Emergency Medical Procedures and Assessments, Exams of Nursing

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Jones and Bartlett EMT

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The tidal volume of an unresponsive patient is rapidly assessed by: - Answer observing for chest rise during inhalation. Medications such as Albuterol (Ventolin) relieve respiratory distress by:

• Answer relaxing the smooth muscle of the bronchioles. A 22-year-old male has a shard of glass impaled in his cheek. You look inside his mouth and see minor bleeding. - Answer carefully stabilize the shard of glass and allow him to suction his own mouth. Which of the following processes occurs during inhalation? - Answer The intercostal muscles and diaphragm both contract.

Which of the following statements regarding artificial ventilation of an apneic patient who has dentures is correct? - Answer Tight-fitting dentures should be left in place because they facilitate the delivery of adequate tidal volume. After an adult cardiac arrest patient has been intubated by a paramedic, you are providing ventilations as your partner performs chest compressions. When ventilating the patient, you should: - Answer deliver each breath over 1 second at a rate of 10 breaths/min. A 60-year-old woman has severe respiratory distress. She is conscious, but confused, and can only say two words at a time. Which of the following would be the MOST appropriate treatment for her? - Answer Ventilation with a bag-valve-mask device. In which position would you place an uninjured, unresponsive patient with a respiratory rate of 14 breaths/min and adequate tidal volume? - Answer Lateral Recumbent Which of the following airway sounds indicates a lower airway obstruction? - Answer Wheezing A 50-year-old woman presents with acute shortness of breath. Her skin is pale and she is anxious. You should: - Answer administer high-flow oxygen and assess the adequacy of her breathing.

Ventilation is defined as the: - Answer Movement of air into and out of the lungs You are assessing a middle-aged male who is experiencing respiratory distress. The patient has a history of emphysema and hypertension. He appears fatigued; has weak retractions; and demonstrates labored, shallow breathing. Your MOST immediate action should be to: - Answer ventilate him with a bag-valve-mask device. Tidal volume is defined as the: - Answer volume of air inhaled or exhaled per breath. Prior to your arrival, a woman experiencing an asthma attack took two puffs from her prescribed inhaler without relief. After administering supplemental oxygen, you should: - Answer contact medical control for further advice. A 50-year-old man, who fell approximately 20 feet and landed on a hard surface, is semiconscious. You should: - Answer stabilize his head while performing the jaw-thrust maneuver. A 60-year-old woman presents with acute respiratory distress. She is conscious and alert, but restless. Her respiratory rate is 26 breaths/ min with adequate chest expansion, her breath sounds are clear to auscultation bilaterally, and her oxygen saturation is 84%. Which of the

following is the MOST appropriate treatment for this patient? - Answer Supplemental oxygen with a nonrebreathing mask. In which of the following situations should the jaw-thrust maneuver be used? - Answer When the mechanism of injury is unknown. You are assessing an elderly man with respiratory distress. He is coughing up bloody sputum and has an oxygen saturation of 85%. You auscultate his breath sounds and hear coarse crackles in all lung fields. This patient MOST likely has: - Answer congestive heart failure. Snoring respirations in an unresponsive patient are MOST often the result of - Answer upper airway obstruction by the tongue. The method by which you administer supplemental oxygen to a hypoxemic patient depends MOSTLY on the: - Answer severity of hypoxemia and adequacy of breathing. Which of the following patients obviously needs positive-pressure ventilation assistance? - Answer Responsive to pain only; respiratory rate of 8 breaths/min and shallow An unresponsive 60-year-old male is apneic and has a weak, rapid pulse. His oxygen saturation reads 79%. You should: - Answer deliver one breath over 1 second every 5 to 6 seconds.

Which of the following clinical findings is MOST consistent with a chronic respiratory disease? - Answer A barrel-shaped chest Occasional, irregular breaths that may be observed in a cardiac arrest patient are called: - Answer agonal gasps. An apneic patient has severe facial trauma and bleeding in the oropharynx. How should this situation be managed? - Answer Alternate suctioning for 15 seconds and ventilations for 2 minutes. Oxygen that is administered through a nasal cannula would be of LEAST benefit to a patient who: - Answer breathes through his or her mouth. Which of the following occurs during positive-pressure ventilation? - Answer Intrathoracic pressure increases. A 60-year-old female is found unresponsive. She is cyanotic, is making a snoring sound, and has a slow respiratory rate. You should: - Answer manually open her airway An unresponsive apneic patient's chest fails to rise after two ventilation attempts. You should: - Answer immediately proceed to chest compressions.

Which of the following would MOST likely occur if an adult patient is breathing at a rate of 45 breaths/min with shallow depth? - Answer Most of his or her inahled air will not go beyond the anatomic dead space. At the peak of the inspiratory phase, the alveoli in the lungs contain: - Answer more oxygen than carbon dioxide. You are ventilating an apneic adult with a bag-valve-mask device and high-flow oxygen. Her pulse rate is 130 beats/min and she has cyanosis to her face and chest. The MOST reliable indicator of adequately performed ventilations in this patient is: - Answer a decrease in her heart rate to 90 beats/min. A 56-year-old man has labored, shallow breathing at a rate of 28 breaths/min. He is responsive to pain only. You should: - Answer insert a nasopharyngeal airway and begin assisting his ventilations. You are ventilating an apneic 50-year-old woman with a bag-valve-mask device. After squeezing the bag and noting visible chest rise, you should. - Answer allow the patient to completely exhale If the level of carbon dioxide in the arterial blood increases: - Answer the respiratory rate and depth increase

A patient's skin will MOST likely become cyanotic if he or she has: - Answer a decrease in the amount of arterial oxygen. Which of the following patients has signs of inadequate breathing? - Answer 41-year-old woman with shallow respirations of 14 breaths/min. When ventilating an unresponsive apneic adult with a bag-valve-mask device, you should ensure that: - Answer an airway adjunct has been inserted. Signs of inadequate breathing in an unresponsive patient include: - Answer cyanotic oral mucosa. Which of the following describes the correct technique for inserting a nasopharyngeal airway? - Answer Insert the device with the bevel facing the septum The respiratory system functions by: - Answer bringing oxygen into the lungs and eliminating carbon dioxide. A young female experienced massive facial trauma and is unresponsive. After several attempts, you are unable to adequately open her airway with the jaw-thrust maneuver. You should: - Answer carefully tilt her head back and lift up on her chin.

The process of loading oxygen molecules onto hemoglobin molecules in the bloodstream is called: - Answer oxygenation Patients with a hypoxic drive: - Answer are stimulated to breathe by low oxygen levels in the blood. A young woman overdosed on heroin and is unresponsive with slow, shallow breathing. She begins to gag after you insert an oropharyngeal airway. You should: - Answer remove the oropharyngeal airway and be prepared to suction her mouth. You are dispatched to a residence for an elderly female who has possibly suffered a stroke. You find her lying supine in her bed. She is semiconscious; has vomited; and has slow, irregular breathing. You should: - Answer manually open her airway and suction her oropharynx. A nonrebreathing mask is MOST appropriate to use on patients who: - Answer have an adequate rate and depth of breathing. During the inhalation phase of breathing: - Answer pressure within the thorax decreases and air is drawn into the lungs.

When ventilating an apneic patient, you note decreased ventilatory compliance. This means that: - Answer the lungs are difficult to ventilate. Which of the following would most likely cause a reduction in tidal volume? - Answer Unequal chest expansion. A 40-year-old man is conscious, but has an increased rate of breathing. You should - Answer assess the regularity and quality of breathing. In which position would you expect a patient with severe dyspnea to be found? - Answer Fowlers Sonorous respirations are MOST rapidly corrected by: - Answer Manually positioning the head. You receive a call for a 49-year-old woman who passed out. The patients husband tells you that they were watching TV when the incident occured. No trauma was involved. The patient is semiconscious and has cyanosis to her lips. After opening her airway with the head tilt- chin lift manuever, you should: - Answer insert a nasopharyngeal airway. Prior to applying a nonrebreathing mask on a patient with difficulty breathing and sings of hypoxemia, you should: - Answer prefill the reservoir bag to ensure a high oxygen concentration.

A 33-year-old female presents with acute respiratory distress. She is conscious but anxious, and tells you that she has a history of asthma. She took two puffs of her albuterol inhaler prior to your arrival, but states that it did not help. Her oxygen saturation reads 89% and you hear diffuse wheezing while auscultating her lungs. You should: - Answer administer high-flow oxygen, contact medical control to request permission to assist her with another albuterol treatment, and prepare for transport. A 35-year-old patient complains of shortness of breath. He is conscious and alert and is able to speak in complete sentences, although with slight difficulty. Assessment reveals diffuse wheezing to auscultation, a respiratory rate of 24 breaths /min, a heart rate of 110 beats/ min, and an oxygen saturation of 96%. Which of the following interventions would be of most benefit to this patient? - Answer Inhaled bronchodilator. Which of the following patients is the BEST candidate for an oropharyngeal airway - Answer an unresponsive trauma patient with blood draining from the nose. Assessment of a 40-year-old patient reveals respiratory distress, tachycardia, audbile expiratory wheezing, and an oxygen saturation of 88%. The EMT should suspect: - Answer diffuse bronchoconstriction.

During your assessment of a trauma patient, you note massive facial injuries, weak radial pulses, and clammy skin. What should be your MOST immediate concern? - Answer Potential obstruction of the airway. Which of the following ventilation techniques will enable you to provide the greatest tidal volume AND allow you to effectively assess lung compliance? - Answer One-rescuer mouth-to-mask ventilation. You are administering oxygen at 15 L/min to a patient with respiratory distress. If you are using a D cylinder (cylinder constant, 0.16), which reads 1500 psi, how long will it take before you need to replace the oxygen cylinder? - Answer 14 minutes. While you are inside a crashed vehicle assessing a patient who is entrapped, the rescue team should be: - Answer assessing exactly how the patient is trapped and determining the safest way to extricate him or her. The set of regulations and ethical considerations that define the extent or limits of an EMT's job is called: - Answer the scope of practice. Which of the following is the MOST practical method of standard precautions when treating multiple patients during a mass-casualty incident? - Answer Changing your gloves in between contact with different patients.

The EMT should avoid focusing all of his or her attention on a single critical patient during the triage process because: - Answer other patients may die from causes that could have been prevented. You are called to transport a patient with terminal lung cancer from a skilled nursing facility to the emergency department for evaluation of possible pneumonia. As you are reviewing the transfer paperwork, you see that the patient has a valid "do not attempt resuscitation" order. During transport, you should: - Answer provide supportive care, such as oxygen, and keep the patient comfortable. A patient presents with severe bradycardia, hypersalivation, vomiting, and excessive tearing. Which of the following agents would MOST likely cause his signs and symptoms? - Answer Soman. You are called to treat a 55-year-old man who is experiencing difficulty breathing. After making contact with your patient, he extends his arm out to allow you to take his blood pressure. This is an example of: - Answer actual consent During the triage process, which of the following injuries or conditions would classify a patient as a high priority? - Answer A large avulsion to the arm and altered mental status.

While you are caring for an emotionally disturbed 30-year-old male, he suddenly becomes violent and needs to be physically restrained. During the restraint procedure, you should: - Answer maintain close communication with him and closely manage his airway. You are giving a presentation to a group of laypeople on the importance of calling EMS immediately for cardiac arrest patients. Which point should you emphasize the MOST? - Answer CPR and defibrillation are key factors in patient survival. How does a unified incident command system differ from a single incident command system? - Answer In a unified incident command system, plans are made in advance by all agencies that assume a shared responsibility for decision making. The safest emergency vehicle operator is one who: - Answer drives with due regard. Failure of the EMT to obtain consent from a responsive patient before taking his or her blood pressure may constitute: - Answer battery. While functioning at a large-scale terrorist incident, it is important for the EMT to: - Answer use triage and base patient care on available resources.

Following a call in which a 6-week-old infant in cardiac arrest did not survive, your partner is exhibiting significant anxiety and irritability. How can you MOST effectively help him? - Answer Allow him to voice his feelings to you. You receive a call at 3:00 a.m. for a patient who is slumped over the steering wheel of his car, which is parked on the shoulder of the road. Your unit and a police officer arrive at the scene at the same time. You should: - Answer stay in your unit until the police officer checks the patient. Which of the following statements BEST describes a mass-casualty incident? - Answer The number of patients overwhelms your resources. Which of the following situations presents the greatest risk for suicide?

• Answer A man who was recently diagnosed with stage 4 lung cancer. At the scene of a mass-casualty incident, you notice a bystander who is emotionally upset. An appropriate action to take would be to: - Answer assign the bystander a simple, non-patient-care task. Which of the following vaccinations is NOT currently recommended by the Centers for Disease Control and Prevention (CDC)? - Answer Smallpox.

Which of the following statements regarding the high-efficiency particulate air (HEPA) respirator is correct? - Answer Long sideburns or a beard will prevent the proper fit of a HEPA respirator. You are caring for a 6-year-old child with a swollen, painful deformity to the left forearm. As you communicate with the parents of this child, you should: - Answer make sure that they remain aware of what you are doing. As soon as you begin transport of a patient to the hospital, you should:

• Answer advise dispatch of your status. You arrive at the scene of a traffic accident in which multiple vehicles are involved. You see at least two patients who are lying on the road and are not moving. You should: - Answer request additional ambulances. While en route to the scene of an injured person, dispatch advises you that law enforcement personnel are at the scene. This indicates that: - Answer The scene is potentially unsafe. Which of the following situations is an example of abandonment? - Answer A paramedic transfers care to an advanced EMT. When using the power lift to lift a stretcher, you should: - Answer ensure that you lift with your palms facing up.

In most states, the EMT is required to report which of the following occurrences? - Answer Animal bite. The primary clinical feature associated with exposure to a vesicant agent is: - Answer skin blistering. The technique of rapid extrication from a vehicle involves: - Answer manually stabilizing the head, applying a cervical collar, and removing the patient from the vehicle onto a long backboard. Which of the following statements regarding the use of an escort vehicle when en route to an emergency call is correct? - Answer An escort vehicle should be used only if you are unfamiliar with the patient's location. Which of the following practices will provide you with the highest degree of safety when responding to an emergency call? - Answer Wearing your seat belt and shoulder harness. You arrive at the scene where a man fell approximately 40 feet and landed on his head. He is unresponsive, has agonal gasps, and has a weak carotid pulse. Further assessment reveals an open head injury with exposed brain matter. Upon identifying this patient as an organ donor, you should: - Answer manage the patient aggressively and provide rapid transport.

When called to the scene of a structural fire to stand by in case any injuries occur at the scene, you should: - Answer ensure that your ambulance does not block or hinder other arriving fire apparatus. The scene size-up includes all of the following components, EXCEPT: - Answer donning personal protective gear. Upon arriving at the scene of a crash involving a large truck, you immediately note the presence of an orange placard on the side of the tank that the truck is pulling. This indicates that the vehicle is carrying a/an ___________ agent. - Answer explosive. Proper body mechanics when lifting and moving a patient include: - Answer keeping the weight as close to you as possible. Medical control has ordered you to administer one tube of oral glucose to a hypoglycemic patient. After receiving this order, you should: - Answer repeat the order back to medical control word for word. As you step out of the ambulance at the scene of a nighttime motor- vehicle crash on the highway, your MOST immediate concern should be: - Answer the presence of oncoming traffic.

Which of the following actions demonstrates an EMT's knowledge of crime scene preservation? - Answer Advising a law enforcement officer after moving a coffee table to access a critically injured patient You are dispatched to a call for an unresponsive patient. Which of the following is the MOST important information that you should initially obtain from the dispatcher? - Answer The exact location of the patient. Proper guidelines for safe reaching include all of the following, EXCEPT:

• Answer reaching no more than 30 inches in front of your body. Which of the following patients has the highest priority at the scene of a mass-casualty incident? - Answer 35-year-old unresponsive woman with snoring respirations and severe burns. The MOST effective means of preventing the spread of disease is: - Answer effective handwashing. When is it MOST appropriate to complete your patient care report for a critically ill or injured patient? - Answer As soon as all patient care activities are completed. Upon arriving at a scene in which a tanker truck overturned and is spilling an unknown liquid on the ground, you should: - Answer park upwind from the scene,

Which of the following is an example of the EMT providing care based on standing orders? - Answer The EMT defibrillates a patient with the automated external defibrillator, directs immediate resumption of CPR, and then contacts medical control for further guidance. When driving in emergency mode on a multilane highway, the emergency vehicle operator should keep to the: - Answer extreme left lane so motorists can yield to the right. Upon returning to the quarters after working a major car accident involving an entire family, a member of the press calls and requests information regarding the call. Which of the following would be the EMT's MOST appropriate action? - Answer Inform him that the patients were transported to the hospital, but you cannot disclose the extent of their injuries. While caring for an injured patient, you remove blood-soaked clothing to treat his injuries. You should dispose of the clothing by: - Answer placing it in a biohazard bag. Which of the following situations is an emergency move of a patient from his or her wrecked vehicle clearly indicated? - Answer Gas is leaking from the vehicle and there is a small fire in the engine compartment.

While caring for a trauma patient, blood splashes into an EMT's eyes. This is an example of: - Answer exposure. When calling in your radio report to the receiving hospital, you should: - Answer be brief, concise, and factual. The immobilization device MOST appropriate to use for a patient with multiple injuries and unstable vital signs is the: - Answer long spine board immobilization device. A man armed with a shotgun has taken two people hostage and has shot one of them. Upon arriving at the scene, you should: - Answer have the incident commander guide you to a shielded staging area and wait for the tactical team to bring the patient to you. A 10-year-old child was struck by a car while crossing the street. He has bilateral femur fractures and a head injury. His father has been notified and is 20 minutes away from the scene. The EMT should: - Answer begin immediate transport and have law enforcement update the father. You and your partner have secured a trauma patient to a long backboard and are preparing to lift the backboard onto the stretcher. When doing so, you should: - Answer ensure that the strongest EMT is positioned at the head of the backboard.

While triaging patients at a mass-casualty incident, you encounter a responsive middle-aged female with a respiratory rate of 26 breaths/ min. What should you do next? - Answer Assess for bilateral radial pulses. Most crashes involving ambulances occur: - Answer at intersections Which of the following scene size-up findings is LEAST suggestive of an unsafe environment? - Answer A large man standing in his yard awaiting your arrival A 70-year-old man with a history of emphysema and congestive heart failure is in cardiac arrest. His wife tells you that he collapsed about 5 minutes before your arrival. Your partner begins one-rescuer CPR as you prepare the AED. As you are applying the AED pads, the man's wife tells you that she wants you to let him die in peace. You should: - Answer continue performing CPR and ask her if he has a living will. You are called to a local state park where a hiker fell from a cliff into a thick, wooded area with rough terrain. It is cold and foggy, and a thunderstorm is approaching. You will MOST likely move the patient to the ambulance by: - Answer placing the patient in a basket stretcher and using at least four people to carry him to the ambulance. Who has ultimate authority for all issues regarding patient care at the scene of a mass-casualty incident? - Answer EMS medical director.

Following an apparent terrorist attack, numerous patients present with shortness of breath and persistent coughing. A green haze is noted in the area in which the patients are located. Which of the following agents should you suspect they were exposed to? - Answer Chlorine (CL) EMTs arrive at a one-vehicle crash on the left shoulder of a 3-lane highway. The fire department has parked their apparatus on the left shoulder, behind the crashed vehicle. The ambulance should be parked:

• Answer past the crashed vehicle, on the left shoulder. Your partner, a veteran EMT of 20 years, has been showing up late to work with increasing frequency over the last several shifts. When he arrives, he is in a bad mood and is clearly not interested in being at work. His behavior is MOST consistent with: - Answer burnout. After arriving at a mass-casualty incident where other ambulances are already present, you should notify the dispatcher and then: - Answer report to the staging area You are called to a residence for a woman in cardiac arrest. Shortly after you start CPR, the patient's husband presents you with an unsigned document that states "do not attempt resuscitation." You should: - Answer continue CPR until you have contacted medical control for guidance.

While treating a patient in cardiac arrest, you turn the AED on and attach the pads to the patient. However, when the AED begins to analyze the patient's cardiac rhythm, it signals "low battery" and then shuts off. The patient subsequently dies. Which of the following statements regarding this scenario is MOST correct? - Answer You and your partner may be held liable for negligence. A 30-year-old woman crashed her car into a tree at a high rate of speed. She is conscious and alert and has stable vital signs. She has some small lacerations and abrasions to her arms and face, but no obviously life-threatening injuries. As you are loading her into the ambulance, she tells you that she does not want to go to the hospital. You should: - Answer advise the patient that she should be transported to the hospital because of the seriousness of the crash. Upon arriving at a mass-casualty incident, the EMT is assigned to the treatment area. Upon completion of duties in the treatment area, the EMT should: - Answer report to the treatment officer for further instructions. A patient injured his arm and asks to be transported to a specific hospital because he has been there before. The EMT states that he does not feel the doctors there are competent and recommends a different hospital. The EMTs behavior is: - Answer legal, but unethical.

A 52-year-old woman crashed her minivan into a tree. She is pinned at the legs by the steering wheel and is semiconscious. After gaining access to the patient, you should: - Answer perform a primary assessment and provide any lifesaving care before extrication. When requesting medical direction for a patient who was involved in a major motor-vehicle accident, you should do all of the following, EXCEPT: - Answer use radio codes to describe the situation As an EMT, your primary responsibility is to: - Answer keep yourself as safe as possible. According to the United States Department of Transportation (USDOT), minimum staffing for a basic life support ambulance includes: - Answer at least one EMT in the patient compartment. All of the following are considered key components at the scene of a mass-casualty incident, EXCEPT: - Answer an on-scene emergency physician. You are the first ambulance to arrive at the scene of a motor-vehicle crash. As you approach the scene, you see three patients: two have been ejected from their vehicles and the other is still in his vehicle. You should: - Answer request additional ambulances to respond to the scene.

When the incident command system is activated at the scene, you should expect to: - Answer report back to your section officer in between assignments. Which of the following components is NOT part of an injury or illness prevention program? - Answer Training a group of daycare employees on infant and child CPR. If the EMT could initially only take two pieces of equipment to the side of a patient in cardiac arrest, which of the following should he or she select? - Answer AED and suction device. The ultimate goal of any EMS quality improvement program is to: - Answer deliver a consistently high standard of care to all patients who are encountered. Upon arriving at the scene of an overturned tanker truck, you see a clear liquid leaking from the rear of the tank. The driver is still in the vehicle, and you can see that his face is covered with blood. You should:

• Answer request fire department assistance if they are not already en route. When providing care to multiple patient at the scene of a mass-casualty incident, your goal should remain focused on: - Answer transporting patients to the hospital.