Emergency Medical Procedures and Protocols, Exams of Nursing

Download Emergency Medical Procedures and Protocols and more Exams Nursing in PDF only on Docsity! NY Notary Exam AND Paramedic Final Exam Top- Tier Questions with Detailed Solutions Compiled by Global Authorities Certified for Academic Excellence 1) A 60F with acute chest discomfort requires 0.4mg of sublingual nitroglycerin. Prior to administering the medication, you should - CORRECT ANSWER- -Ask her if she wears a transdermal nitro patch 2) An elderly man with CHF and shortness of breath requires an IV line in case medication administration is necessary. Which IV is the most appropriate? - CORRECT ANSWER- -20g, 1 1/4 inch 3) During the attempted resuscitation of a man in V-Fib cardiac arrest, your protocols call for the administration of 1.5 mg/kg of lidocaine. You have prefilled syringes of lidocaine in a concentration of 100 mg/5 mL. The patient weighs 180 lb. How many milliliters will you administer? - CORRECT ANSWER- -6.2 4) 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? - CORRECT ANSWER- -45 5) The most common inhaled medication is - CORRECT ANSWER- -Oxygen 6) When administering sublingual nitro to a pt, you should do all of the following, except - CORRECT ANSWER- -Instruct the pt to chew and swallow the tablet 7) Which of the following inhaled medications is NOT a beta2 agonist bronchodilator? - CORRECT ANSWER- -Ipratropium 8) You are preparing to administer a dopamine infusion to a severely hypotensive patient. What is the concentration on hand if you add 800mg of dopamine to a 500mL of NS? - CORRECT ANSWER- -1600mcg/mL 9) You are transporting a 1 year old child with moderate dehydration. Your estimated time of arrival at the hospital is 45 minutes. When administering an isotonic crystalloid solution to this child, you should: - CORRECT ANSWER- -Use a volutrol administer set and fill the calibrated drip chamber with a pre calculated volume of fluid 10) You are treating a 29M who was struck in the abdomen with a steel pipe. He is confused, has absent radial pulses, BP of 78/50, you should administer - CORRECT ANSWER- -Normal saline boluses until his mental status and radial pulses improve 11) Your protocols call for you to administer 5mg of diazepam (Valium) to a patient who is seizing. You have a 10mL vial of Valium that contains 10mg. How many mL will you give - CORRECT ANSWER- -5mL 12) A 36 year old man experienced significant burns to his face, head, and chest following an incident with a barbecue pit. Your assessment of his airway reveals severe swelling. After administering medications to sedate and paralyze the patient, you are unable to intubate him. Furthermore, BVM are producing no chest rise. The quickest way to secure a patient airway in this patient is to: - CORRECT ANSWER- -Perform a needle cricothyrotomy 13) A 40M fell 20ft from a tree while trimming branches. Your assessment reveals that he is unresponsive. You cannot open his airway effectively with the jaw-thrust maneuver. You should: - CORRECT ANSWER- -Carefully open his airway with the head tilt chin lift maneuver 14) A 50W presents with acute respiratory distress while eating. Upon arrival, you note that she is conscious, coughing, and wheezing between coughs. Further assessment reveals 30) When two paramedics are ventilating an apneic pt with a bag-mask device, the paramedic not squeezing the bag should: - CORRECT ANSWER- -Maintain an adequate mask-to-face seal 31) When ventilating a patient with facial injuries, it is most important to: - CORRECT ANSWER- -Be alert for changes in ventilation compliance 32) You are caring for a 69M with CHF. His breathing is profoundly labored, his oxygen saturation reads 79% on oxygen via nonrebreather, and he is showing signs of physical exhaustion. Considering that your protocols do not allow you to perform RSI, you should: - CORRECT ANSWER- -Preoxygenate him with a bag-mask device and then perform blind nasotracheal intubation 33) You are dispatched to the residence of a 19M who has a tracheostomy tube and is on a mechanical ventilator. According to the patients mother, he began experiencing difficulty breathing about 30 minutes ago. Auscultation of his lungs reveals bilaterally diminished breath sounds, and his oxygen saturation is 80%. You disconnect the pt from the ventilator and begin bag-mask ventilations; however, you meet significant resistance. You should: - CORRECT ANSWER- -Remove the bag mask device and suction his tracheostomy tube 34) You have intubated a 70F with chronic bronchitis and are en route to the hospital. During transport, you note that ventilations are becoming increasingly difficult and her ETCO2 is falling. Your partner tells you that she can still hear bilaterally equal breath sounds, but they are faint. She further tells you that there are no sounds over the epigastrium. What intervention is most likely indicated for this patient. - CORRECT ANSWER- -Tracheobronchial suctioning 35) A 29W is experiencing a severe asthma attack. Her husband reports that she was admitted to an ICU about 6 months ago, she had a breathing tube in place. Prior to your arrival, the patient took three puffs of her rescue inhaler without effect. She is anxious and restless, tachypneic, and has audible wheezing. You should: - CORRECT ANSWER- -Apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital 36) A 36M with a history of asthma presents with severe respiratory distress. You attempt to administer a nebulized beta2 agonist, but his poor respiratory effort is inhibiting effective drug delivery via the nebulizer and his mental status is deteriorating. You should: - CORRECT ANSWER- -Assist him with his ventilations and establish vascular access 37) A 66M with chronic bronchitis presents with severe respiratory distress. The patients wife tells you that he takes medications for high blood pressure and bronchitis, is on home 02, and has recently been taking an over the counter antitussive. She further tells you that he has not been compliant with his 02 therapy. Auscultation of his lungs reveals diffuse rhonchi. What is the most likely cause of this patients respiratory distress - CORRECT ANSWER- -Recent antitussive use 38) A 76 W with emphysema presents with respiratory distress that has worsened progressively over the past 2 days. She is breathing through pursed lips and has prolonged expiratory phase and an oxygen saturation of 76%. She is on home oxygen at 2Lpm. Your initial action should be to: - CORRECT ANSWER- -Auscultate her lungs for adventitious breath sounds 39) A patient who is coughing up purulent sputum is MOST likely experiencing - CORRECT ANSWER- -An infection 40) A patient with a history of asthma is at greatest risk for respiratory arrest if he or she - CORRECT ANSWER- -Was previously intubated for his or her condition 41) A patient with status asthmaticus commonly presents with - CORRECT ANSWER- - Physical exhaustion and inaudible breath sounds 42) An elderly woman with COPD presents with peripheral edema. The patient is conscious but agitated. She is breathing with slight difficulty but has adequate total volume. During your assessment, you note that her jugular veins engorge when you apply pressure to her RUQ. She tells you that she takes a "water pill" and Vasotec for hypertension. You should: - CORRECT ANSWER- -Suspect acute right sided heart failure and administer oxygen 43) COPD is characterized by - CORRECT ANSWER- -Changes in pulmonary structure and function that are progressive and irreversible 44) Frothy sputum that has pink tinge to it is most suggestive of - CORRECT ANSWER- -CHF 45) You are dispatched to a residence for a 59M with difficulty breathing. The patient,who has a history of COPD, is conscious and alert. During your assessment, he tells you that he developed chills, fever, and a productive cough 2 days ago. Auscultation of his lungs reveals rhonchi to the left lower lobe. The patient is MOST likely experiencing: - CORRECT ANSWER- -Pneumonia 46) You are transporting a middle aged man on a CPAP unit for severe pulmonary edema. An IV line of NS is in place. Prior to applying the CPAP device, the patient was tachypneic and had an oxygen saturation of 90%. When you reassess him, you note that his respirations have increased and his oxygen saturation has dropped to 84%. You should: - CORRECT ANSWER- -Remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him. 47) You are transporting a patient with a long history of emphysema. The patient called 9-1- 1 because his shortness of breath has progressively worsened over the past few days. He is on high-flow oxygen via nonrebreathing mask and has an IV of NS in place. The cardiac monitor shows sinus tachycardia and the pulse ox reads 89%. When you reassess the patient, you note that his respiratory rate and depth have decreased. You should: - CORRECT ANSWER- -Begin assisting his ventilations with a bag-mask device and 100% oxygen supine position, insert a nasal airway, assist his ventilations with a BVM, begin transport, establish vascular access en route, consider a 100-200mL saline bolus, and start an infusion of dopamine 62) After delivering a shock to a patient in pulseless ventricular tachycardia, you should: - CORRECT ANSWER- -Resume cpr 63) An unresponsive, pulseless, apneic patient presents with ventricular tachycardia on the cardiac monitor. After defibrillating that patient you should: - CORRECT ANSWER- -Resume cpr and reassess the patient after 2 minutes 64) common causes of cardiac arrest include all of the following, except: - CORRECT ANSWER- -Hyperglycemia 65) common signs of left ventricular failure include all of the following, EXCEPT: - CORRECT ANSWER- -Hypotension 66) Cor pulmonale is a term used to describe: - CORRECT ANSWER- -A right ventricular failure caused by pulmonary disease 67) Following 2 minutes of CPR, you reassess an unresponsive man's pulse and cardiac rhythm. He remains pulseless and the monitor displays coarse v-fib. You should:` - CORRECT ANSWER- -Resume CPR as the defibrillator is charging *68) Nitroglycerin is contraindicated for patients: - CORRECT ANSWER- -With a systolic BP less than 110mmHg 69) Shortly after administering a second dose of 4mg of morphine to a 49F who is experiencing chest pain, the patients level of consciousness markedly decreases. Further assessment reveals that she is hypotensive, bradycardic, and hypoventilating. You should: - CORRECT ANSWER- -Assist her ventilations and administer naloxone. 70) ST elevation myocardial infarction (STEMI) should be suspected if: - CORRECT ANSWER- -ST elevation greater than 0.5mm is observed in two or more contiguous leads 71) The recommended first-line treatment for third degree heart block associated with bradycardia and Hemodynamic compromise is: - CORRECT ANSWER- -Transcutaneous pacing 72) The treatment for sinus tachycardia should be focused on: - CORRECT ANSWER- - Correcting the underlying cause 73) Treatment for a patient with bradycardia and significantly compromised cardiac output includes: - CORRECT ANSWER- -Transcutaneous cardiac pacing 74) When administering aspirin to a patient with an acute coronary syndrome, you should: - CORRECT ANSWER- -Have him or her chew and swallow 160-325mg of baby aspirin 75) When performing CPR on an adult patient in cardiac arrest, it is important to: - CORRECT ANSWER- -Allow for the chest to fully recoil between compressions 76) Which of the following clinical findings is LEAST suggestive of left-sided heart failure? - CORRECT ANSWER- -Sacral edema 77) Which of the following clinical signs would you MOST likely observe in a patient with right ventricular failure? - CORRECT ANSWER- -Splenomegaly 78) Why may fentanyl (Sublimaze) be preferred over morphine sulfate for pain management in patients experiencing acute myocardial infarction? - CORRECT ANSWER- -Relatively short duration 79) You and an EMT are performing CPR on an elderly woman in cardiac arrest as your paramedic partner prepares to intubate her. After the patient has been intubated and proper ET tube placement has been confirmed, you should: - CORRECT ANSWER- -Perform asynchronous CPR while ventilating the patient at a rate of 10 breaths/min 80) You and your partner arrive at the scene of a unresponsive male patient. Your assessment reveals that he is pulseless and apneic. The patients wife tells you that he collapsed about 10 minutes ago. You should: - CORRECT ANSWER- -Initiate CPR as your partner applies the defibrillator pads 81) You are assessing a conscious and alert middle aged man who complains of chest discomfort and nausea. His blood pressure is 112/70mmHg, pulse 90 and regular, respirations are 20 and regular. The patients past medical history is significant for hypothyroidism and hyperlipidemia. His medications include Synthroid, Lipitor, Cialis, and one baby aspirin per day. Which of the following medications would you LEAST likely administer? - CORRECT ANSWER- -Nitroglycerin 82) You are dispatched to a grocery store for a 39F with severe headache. The patient advises you that her headache, which was present when she woke up this morning, is located in the back of her head. She is conscious and alert, with a BP of 194/112mmHg, pulse of 100 and strong, respirations of 14 and regular. She denies a history of hypertension or any other significant medical problems. The closest appropriate facility is located 15 miles away. You should: - CORRECT ANSWER- -Administer supplemental oxygen, start an IV line of normal saline at a keep open rate, and transport 83) You are dispatched to a residence at 2:00 AM for an elderly man with shortness of breath. The patient tells you that he was suddenly awakened with the feeling that he was smothering. You note dried blood on his lips. The patient tells you that he has some type of 95) You are assessing an unresponsive 66M with a history of two prior strokes. According to the patients wife, he complained of a severe headache and then passed out. His respiratory effort is poor, blood pressure is elevated, and pulse is slow and bounding. The glucometer reads "error". You should: - CORRECT ANSWER- -Assist his ventilations, apply the cardiac monitor, start and IV with NS, administer 12.5g of 50% dextrose, and reassess his level of consciousness. 96) You are dispatched to a local pharmacy, where a 24F experienced an apparent seizure. During your assessment, you note that the patient is conscious but combative. The patients supervisor states that she has a history of seizures and takes Tegretol. The patients BP is 146/90, pulse 110 and regular, respirations are 24 with adequate depth. The MOST appropriate treatment for this patient includes: - CORRECT ANSWER- -Administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and sirens 97) You are dispatched to a residence for a 44F with a severe headache. You arrive to find the patient lying on her sofa with a wet washcloth on her forehead. She tells you that she has a history of migraine headaches and that this is one of her "typical" headaches. She also complains of nausea and photophobia. Her BP is 170/94, pulse is 120 and regular, respirations are 22 with adequate depth. The MOST appropriate treatment for this patient includes: - CORRECT ANSWER- -Oxygen as tolerated, starting an IV line and administering ondansetron, transporting without lights and sirens 98) You are dispatched to a residence for a middle aged woman with generalized weakness of approximately 18 hours duration. Your primary assessment reveals right sided hemiparesis, a left sided facial droop, and bilaterally equal and reactive pupils. Further assessment reveals that her blood glucose is 70. En route to the hospital, you note increased movement of her right arm. She is receiving oxygen via nasal cannula and has a patent IV line in place. Which of the following statements regarding this scenario is correct? - CORRECT ANSWER- -Although the patient is likely experiencing a TIA, you should treat her as though she is experiencing a stroke 99) You arrive at the scene shortly after the 7 year old girl experienced a seizure. According to the child's mother, she was sitting at the dinner table and then suddenly stopped speaking and started blinking her eyes very rapidly. The episode lasted less than 1 minute, after which the child's condition rapidly improved. This clinical presentation is consistent with an_____ - CORRECT ANSWER- -Absence 100) A 62M presents with an acute onset of bright red vomit. According to his wife he ingests excessive amounts of alcohol each day. As you are assessing the patient, you note that his level of consciousness has decreased markedly. His mouth is full of blood and his skin is pale and moist. You should: - CORRECT ANSWER- -Turn him on his side and suction his oropharynx, intubate his trachea if the oral bleeding continues, establish at least one large-bore IV with normal saline, and administer enough fluids to maintain adequate perfusion. 101) You are caring for a middle aged man with severe abdominal pain and dark, tarry stools. He is conscious but very restless. His blood pressure is 78/52, pulse 130 and weak, and respirations are 24 and shallow. Further assessment reveals that his skin is cool and clammy and his radial pulses are weakly present. You should: - CORRECT ANSWER- - Administer high flow 02, start two large bore IVs and administer 20mL/kg NS until his radial pulses strengthen. 102) A 40M presents with difficulty urinating, fever, and tremors. Which should you suspect? - CORRECT ANSWER- -Prostatitis 103) A 50M presents with a painful penile erection that has persisted for the past several hours. He is conscious, but restless, and his vital signs are stable. Which of the following conditions could cause his clinical presentation? - CORRECT ANSWER- -Antidepressant use 104) A 29M presents with bizarre behavior and profuse sweating. His wife tells you that he has DM1 and that he took his insulin today. During your assessment, you will most likely find that the patient is: - CORRECT ANSWER- -Tachypneic 105) A 51M with type 2 diabetes presents with confusion, blurred vision, and signs of significant dehydration. According to the mans wife, he has had a fever and flu like symptoms for the past few days. She further tells you that he has "stuck to his diet" as advised by his physician. His BGL reads "high". This patient is most likely: - CORRECT ANSWER- -Experiencing a hypersmolar nonketonic coma 106) A 29F was found unresponsive by her husband. When you arrive at the scene and begin your assessment, you note that the patients respirations are slow and shallow, her pulse is slow and weak, and her pupils are dilated. Your partner begins assisting the patients ventilations as you assess her BP, which is 70/48. The patients husband hands you and empty bottle of phenobarbital, which was filled the day before, and tells you that his wife takes the medication for seizures. After establishing vascular access, you should: - CORRECT ANSWER- -Administer crystalloid fluid blouses to improve her blood pressure 107) A 45F is found unresponsive in an alley. During your assessment, you note that she is tachycardic and breathing rapidly. She has an obvious odor of alcohol on her breath. Your MOST immediate concern should be to: - CORRECT ANSWER- -Take actions to prevent aspirations 108) During your assessment of an unresponsive 70M, the patients wife tells you that he takes escitalopram (Lexapro) and buspirone (Buspar), among other medications. From this limited information, you should conclude that the patient suffers from: - CORRECT ANSWER- -Depression and anxiety 109) You are assessing a 34F who appears to be depressed. You were summoned to see the patient by her husband who tells you that she won't talk to him. During your interview of the pt, which of the following questions or comments would MOST likely yield a response from the patient? - CORRECT ANSWER- -"Do you want to hurt anyone?" 110) A young female with experienced trauma to her genitalia and has profuse vaginal bleeding. She is hypotensive, tachycardic, and tachypneic. You should: - CORRECT ANSWER- -Transport immediately notably dyspneic and has diffuse wheezing. In addition to administering supplemental oxygen, you should: - CORRECT ANSWER- -Give nebulized ipratropium 122) A 4F presents with a fever of 103.2 degrees F. The child's mother states that the fever came on suddenly and was not preceded by any symptoms. The child is conscious and alert with unlabeled tachypnea, tachycardia, and a BP consistent with her age. Prehospital treatment for this child includes all of the following EXCEPT: - CORRECT ANSWER- -81mg of aspirin 123) A 9 year old 55lb girl presents with generalized hives, marked facial swelling, and loud inspiratory stridor. She is conscious but appears sleepy. You can MOST rapidly improve this child's condition by: - CORRECT ANSWER- -Administering epinephrine IM 124) You receive a call at 11:50pm for a 3-year old boy with respiratory distress. As soon as you enter the child's residence, you can hear a loud, barking cough. You find the child sitting on his mothers lap. He is conscious and appears alert to his surroundings. According to the child's mother, he has been sick for the past few days with a low grade fever, but then began experiencing a high pitched cough. His skin is warm and dry, HR is 120, oxygen saturation is 99% on room air. There are no signs of increased work of breathing. You should: - CORRECT ANSWER- -Allow the child to assume a position of comfort, avoid agitating him, and transport to the hospital. 125) You receive a call for a "sick child". When you arrive at the scene, the child's mother tells you that her 5M had vomiting and diarrhea for the past day and will not eat or drink anything. On exam, the child's level of consciousness appears consistent with his age. His skin is cool and pale, he is tachypneic, his capillary refill time is 4 seconds, and his HR is 150. The MOST appropriate treatment for this child involves: - CORRECT ANSWER- - Administering supplemental oxygen, keeping the child warm, assessing his BGL, transporting and establishing vascular access. 126) Your primary survey of an unresponsive 5 year old, 40lb child reveals that he is apneic and pulseless. CPR is initiated and the cardiac monitor is applied, which reveals ventricular fibrillation. You should: - CORRECT ANSWER- -Defibrillate with 40J and immediately resume CPR. 127) A 24F was struck by lightning. Bystanders moved the patient to an area of safety but did not provide any other care before your arrival. Your primary assessment reveals that the patient is pulseless and apneic. You begin CPR and apply the cardiac monitor, which reveals asystole. After requesting a back up paramedic unit, the MOST appropriate treatment for this patient involves: - CORRECT ANSWER- -Continuing CPR, protecting her spine while ventilating, reassessing her cardiac rhythm after 2 minutes of CPR, and defibrillating if necessary 128) A 52M sustained superficial and partial thickness burns to his left arm approximately 15 minutes ago when he opened the radiator cap on his car. He is conscious, alert, and in severe pain. His BP is 138/76, pulse 110 and strong, respirations are 22 and regular, oxygen saturation is 97% on room air. He denies ant other injuries Initial management for this patient involves: - CORRECT ANSWER- -Applying cool, wet dressings to stop the burn and administer analgesic drug 129) A 22M was struck in the forehead by a softball. He is conscious and left, but complains of a severe headache. Your assessment reveals a large hematoma to his forehead. His vital signs are stable and his breathing is adequate. You should: - CORRECT ANSWER- -Apply and ice pack to the hematoma and monitor his level of consciousness 130) A 41M was assaulted during a robbery attempt. Your primary assessment reveals that the patient is semiconscious. He has a massive soft tissue trauma to the face, inadequate breathing, and oropharyngeal bleeding. You should: - CORRECT ANSWER- -Suction the blood from his mouth and assist ventilations with a bag mask device 131) A 45 year old unrestrained man was ejected from his small truck when it struck a tree. The patient is found approximately 20ft from the wreckage. Your primary assessment reveals that he is unresponsive and has sonorous respirations and a rapid pulse. Your initial actions should include: - CORRECT ANSWER- -Manually stabilizing his head and opening his airway with the jaw thrust maneuver 132) You are assessing a patient who sustained blunt trauma to the center of her back. She is conscious, but is unable to feel or move her lower extremities. BP is 80/50, pulse is 40 and weak, respirations are 24 and shallow. If IV fluids do not adequately improve perfusion, you should: - CORRECT ANSWER- -Give 0.5mg of atropine and consider a dopamine infusion. 133) You arrive at the scene of a motorcycle crash and find the rider lying supine approximately 20ft from his bike; he is still wearing his helmet. As you approach him, you note that he has bilaterally deformed femurs. You should: - CORRECT ANSWER- -Manually stabilize his head and assess his airway. 134) A 40 year old woman has an unstable pelvis following a motor vehicle crash. She is conscious but confused. Her BP is 80/50, pulse 120 and weak at the radial arteries, respirations are 24 and shallow. After starting at least one large bore IV, you should: - CORRECT ANSWER- -Give enough isotonic crystalloid fluids to improve her mental status and radial pulse quality. 135) You are the team leader in the attempted resuscitation of an adult man in ventricular fibrillation. An advanced airway device has been inserted and vascular access has been obtained. As you observe the actions of your team members, you should ensue that: - CORRECT ANSWER- -Compressions are hard and fast, with full chest recoil between compressions 136) Your assessment of a 68F reveals an organized cardiac rhythm at a rate of 80 bpm and an absent carotid pulse. Treatment for this patient may include all of the following, EXCEPT: - CORRECT ANSWER- -Cardiac pacing 137) A 6 year old, 40lb child remains in ventricular fibrillation after an initial defibrillation and 2 minutes of CPR, vascular access has not been obtained. Your next action should be: - CORRECT ANSWER- -Defibrillate with 70J