental pain and dyspnea. the patient has a firm, red pronounced swelling in the sublingual anterior throat area and tongue. What diagnosis is most likely? - ANSWER-Ludwig's angina Patients on mechanical ventilation may have hypoxemia due to alveolar collapse from mucous plugging. The best treatment for this is: - ANSWER-Administer PEEP Anaphylaxis is most associated with which physiological event? - ANSWER- Vasodilation An elderly patient in an assisted living facility presents with a diminished level of consciousness and elevated white blood count. Assessment reveals pale, clammy skin and a urinary catherter with dark colored urine. Vital signs are P132, R 38 and shallow, BP 78/46, SpO2 91% and T 100.8°F (32.8°C). What classification of shock is the patient most likely experiencing? - ANSWER-Distributive Healthcare providers are assessing a patient with pronounced jugular vein distention and muffled heart tones. Vitals are P 128, R 26, BP 74/52. What classification of shock should be suspected? - ANSWER-Obstructive During compensatory shock, the renin-angiotensin-aldosterone system is activated to cause a/an: - ANSWER-Increase in preload, afterload and re-absorption of sodium A 42 year old patient with a history of rheumatoid arthritis is taking glucocorticoids. Over the past two weeks, she complains of chronic fatigue, weakness, and loss of appetite with weight loss. Lab results indicate hyponatremia and hyperkalemia. What underlying diagnosis is suspected? - ANSWER-Adrenal insuffiency Which condition should the healthcare provider consider to usually be a non-emergent, non-life threatening illness? - ANSWER-Thoracic outlet syndrome Healthcare providers should use extreme caution with nitroglycerin when ST elevation is present in which ECG leads? - ANSWER-II, III, aVF Which is a high-risk factor for intracerebral hemorrhage? - ANSWER-Cocaine drug abuse What is the initial treatment for a patient experiencing Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)? - ANSWER-Crystalloid IV fluid resuscitation What condition is most likely to cause respiratory acidosis? - ANSWER-narcotic overdose What is the most effective treatment for an unconscious patient in respiratory acidosis? - ANSWER-Assisted bag-mask ventilation An autoimmune disease which produces antibodies that mimic the role of TSH and cause an increase in thyroid hormones is: - ANSWER-Grave's disease Glucagon may not be effective treatment for a patient with hypoglycemia if they also have which underlying illness? - ANSWER-Alcoholism A 24 year old has completed a triathlon on a hot, humid day. The athlete complains of a severe headache, muscle cramps and abdominal pain. As the patient history is obtained, the athlete becomes lethargic. What underlying electrolyte disturbance should the healthcare provider most likely suspect? - ANSWER-Hyponatremia What is the sign on the ECG that will indicate a patient is experiencing hyperkalemia? - ANSWER-Peaked T waves An 82 year old alcoholic complains of nausea, non-bloody vomiting and severe epigastric and right upper quadrant pain that radiates to the back. Palpation reveals epigastric tenderness without peritoneal signs. What working diagnosis should be considered most likely? - ANSWER-Acute pancreatitis A 23 year old male complains of a productive cough, fever, chills and pleuritic chest pain that has worsened over 3 days. A physical exam reveals unilateral wheezing with shallow respirations. Vitals are P 128, R 26, BP 144/88, SpO2 90%, and T 102°F (38.8°C). What treatment should be performed? - ANSWER-Supplemental oxygen and immediate transport A patient with suspected gallbladder disease is asked to take a deep breath while the provider presses upward into the upper right quadrant. If the patient ceases inspiration due to increase pain while being examined, this is known as: - ANSWER-Muphy's sign The patient is alert and oriented presenting with hypotension, bradycardia, normal capillary refill and warm, dry skin. These are cardinal signs of which type of distributive shock? - ANSWER-Neurogenic During what period of the communicable disease process will antibodies begin to reach detectable levels and the infected blood will test positive for exposure to a pathogen? - ANSWER-Incubation The patient presents with a history of headache, weight loss, chest discomfort, night sweats and a persistent cough for several weeks. Which infectious disease is most likely occurring? - ANSWER-Tuberculosis A lethargic patient presents with dilated pupils and vital signs of P 122, R 26 and BP 130/80. He admits to excessive ingestion of diphenhydramine. What response is the cause for the presenting signs and symptoms? - ANSWER-Anticholinergic Organophosphate poisoning will present with which signs and symptoms? - ANSWER- Salivation and incontinence of urine and liquid stool What medication classification should be administered to an uncooperative, agitated patient? - ANSWER-Benzodizepine A patient presents with mildly decreased mental status, slow respirations, bradycardia, hypotension, has a blood sugar of 42mg/dl (2.3 mmol/L). This is most likely caused from excessive ingestion of: - ANSWER-Beta blockers The patient complains of a deep burning discomfort diffusely throughout the epigastrium. This is an example of which type of pain? - ANSWER-Visceral A 24 year old female presents with lower right quadrant abdominal pain. Her skin is hot to the touch and she exhibits a Psoa Sign. She complains of nausea and vomiting for 2 days. What diagnosis is suspected? - ANSWER-Appendicitis A known chronic alcoholic complains of the constant, severe mid-epigastric pain, nausea and blood-streaked emesis. The patient has a temperature of 101.9°F (38.8°C) and severe abdominal tenderness. What underlying diagnosis should be suspected? - ANSWER-Pancreatitis What component of a patient's past medical history is most helpful in considering myocardial infarction as a working diagnosis? - ANSWER-Familial heart disease history A patient describes an "aching" sensation in his chest. It occurred suddenly while resting and radiates to the jaw. He self administered 1 nitroglycerin tablet without relief and the 12 lead reveals a normal sinus rhythm with ST elevation in leads II, III, and aVF. What working diagnosis is most likely? - ANSWER-Inferior wall myocardial injury Healthcare providers are managing a patient presenting with substernal chest discomfort. They describe the pain as "pressure-like" and it radiates to the jaw and left arm. The discomfort subsides with rest, oxygen and administration of nitroglycerin. What is the most likely working diagnosis? - ANSWER-Myocardial infarction Hyponatremia - ANSWER-Is an electrolyte disturbance in which the sodium ion concentration in the serum is lower than normal. Hypovolemic Shock - ANSWER-cool,clammy,pale,cyanotic,decreased BP,ALOC,decreased cap. refill TX-20 ML/KG fluid challenge Life Threats - ANSWER-Upper Airway Obstruction (noise/swelling) Severe decrease in consciousness Ludwigs Angina - ANSWER-infection of the anterior neck below the mandible swelling of the tongue,drooling,airway obstruction Normal Capnography Reading - ANSWER-32-43 mm HG. Obstructive Shock - ANSWER-Decreased BP, difficulty breathing, tachycardia,tachypnea,JVD,decreased breath sounds,muffled heart tones. PEEP Common Settings - ANSWER-5-20 cm H2O PEEP - ANSWER-Positive End Expiratory Pressure delivered at the end of exhalation. Pericarditis S/S - ANSWER-sitting forward or sleep propped up with pillows fever,chills,fatigue,malaise, global ST elevation Pert. Negative & Positives - ANSWER-Recent Illness/Injury N/V Head Ache/Chills Abdom. Pain/Chest Pain/SOB Pedal Edema Stool & Urine Normal Eat & Drinking Normally Renin-Angiotensin - ANSWER-renin-angiotensin-tirggers vasoconstriction to vessels farthest away from vital organs, to keep perfusion going to brain,heart,lungs and liver causing other organs to become ischemic ABDOMEN: Boerhaaves Syndrome - ANSWER-Spontaneous rupture of the esophagus S/S - mediastinitis, sepsis, and shock. Swallowing often aggravates the pain ABDOMEN: Cholangitis - ANSWER-infection of the common bile duct; the tube that carries bile from the liver to the gall bladder ABDOMEN: Coffee Ground Emesis - ANSWER-Vomiting of partially digested blood - (GI BLEEDING) ABDOMEN: Colitis - ANSWER-Clostridium difficile (C. diff) a. s/s - n/v, foul smelling, watery, green, diarrhea, fever, loss of appetite, abd pain b. Tx - PPE, IV clean all equipment very good c. Antibiotic therapy, which suppresses the normal flora in the GI tract and allows C. diff to predominate ABDOMEN: Cullen Sign - ANSWER-bruising around the belly button that may indicate intra- abdominal bleeding or PANCREATITIS. -Cullen's got the belly button tattoos (bruises) and pancreas is in the middle ABDOMEN: Diverticultis - ANSWER-Diverticulum is a weak area in the colon that begins to have small outcroppings that turn into pouches. These become inflamed. ABDOMEN: Feculant Vomiting - ANSWER-- Foul Smelling vomit with a feculent odor- (BOWEL OBSTRUCTION) ABDOMEN: Gray turners sign - ANSWER-bruising in the flanks, indicative of pancreatitis ABDOMEN: Hemataemesis- - ANSWER-vomiting of blood-(UPPER GI BLEEDING) BRIGHT RED - INDICATIVE OF ACTIVE BLEEDING ABDOMEN: Hematochezia - ANSWER-bright red blood in the stool. (LOWER GI BLEEDING) INDICATIVE OF ACTIVE BLEEDING ABDOMEN: Hepatic Encephalopathy - ANSWER-Decreased brain function caused by diminished liver functions S/S: confusion, LOC, Coma, as a result of liver failure ABDOMEN: Identify the Signs/Symptoms and Treatment for the following medical condition: Appendicitis - ANSWER-INFLAMMATION OF THE APPENDIX: periumbilical pain. n/v, low grade fever, loss of appetite. Pain rlq, rebound tenderness -Fecal matter or other material accumulates in the appendix. Pressure builds and decreases blood flow. This causes an uncontrolled rise in bacteria TX: pain and anti nausea meds ABDOMEN: Identify the Signs/Symptoms and Treatment for the following medical condition: Bowel Obstruction - ANSWER-S/S: crampy abdominal pain, constipation or diarrhea, inability to pass flatus, distended abdomen, absent or high-pitched bowel sounds. tx: administer oxygen, place pt in comfortable position, establish iv, give nothing PO ABDOMEN: Identify the Signs/Symptoms of Gastroenteritis - ANSWER-Abdominal pain/tenderness, myalgia, and headache. Vomiting may occur, followed by colitis, which causes visible Blood in the stool. (3-7 days). Watery, yellow, green, or bloody stool, or stools containing pus. Also look for signs of dehydration or shock ABDOMEN: Kehrs Sign - ANSWER-Abdominal pain that radiates to the Left Shoulder, could indicate irritation of the DIAPHRAGM OR SPLEEN INVOLVEMENT (Irritants in the peritoneal cavity) -Steve Kerr shoots the ball goofy and from his abdomen to the left shoulder ABDOMEN: Liver Abscess - ANSWER-puss-filled mass inside the liver ABDOMEN: Mallory Weiss Syndrome - ANSWER--A condition in which the junction between the esophagus and the stomach (Cardiac Sphincter) tears, causing severe bleeding and potentially death -Secondary to eating disorders, caused by alcoholism, retching, coughing or vomiting. ABDOMEN: Melena - ANSWER-black tarry feces that contains digested blood - (UPPER GI BLEEDING). ABDOMEN: Murphy's Sign - ANSWER-Press firmly upward into the RUQ and ask the patient to take a deep breath. Arrest of inspiration because of pain is a positive finding. This could indicate a GALL BLADDER OR HEPATIC PROBLEM -Dale Murphy took a fastball in RUQ and knocked wind out of him (RUQ is where gall bladder is) ABDOMEN: Pancreatitis - ANSWER-S/S- pain to epigastric area or RUQ, radiate to back, n/v fever, tachycardia, hypotension, muscle spasms to ext, Cullen, grey turners TX:- IV, pain management. In the AMLS Patient Assessment Pathway - What is included in the Detailed Assessment Section? - ANSWER-History - OPQRST, and SAMPLER Secondary Survey - VS, Physical Exam of Body Systems Diagnostic - Glucose, EKG, O2 sat, etc. ASSESSMENT: In the AMLS Patient Assessment Pathway - What is included in the Ongoing Management? - ANSWER--Reassess, Refine Diagnosis, Modify Treatment -Patient Disposition ASSESSMENT: In the AMLS Patient Assessment Pathway - What is included in the Refine Differential Diagnosis Section? - ANSWER--Life Threatening - -Critical - -Non-Emergent - ASSESSMENT: In the AMLS Patient Assessment Pathway - What should you do if you discover new life threats? - ANSWER-Treat immediately!! BAD STUFF: Anthrax - ANSWER-a. Deadly bacterium that lies dormant in a spore. b. Routes are inhalation, cutaneous, or gastrointestinal BAD STUFF: Botulism - ANSWER-a. Nerve toxin caused by bacteria b. Usually caused by food poisoning or giving infants raw honey BAD STUFF: Ricin - ANSWER-a. Derived from castor beans b. Burning of mouth, throat, nausea, vomiting, diarrhea, and severe stomach pains BAD STUFF: Toxidrome - ANSWER-a. Symptoms of a class or group of similar poisonous agents b. i.e. - stimulants, narcotics (opiates), sympathomimetics, cholinergic, anticholinergic CARDIAC: Cardiac Output - ANSWER-a. The amount of blood that is pumped out by either ventricle b. Normal output for an average healthy adult is 5-6 L/min (CO = SV x HR) CARDIAC: Identify the Signs/Symptoms and Treatment for the following medical condition: Acute Myocardial Infarction - ANSWER-chest pain, sudden dyspnea, pulmonary edema, drop in BP, confusion nausea, lighthead, epigastric burning, tiredness, sweating Tx: 12 lead, o2, aspirin, nitro, morphine MONA CARDIAC: Identify the Signs/Symptoms and Treatment for the following medical condition: Angina Pectoris - ANSWER-chest pain TX: treat as a MI CARDIAC: Identify the Signs/Symptoms and Treatment for the following medical condition: Cardiac Tamponade - ANSWER-a. s/s - chest pain, drop in systolic BP, narrowing pulse pressure, JVD, muffled heart sounds b. Tx - airway, breathing, O2, IV a. Excessive fluid accumulates within the pericardium, limiting the heart's ability to expand fully after each contraction and resulting in reduced CO EXCESSIVE FLUIDS ACCUMULATE WITHIN THE PERICARDIUM CARDIAC: Identify the Signs/Symptoms and Treatment for the following medical condition: Left- Sided Heart Failure - ANSWER-extreme restlessness and agitation, confusion, severe dyspnea and tachypnea, tachycardia, elevated BP, crackles, possibly wheezes, frothy pink sputum, cannon A waves, distended neck veins, pedal edema Tx: 100 % 02, cpap, monitor, IV, morphine, nitro, diuretics CARDIAC: Identify the Signs/Symptoms and Treatment for the following medical condition: Right- Sided Heart Failure - ANSWER-abd distention, neck veins, distention of veins on surface of body Tx: make pt comfortable, semi-fowler, monitoring CARDIAC: Pericarditis - ANSWER-a. Acute inflammation of the pericardium that can last anywhere from several weeks to several months. b. Positional chest pain (often alleviated by sitting forward), shortness of breath, history of recent infection or fever. CARDIAC: ST Sement MI - ANSWER-Coronary Artery is totally blocked by a blood clot S/S - chest pain, sudden dyspnea, pulmonary edema, drop in BP, confusion nausea, lighthead, epigastric burning, tiredness, sweating TX - 12 lead, o2, aspirin, nitro, morphine CARDIAC: Stable Angina - ANSWER-i. Recurrent pattern of chest pain. ii. After a certain, predictable amount of exertion. iii. Often relieved with rest or medication CARDIAC: Unstable Angina - ANSWER-Occurs at REST, and is more severe than normal episodes of angina. i. Characterized by noticeable changes in frequency, severity, and duration of pain. ii. Often occurs without predicable stress. iii. May not be relieved with medication CARDIAC: What do you need to see on the monitor to be considered a STEMI? - ANSWER-a. ST segment elevation of 1 mm or more in two or more contiguous leads i. Inferior - II, III, aVF ii. Septal - V1 and V2 iii. Anterior - V3 and V4 iv. Lateral - V5 and V6 DISEASES: Epidemic - ANSWER-widespread transmission of a disease DISEASES: Epiglottitis - ANSWER-a. s/s - fever, sore throat, painful swallowing, stridor resp distress b. tx - immediate transport, maintain airway c. Inflammation of the epiglottis. Caused by a virus DISEASES: H1N1 - ANSWER-S/S- fever,shaking, chills, muscle pain, malaise, loss of appetite, dry cough TX: mask, IV, supportive care -Virus aka Influenza A DISEASES: Hepatitis A - ANSWER-a. Infectious hepatitis b. Most common type in US c. Transmission by fecal-oral route DISEASES: Hepatitis B - ANSWER-a. Serum hepatitis b. Transmitted through sexual contact, blood transfusion, or dirty needle stick DISEASES: DISEASES: Nosocomial Infection - ANSWER-An infection Acquired while at the hospital. DISEASES: Pandemic - ANSWER-a worldwide transmission (spread) of a disease DISEASES: Pertussis - ANSWER-bacterial disease that causes uncontrollable violent coughiing (whooping cough) a. uncontrollable violent coughing (Whooping cough) b. Infection caused by the bacteria DISEASES: Petechia - ANSWER-a. Small purplish, nonblanching spots on the skin b. Meningococcal meningitis DISEASES: PURPURA - ANSWER-a. Bruising of the skin b. Meningococcal meningitis DISEASES: Rocky Mountain Spotted Fever - ANSWER-a. Tick-borne disease caused by bacteria DISEASES: RSV - ANSWER-a. Leading cause of lower respiratory tract infections in infants, older people, and immunocompromised people -Respiratory virus that affects the lungs and breathing passages. can cause Pneumonia and Bronchiolitis in small children DISEASES: Rubella - ANSWER-a. German measles or 3-day measles b. Virus most commonly during the winter and spring c. Highly communicable by direct contact with nasopharyngeal secretions, droplet spread, or patient belongings recently infected with secretions DISEASES: Tetanus - ANSWER-a. Disease caused by spores that enter the body through a puncture wound contaminated with animal feces, street dust, or soil. b. S/S include pain at wound site, painful muscle contraction in neck and trunk muscles DISEASES: Tuberculosis - ANSWER-S/S: persistent cough for more than 3 weeks plus one or more of the following: night sweats, headache, fever, fatigue, weight loss, hemoptysis, hoarseness, chest pain TX: - mask, 02, vent support, transport. c. Not highly communicable d. Infection that can progress to a disease characterized by a persistent cough plus night sweats, headache, weight loss, hemoptysis, and/or chest pain ENDOCINE: Cushings Syndrome- - ANSWER-S/S- hyperglycemia, obesity, hypertension, and electrolyte imbalances -Caused by an excess of cortisol production by the adrenal glands or by excessive use of corticosteroid hormones "buffalo hump" or "moon face" ENDOCRINE: Addisons Disease - ANSWER-S/S- hypoglycemia, hypotension, hyperkalemia, hyponatremia, and emaciation b. Primary adrenal insufficiency - atrophy or destruction of both adrenal glands, leading to deficiency of all the steroid hormones these glands produce ENDOCRINE: Adrenal Crisis - ANSWER-a. Adrenal insufficiency accompanied by hypotension b. Adrenal insufficiency is when the body's needs for glucocorticoids and mineralocorticoids is not met ENDOCRINE: Chvosteks Sign - ANSWER-- tap the facial nerve against the mandibular bone just anterior to the ear, which produces an abnormal ipsilateral spasm of the facial muscles. (MUSCULAR IRRITABILITY CAUSED BY HYPOCALCEMIA) -cheeks. Tap them and another part of the face will twitch. -calcium is for strength and the spasm occurs due to lack of strength. ENDOCRINE: Comopare and Contracst the signs and symptoms and treatment for hypoglycemia, hyperglycemia, DKA and HHNS? - ANSWER-Hypoglycemia- Abnormally low Blood surgar (<45mg/dl), usually results from too much insulin, too little food or both. S/S- headache, confusion, memory loss, slurred speech, seizure/coma. Tx- D10, oxygen, oral glucose if can swallow, txp. Hyperglycemia- abnormally high bsg (>120mg/dl). The body cannot use glucose and turns it to other energy sources (fat) - S/S depends on level of sugar. Tx- 100% oxygen, assisted ventilations prn, monitor vitals, saline bolus 20ml/kg DKA- a plasma concentration of >350mg/dl, and often associated with electrolyte imbalance. S/S-n/v, abd pain, tachypnea, fruity breath odor, fatigue, increased diuresis, altered loc, seizures. Tx- 3-6liters of fluid during initial resuscitation, monitor, iv. DKA cant reverse without insulin therapy. HHNK- may not be able to differentiate between DKA and HHNK in field, but is more common in pts with type 2 Diabetes and is triggered by the same stressors that cause DKA. (bsg >600mg/dl), absent ketone production. S/S- fever dehydration, vomiting and abd pain, tachycardia, rapid breathing, thirst, polyuria, oliguria, polydipsia, focal seizures, altered loc. Tx- same as DKA ENDOCRINE: Diabetic Ketoacidosis - ANSWER-S/S- polyuria, polydipsia, polyphasia, n/v, tachycardia, deep rapid resp, dry mucous membrane, fruity odor on breath, abd pain, hypotension, fever TX: begin rehydration, monitor T waves- sodium bicarb a. Untreated hyperglycemia which is associated with predominately in people with Type I diabetes. b. Certain acids build up in the body because insulin is not available. c. Common causes include infection, injury, alcohol use, emotional discord, stroke, and MI ENDOCRINE: Exophthalmos - ANSWER-BUG EYES -Graves disease - Protrusion of the eyes from the normal position within the socket ENDOCRINE: Graves Disease - ANSWER-aka diffuse toxic goiter, is the most common form of Hyperthyroidism (bug eyed) -an autoimmune disorder in which antibodies that mimic the role of TSH produce an increase in secretion of thyroid hormones ENDOCRINE: HHNS, HONK - ANSWER-S/S: blood sugar > than 500, acute confusion, dehydration, dizziness, polydipsia TX: vitals, 12 lead, capnography CAUSES: infection, hypothermia, cardiac disease, pancreatitis, stroke d. Metabolic derangement that occurs in patients type 2 diabetes e. Hyperglycemia, hyperosmolarity, absence of ketosis ENDOCRINE: Hyperthyroidism - ANSWER-a. s/s - exophthalmos, hyperactive reflexes, Chvostek's sign ENDOCRINE: Hypoparathyroidism - ANSWER-a. s/s - bradycardia and trousseau's sign ENDOCRINE: Hypothryoidism - ANSWER-a. s/s - CHF, myxedema, hyponatremia, and hypoglycemia ENDOCRINE: cold, without sensation. Tx: opt to leave if frozen, get out of cold, do not rub or massage, elevate, pain meds, cover blisters with dry sterile dressing, rewarm appropriately MED EMERGENCIES: Identify the Signs/Symptoms and Treatment for the following medical condition: Ectopic Pregnancy - ANSWER-abd pain, referred shoulder pain, vaginal bleeding, Cullen or grey turners sign Tx: Airway, highflow 02, left lateral recumbent, IV, p warm, monitor, transport MED EMERGENCIES: Identify the Signs/Symptoms and Treatment for the following medical condition: Mild, Moderate, Severe Hypothermia - ANSWER-stumbles, mumbles,fumbles, grumbles mild: >93.2 passive rewarming. Remove wet clothes, blankets and warm fluids mod- 86-93.2 warm IV fluids and commercial warming devices severe<86 warming at hospital MED EMERGENCIES: Identify the Signs/Symptoms and Treatment for the following medical condition: Sepsis - ANSWER-SYSTEMIC INFECTION MED EMERGENCIES: Identify the Signs/Symptoms and treatment of Salicylate Poisoning - ANSWER- hyperthermia,burning sensation in mouth or throat, change in level of consciousness, petechiae, rash, hives, hyperventilation, nausea, vomiting thirst,tinnitus,diaphoresis,hearing loss,motor weakness, vasodilation and hypotension respiratory depression to respiratory arrest metabolic acidosis MED EMERGENCIES: Identify the Signs/Symptoms of an Opiate Overdose - ANSWER-euphoria or irritability, diaphoresis,tremors,miosis, abdominal cramps, n/v, hyperthermia, cns depression resp depression, hypotension ,bradycardia, tachcardia, pulmonanary edema. MED EMERGENCIES: Identify the Signs/symptoms of Organophosphate Poisoning - ANSWER-SLUDGE BBM (NEW)- Salivation, Lacrimation, Urination, Defecation, GI Distress, Emesis, Bronchoconstriction, Bradycardia, Miosis NEUROLOGIC: Absent Seizures (Petit Mal) - ANSWER-generalized seizures that involve a brief loss of attention without abnormal body movement. (staring to space briefly) NEUROLOGIC: ATAXIA - ANSWER-Alteration of a person's ability to perform coordinated motions, such as walking NEUROLOGIC: Babinski Sign - ANSWER-Take a pen or similar dull object and run it along the lateral length of the sole of the foot. Normal reaction to this stimulation is for the toes to move downward (plantar flexion). A positive BABINSKI TEST is indicated by abnormal extension of the great toe and fanning of the remaining toes, (dorsiflexion), which suggests NEUROLOGIC DYSFUNCTION. NEUROLOGIC: Biots Respirations - ANSWER-Irregular pattern, rate, and depth of breathing with intermittent periods of apnea; results from increased intracranial pressure that bitch is irregularly crazy and she keeps going apneic NEUROLOGIC: Brudzinski Sign - ANSWER-Involuntary flexing of the legs in response to flexing of the neck. A possible sign—MENINGEAL IRRITATION -bud bundy does crunches involuntarily by flexing his neck (hands behind head) NEUROLOGIC: Cheyne-Stokes Respirations - ANSWER-Gradually increasing rate and depth of respirations followed by a gradual decrease of respirations with intermittent periods of apnea; associated with brainstem insult -chain links gradually increase in size and eventually skip a link (chain is the brainstem) NEUROLOGIC: Complex Febrile Seizures - ANSWER-longer lasting (longer than 15 minutes), focal, or occur in a child with baseline developmental or neurologic abnormality. may also be associated with serious illness NEUROLOGIC: Complex Partial Seizures - ANSWER-Focal Motor Jerking WITH loss oc consciousness NEUROLOGIC: Cushings Triad - ANSWER-Systolic Hypertension, Bradycardia, Irregular Respiratory Pattern, Indicates INCREASED (ICP) NEUROLOGIC: Describe the components of The Cushings Triad. - ANSWER-Systolic Hypertension, Bradycardia, Irregular Respiratory Pattern, Indicates INCREASED (ICP) NEUROLOGIC: Epidural Hematoma - ANSWER-blood between the inner table of the skull and the Dura Mater. Usually caused by trauma, and is nearly always a skull fracture, usually in the area of the middle meningeal artery of the skull. -may or may not have LOC, or may lose consciousness and then awaken for a period of time until they go unresponsive. -severe headache, ams, n/v, unilateral dilated pupil. NEUROLOGIC: Febrile Seizures - ANSWER-seizure brought on by a spike in body temperature, usually occurs in young children (6mo-6 y/o) NEUROLOGIC: Grand-Mal Seizures - ANSWER-generalized tonic-clonic seizures, which involve jerking of both arms and/or legs NEUROLOGIC: Guillian Barre Syndrome - ANSWER-a. Progressive muscle weakness and paralysis move up the body from the feet, can result in ineffective breathing if the paralysis reaches the diaphragm NEUROLOGIC: Identify the complications of Meningitis - ANSWER-(older children and adults)- lethargy, recurring headaches, difficulty in concentration, short-term memory loss, clumsiness, balance problems, depression, aggression, mood swings, learning difficulty NEUROLOGIC: Identify the LOCATION and FUNCTION of the Lobes of the Brain? - ANSWER-lobes correspond to the bone they are under ex: frontal lobe under frontal bone frontal lobe-controls motor function, determines personality, elaborates thought and speech parietal-interprets bodily sensations temporal- long term memory and interprets sound occiptal-sight NEUROLOGIC: Identify the Signs/Symptoms and Treatment for the following medical condition: Epidural Hematoma - ANSWER-a. s/s - coma, decerebrate posturing, one pupil fixed and dilated on the side of the injury b. tx - supportive care, transport, pt will probably need surgery NEUROLOGIC: Identify the Signs/Symptoms and Treatment for the following medical condition: Meningitis - ANSWER-a. s/s - upper resp infection, headache, nuchal rigidity, fever and chills, photophobia, vomiting, seizures, confusion, kernig and brudzinski sign. b. Tx - mask for them and you, supportive, follow up. If bacterial, pmdc may need to go on antibiotics. NEUROLOGIC: Subdural Hematoma - ANSWER-blood between the Arachnoid Membrane of the Dura Mater. the hematoma may be acute, subacute, or chronic. The patient may present with a LOC, or amnesia, headache, and weakness. (20% Mortality) BLOOD BELOW THE INNER LAYER OF THE DURA MATER NEUROLOGIC: Sub-Arachnoid Hemorrhage - ANSWER-A kind of hemorrhagic stroke that occurs when arteries on the brain's surface bleed into the subarachnoid space, the area between the pia mater and the arachnoid. -should be suspected in patients who have a sudden onset of severe EXPLOSIVE headache, LOC and elevated BP. NEUROLOGIC: Wernicke Encephalopathy - ANSWER-A neurologic disorder which may be exacerbated by the sudden administration of IV dextrose. Confusion and dementia are partially reversible i. Administer thiamine NEUROLOGIC: What are Migraines and what are the S/S? - ANSWER-a. s/s - cognitive or visual disturbances, dizziness, nausea, vomiting. b. severe, recurrent headaches accompanied by incapacitating neurologic symptoms NEUROLOGIC: Identify the Signs/Symptoms and Treatment for the following medical condition: Encephalitis - ANSWER-S/S: fever, flu like symptoms, photophobia, lethargy, altered loc, stiff neck Tx: place mask on them, follow local protocol. PAIN: Define and give examples of various types of abdominal pain (Visceral, Somatic, Referred, Pleuritic) - ANSWER-Somatic pain- Well LOCALIZED and described as sharp in nature. comes from skin and muscle as well as joints, ligaments, tendons Visceral pain- Originates within the chest and abdomen, and is often described as heaviness, pressure, aching, or burning that is NOT EASY TO PIN POINT! Visceral pain may also radiate to other areas of the body. It comes from organs inside the body with injury or illness. Referred- Pain felt at a site different from that of an injured or diseased organ or body part Pleuritic- Inflammation of visceral or parietal pleura, causing a sudden onset of chest pain. Parenteral - ANSWER-Meds given as IV's or infusions RESPIRATORY: Acute Respiratory Distress Syndrome - ANSWER-a. Diffuse damaged to the alveoli, perhaps from shock, aspiration pulmonary edema or a hypoxic event. i. Washes away surfactant and alveoli become non-compliant RESPIRATORY: Compare and contrast the signs and symptoms and treatment for Respiratory distress and respiratory failure - ANSWER-If the patient improves with simple resuscitation maneuvers, then respiratory distress is the answer. If the patient does not improve with basic interventions, or if any patient with respiratory distress has signs of fatigue, altered mental status, RESPIRATORY FAILURE IS IMMINENT! S/S Impending Respiratory Failure include: RR >30 or <6 breaths/min, O2 Saturation <90%, Use of multiple accessory muscle groups, Inability to lie supine, Tachycardia >140 bpm, Mental Status Changes, Inability to clear secretions/mucus, Cyanosis of nail beds. RESPIRATORY: Contrast the Signs/Symptoms of Hypoventilation and Hyperventilation? - ANSWER- hypoventilation-weakness, breathing diff, aloc hyperventilation-paresthesia of the face or lips, lightheadedness, dizziness, muscular pain cramps RESPIRATORY: Identify the Signs/Symptoms and Treatment for the following medical condition: Tension Pneumothorax - ANSWER-absent breath sounds on affected side, unequal chest rise, pulsus paradoxus, tachycardia, dysrhythmias, JVD, narrow pulse pressure, JVD, tracheal deviation - blood return to the heart from vena cava is obstructed and leads to decreased preload and ultimately decreased cardiac output TX: needle decompression RESPIRATORY: Identify the Signs/Symptoms and Treatment for the following medical condition: Asthma - ANSWER-runny nose, NO fever, wheezing,coughing,tachypnea,tachycardia Tx: o2, breathing tx, steroid, and supportive care RESPIRATORY: Identify the Signs/Symptoms and Treatment for the following medical condition: COPD - ANSWER-TX: breathing treatment, o2, cpap RESPIRATORY: Identify the Signs/Symptoms and Treatment for the following medical condition: Pneumothorax - ANSWER-S/S - sudden onset, absent breath sounds, unequal chest rise, pulsus paradoxus, tachycardia, dysrhythmias, JVD, narrow pulse pressure, tracheal deviation TX: needle decompression RESPIRATORY: Identify the Signs/Symptoms and Treatment for the following medical condition: Pulmonary Edema - ANSWER-S/S - sudden onset, no fever, and bilateral lung findings, crackles in the bases of the lungs, progresses to higher lung fields, cough up pink sputum TX: - cpap RESPIRATORY: Identify the Signs/Symptoms and Treatment for the following medical condition: Pulmonary Embolus - ANSWER-sudden dyspnea and cyanosis, sharp pain the chest, cyanosis does not resolve with 02 therapy. Tx:supportive, 02, immediate transport -Blood clot or other embolus lodges in the pulmonary artery and prevent blood flow through that branch. RESPIRATORY: Jugular Vein Distention (JVD) Causes? - ANSWER-a. From right sided heart failure; causes include: i. Pulmonary Embolus ii. COPD iii. Pulmonary Hypertension RESPIRATORY: Pulmonary Embolism - ANSWER-any blockage that compromises pulmonary circulation c. Blood clot or other embolus lodges in the pulmonary artery and prevent blood flow through that branch. RESPIRATORY: Pulsus Paradoxus - ANSWER-a. Decompensated COPD, severe pericardial tamponade, tension pneumothorax, and severe asthma attack. i. Systolic blood pressure drops more than 10 mm Hg during inhalation ii. A change in pulse quality or even the disappearance of a pulse may be noted RESPIRATORY: RESPIRATION- - ANSWER-a. Passage of oxygen into the blood and carbon dioxide into the alveoli b. Assessed by pulse oximetry RESPIRATORY: VENTILATION- - ANSWER-a. Mechanical movement of air into and out of the lungs b. Assessed by capnography SHOCK: Anaphylactic Shock - ANSWER-Widespread dilation (systemic) HISTAMINE RELEASE SHOCK: SHOCK: Pulse pressure - ANSWER-a. Systolic BP - Diastolic BP b. Narrowing pulse pressure is a sign of impending shock SHOCK: Septic Shock - ANSWER-Systemic Infection STAGES OF SHOCK: 1st - ANSWER-HR: NORMAL RESP: NORMAL CAP REFILL: NORMAL BP: NORMAL STAGES OF SHOCK: 2nd - ANSWER-HR: >100 RESP: UP CAP REFILL: >2 SECONDS BP: ORTHOSTATIC CHANGES STAGES OF SHOCK: 3rd - ANSWER-HR: >120 RESP: UP CAP REFILL: >3 SECONDS BP: <90 SYSTOLIC STAGES OF SHOCK: 4th - ANSWER-HR: >130 RESP: UP CAP REFILL: >3 SECONDS BP: <80 SYSTOLIC Thrombocytopenia - ANSWER-blood has low number of platelets TRAUMA: Disseminated Intravascular Coagulation (TWO STAGES) - ANSWER-a. Life-threatening condition found with severe trauma b. Two stages i. Free thrombin and fibrin deposits in the blood increase, and platelets begin to aggregate. ii. Uncontrolled hemorrhage results from the severe reduction in clotting factors A 19-year-old female is flushed, itchy, and wheezing after eating crab legs. Her vital signs are BP 90/64 mm Hg, P 128 bpm, R 24 breaths/min. Which intervention is indicated first? - ANSWER-Epinephrine intramuscular A 2-year-old male is found chewing on berries from a lily of the valley plant. Predict his vital signs. - ANSWER-BP 70/50 P 70 bpm A 22-year-old female is found at a party unresponsive and breathing approximately 8 breaths/min. Her skin is gray. Which of the following signs or symptoms will confirm your suspicion that the opioid toxidrome is causing her emergency? - ANSWER-Pupils 2 mm and equal A 22-year-old male complains of a 2-day history of abdominal pain. His skin is flushed, and he has a fruity odor on his breath. Assessment reveals BP 106/54 mm Hg, P 128, R 28, glucose 568 mg/dL. Your highest priority intervention would be to: - ANSWER- Infuse normal saline rapid IV A 22-year-old patient at a restaurant is complaining of abdominal pain and diarrhea. Her skin is flushed, and she feels faint. Her vital signs are: BP 98/50, P 124, R 24. Which finding in her SAMPLER history is most likely to guide your differential diagnosis for this patient? - ANSWER-Illness began about 10 minutes after eating A 23-year-old female has an acute onset of left flank pain. You should investigate which of the following regarding her pain? - ANSWER-Dysuria A 24-year-old female took 24 diphenhydramine tablets. Her vital signs are BP 86/54 mm Hg, P 110 bpm, R 20/min. What other sign or symptom should you anticipate. - ANSWER-Seizures A 24-year-old male complains of sudden explosive headache . He asks you to lower the lights. He has vomited once. Which of these findings would increase your index of suspicion for subarachnoid hemorrhage? - ANSWER-Stiff neck A 24-year-old male injuries in a shallow diving incident. Which assessment finding would you anticipate if he is developing neurogenic shock? - ANSWER-Heart rate 58 bpm A 25-year-old helmeted female was thrown from a horse. She is complaining of weakness in her upper extremities. You ask her to close her eyes and identify whether you are moving her thumb up or down. She is unable to do so. This indicates she does not have normal: - ANSWER-Proprioception A 25-year-old woman was involved in a motor vehicle collision. Her initial vital signs were BP 122/80 mm Hg, P 128 bpm, R 20 breath/min. Which of the following findings on repeat assessment would indicate that she is developing shock? - ANSWER-Pulse pressure 32 mm Hg A 32-year-old complains of headache and dizziness. He vomited once and is walking with a staggering gait. His blood pressure is 148/72, pulse 92, respirations 20. He has a steady stare up toward his right ear. Which sign or symptom makes you consider intracerebral hemorrhage more strongly than migraine headache as a cause of his emergency? - ANSWER-Abnormal gaze A 33-year-old male has right lower quadrant abdominal pain and vomiting. Five minutes after you administer a dose of ondansetron, he vomits forcefully. His vitals are now BP 102/72, P 52, R 20. The alteration in his vital signs is likely related to: - ANSWER-Vagal stimulation A 40-year-old male has chest pain reported as an "elephant sitting on my chest." He confides that he snorted cocaine 5 minutes before his pain began. You should first administer: - ANSWER-Lorazepam, 2 mg IV A 42-year-old male complains of a gnawing, sever pain in the epigastric area that radiates to his back. His vital signs are T 102*F, BP 94/68, P 128, R 24. Your highest priority intervention would be to administer: - ANSWER-Normal saline, 250 mL bolus A 43-year-old male with diffuse abdominal pain and vomiting has a yellowish discoloration of his sclera. This indicates he has excess serum: - ANSWER-Bilirubin A 44-year-old male is postictal after a witnessed grand mal seizure. He is arousable to light pain and is presently snoring. His vital signs are BP 142/86, P 120, R 20, Sa02 98%. You should: - ANSWER-Insert a nasopharyngeal airway A 45-year-old female complains of right upper quadrant abdominal pain. To help confirm your differential if you suspect cholecystitis you should: - ANSWER-Ask her to take a deep breath as you press upward into her right upper quadrant A 45-year-old male complains of severe epigastric pain radiating to his back. He has vomited several times. His history is significant for alcohol abuse and hypertension. You suspect an inflammatory condition of a gastric accessory organ. To confirm your differential on physical exam you should assess for: - ANSWER-Psoas sign A 45-year-old male with a history of hypertension complains of chest "pressure," about a 5 on a scale of 1 to 10, for 20 minutes. He just "wants to be checked out." Vitals signs and 12-lead ECG are normal. You have already administered oxygen and aspirin. You should next: - ANSWER-Administer nitroglycerin 0.4 mg sublingual. A 47-year-old female is anxious and complaining of heart palpitations. She reports a recent diagnosis of "thyroid problems." On exam you note exophthalmos. Her vital signs are BP 108/72 mm Hg, P 128 bpm, R 20/min. Interventions should include administration of: - ANSWER-Intravenous fluids A 52-year-old male with a history of alcoholism complains of pleuritic chest pain. He states the pain increases when he swallows. He appears very ill and has subcutaneous emphysema around his neck. You suspect: - ANSWER-Boerhaave's syndrome A 56-year-old female experiences a sudden onset of headache and blurred vision during yoga class. Her right eyelid is drooping, and the pupil on that side is small compared to the left pupil. You should take her to a hospital with: - ANSWER- Specialized neurologic and vascular capability The most common sign or symptom found in patients with pulmonary embolism is: - ANSWER-increased respiratory rate The primary mechanism for septic shock is: - ANSWER-Widespread inflammatory response What findings should you anticipate on the physical examination of a patient with Cushing's syndrome? - ANSWER-Blood glucose 180 mg/dL (10 mmol/L) What treatment should you anticipate in a patient with a history of Addison's disease who has the following vital signs: BP 94/58 mm Hg, P 124 bpm, R 20/min? - ANSWER- Hydrocortisone When assessing your patient's medication history, which would indicate the patient may have a preexisting ulcer? - ANSWER-Famotidine When serum glucose drops below 70 mg/dL (3.9 mmol/L), which of the following occurs? - ANSWER-Epinephrine secretion increases When you use an interpreter to question a 42-year-old female about her abdominal pain, what is the best way to ensure information has been conveyed accurately and completely? - ANSWER-Let the patient write her answers, and have the interpreter restate them so you will have a recored of her statements for your report. (yeah right) Which agency oversees the compliance, tracking and reporting, and guidelines for preventing transmission of bloodborne pathogens in the workplace? - ANSWER-OSHA Which assessment evaluates at least one aspect of cranial nerve function? - ANSWER- Cincinnati Prehospital Stroke Scale Which assessment finding(s) should you anticipate in a patient who has myxedema? - ANSWER-Dry yellow skin Which diagnostic test most accurately assesses the presence and magnitude of anaerobic metabolism? - ANSWER-Lactic acid Which gland is responsible for some of the vasoconstriction in shock? - ANSWER- Pituitary Which intervention for patient in shock prevents an increase in myocardial oxygen demand? - ANSWER-Maintain normal body temperature Which is the most reliable indicator that ventilation should be assisted in a patient with altered mental status? - ANSWER-End-tidal CO2 is 60 mm Hg Which of the following biological warfare agents causes serious neurologic symptoms that may include paralysis? - ANSWER-botulism Which of the following describes a behavior that represents normal mental status? A person who: - ANSWER-Is drowsy and slow to respond to questions after awakening from a nap. Which of the following findings indicates the need to increase the rate of ventilation in a intubated patient you suspect to have an epidural hematoma? - ANSWER-Unilateral blown pupil Which of the following is an occupational exposure incident? - ANSWER-Blood sprays in your face when a child with a face laceration sneezes Which of the following patients is at highest risk for pericardial tamponade? - ANSWER- 55-year-old with end-stage lung cancer Which of the following physical findings points most specifically to increased intracranial pressure? - ANSWER-Respiratory rate is 8 and irregular. Which patient is at highest risk for non traumatic obstructive shock? - ANSWER-22- year-old who is 38 weeks pregnant Which patient would be an appropriate candidate for immediate intravenous administration of sodium bicarbonate? - ANSWER-45-year-old who complained of chest pain and is now in cardiac arrest and unresponsive to treatment Which sign or symptom can help diagnose headache from meningococcal meningitis? - ANSWER-Petechial rash Which source provides the most detailed information related to hazardous materials? - ANSWER-Material Safety Data Sheets While treating a trauma patient, you lacerate your hand. Your bleeding hand comes in contact with the blood of the patient. What action is most important to increase your chance of appropriate follow-up? - ANSWER-Notify the receiving facility and your designated infection control officer immediately. You are transferring a 65-year-old female with renal failure from the nursing home. She has a history of "abnormal lab values" and is drowsy and weak. You note the following lab values: serum calcium 10.0 mg/dL (0.55 mmol/L), pH 7.28, potassium 6.1 mEq/L. The patient goes into cardiac arrest after you load her into the ambulance. After epinephrine, you should first consider giving her: - ANSWER-Magnesium sulfate You are treating a patient who has been diagnosed with herpes simplex type 1. He exhibits no signs or symptoms at this time. He is in which stage of the communicable disease? - ANSWER-Latent You evaluate the patient's environment to assess for: - ANSWER-all of the above; Safety concerns, Room Temp, Assistive devices You respond to a warehouse for "multiple patients with difficulty breathing." From a hallway, you see your patient lying in a room with two other people who don't seem to be breathing. He calls out to you, saying he can't breathe. You should first: - ANSWER- Stage at a safe distance. Your adolescent patient presents with a fever, malaise, sneezing, and paroxysmal spasmodic coughing phases. Which infectious disease would you suspect? - ANSWER- Pertussis Your patient complains of discomfort in his hand as you inflate the cuff to asses the blood pressure. You note flexion of the wrist and adduction of his fingers. What endocrine disorder do you suspect? - ANSWER-Hypoparathyroidism Your patient is agitated and sweaty. Her vital signs are BP 107/108 mmHG, P 132 bpm, and R 20/min. Her pupils are dilated, and her hands are trembling. These signs and symptoms may be associated with: - ANSWER-Alcohol withdrawal Your patient is complaining of a cramping pain around her umbilical area that "won't let up." This is most suggestive of disease involving the: - ANSWER-Appendix Your patient is reported is reported to have taken an overdose. She has a history of anxiety disorder and depression. She is unresponsive, and vital signs are BP 110/70, P 125 bpm, R 20/min. Her ECG shows right bundle branch block. You expect she has taken: - ANSWER-Amilytriptyline