Emergency Medical Procedures and Protocols, Exams of Nursing

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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.
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

22. After inserting the ET tube between the vocal cords, you should remove the stylet from the tube and then: - CORRECT ANSWER- - inflate the distal cuff with 5 to 10 mL of air.
23. After inserting the needle into through the cricothyroid membrane, you should next: - CORRECT ANSWER- - Insert the needle about 1 cm farther and then aspirate with the syringe
24. After opening an unresponsive pt airway, you determine that his respirations are rapid, irregular, and shallow. You should: - CORRECT ANSWER- - Begin PPV
25. After you have intubated an apneic pt with chest trauma, your partner is auscultating breath sounds and tells you that breath sounds are faint on the right side of the chest. You should - CORRECT ANSWER- - Suspect that the patient has a pneumothorax on the right side of the chest
26. An 8yr old in cardiac arrest has been intubated. When ventilating the child, the paramedic should: - CORRECT ANSWER- - Deliver 8-10 breaths per minute
27. Assessment of a spontaneous perfusing pt ETCO2 reveals small capnographic waveforms and a reading of 22mmHg. Which of the following does this indicate? - CORRECT ANSWER- - Hyperventilation
28. Decreased ventilation compliance following intubation is LEAST suggestive of: - CORRECT ANSWER- - Left bronchus intubation
29. Several attempts to orotracheally intubate an unresponsive, apneic young pt have failed. You resume bag-mask ventilations and begin transport to a hospital located 25 miles away. En route, you begin having difficulty maintaining an adequate mask to face seal with the bag-mask device. Assuming that you have the proper equipment, which of the following techniques to secure a patent airway would be most appropriate? - CORRECT ANSWER- - Transillumination intubation

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

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

48. A 33M presents with chest pain that is alleviated when he sits forward. The 12 lead ECG shows ST elevation of 2-3mm in multiple leads. What should you suspect? - CORRECT ANSWER- - Pericarditis
49. A 39M is asystole has been unresponsive on high quality CPR and two doses of epinephrine. The patient is intubated and an IO catheter is in place. You should focus on: - CORRECT ANSWER- - Searching for reversible causes
50. A 50M is experiencing an acute myocardial infarction. He has no prior history of cardiac problems, takes no meds, and has no drug allergies. His oxygen saturation is 96%. He should receive: - CORRECT ANSWER- - Aspirin
51. A 55M complains of severe pain between his shoulder blades, which he describes as "ripping" in nature. He tells you that the pain began suddenly and has been intense and unrelenting since its onset. His medical history is HTN, he admits to being non compliant with his anti hypertensive meds. Which of the following assessment findings would MOST likely reinforce your suspicion regarding the cause of his pain? - CORRECT ANSWER- - Difference in blood pressure between the two arms
52. A 56M presents with an acute onset chest pressure, shortness of breath, and diaphoresis. He has a history of HTN and DM2. You should: - CORRECT ANSWER- - Administer supplemental oxygen
53. A 59F presents with severe substernal chest pain. She is anxious and diaphoretic. What should you do? - CORRECT ANSWER- - Administer aspirin
54. A 60M with a crushing chest pain has 3mm of ST elevation in leads V1-V4. What should you suspect? - CORRECT ANSWER- - Left anterior descending artery occlusion
55. A 67F presents with severe dyspnea, coarse crackles to all lung fields, and anxiety. She has a history of several myocardial infarctions and hypertension. Which of the following

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
68. 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

"breathing problem," for which he uses a prescribed inhaler and "heart pill". You should suspect: - CORRECT ANSWER- - Left Ventricular failure

84. You are performing CPR on an 80F whose cardiac arrest was witnessed by her husband. Several intubation attempts have been unsuccessful, but ventilations with a BVM are producing adequate chest rise. IV access has been obtained and 1mg of epinephrine has been administered. The cardiac monitor displays a narrow QRS complex rhythm at a rate of 70 bpm. According to the patients husband, she has had numerous episodes of diarrhea over the past 24 hours and has not had much of an appetite. The MOST appropriate next action should be to: - CORRECT ANSWER- - Continue CPR and administer crystalloid fluid boluses
85. You have applied the defibrillator pads to a pulseless and apneic 60F and observe a slow, wide QRS complex rhythm. Your next action should be to: - CORRECT ANSWER- - Resume cpr at once
86. You have just administered 0.4mg of sublingual nitroglycerin to a 60F with severe chest pain. The patient is receiving supplemental oxygen and has an IV line of normal saline in place. After 5 minutes, the patient states that the pain has not subsided. You should: - CORRECT ANSWER- - Reassess her BP
87. The MOST immediate for the patient with a tension pneumothorax is to: - CORRECT ANSWER- - Evacuate air from the pleural space
88. The negative target-organ effects of the anaphylactic shock are reversed with: - CORRECT ANSWER- - Epinephrine
89. A 29M who was recently prescribed an antipsychotic medication, presents with an acute onset of bizarre contortions to the face (dystonic). Treatment should include - CORRECT ANSWER- - Diphenhydramine 25mg

90. A 33F had an apparent syncopal episode. According to her husband, she complained of dizziness shortly before the episode. He further states that he caught her before she fell to the ground. Upon your arrival, the patient is conscious but confused and is sitting in a chair. Her blood pressure us 90/60 mmHg, pulse 110 and weak, respirations are 22 and regular. Her BGL is 74. The MOST likely cause of her syncopal episode is: - CORRECT ANSWER- - dehydration
91. A 51M complains of a chronic headache that have worsened progressively over the past 3 months. Today, he called 9- 1 - 1 because his headache is severe and he is nauseated. His vitals are stable and he is breathing adequately. The patient denies any medical problems and states that he has been taking acetaminophen for the headaches. You should be MOST suspicious for: - CORRECT ANSWER- - An intracranial neoplasm
92. A 59F presents with acute onset of confusion, left sided hemiparesis, and a right sided facial droop. Her airway is patent and she is breathing adequately. Her BP is 150/100 and her pulse is 70. The cardiac monitor displays atrial fibrillation with a variable rate of 60-90. When obtaining the patients medical history from her husband, the MOST important question to ask him is: - CORRECT ANSWER- - "When did you first notice your wife's symptoms?"
93. A woman brings her 18yr old son to your EMS station. The patient is actively seizing and according to the mother, has been seizing for the past 10 minutes. She states that her son has a history of seizures and takes Depakote. The patient is cyanotic, breathing erratically, and had generalized muscle twitching to all extremities. You should: - CORRECT ANSWER-

• Open his airway and begin assisting his ventilations, establish and IV or IO line and administer diazepam

94. An elderly man presents with slurred speech, confusion, and unilateral facial asymmetry. When asked to squeeze your hands the strength in his right hand. The patients wife tells you that her husband has type 2 diabetes and hypertension. On the basis of your clinical findings, you should: - CORRECT ANSWER- - Rule out hypoglycemia by assessing his blood sugar, but suspect a right sided ischemic stroke

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

respirations are 24. The MOST appropriate treatment for this patient involves: - CORRECT ANSWER- - High flow oxygen, a sanitary pad over her vagina, large bore IV, crystalloid boluses as needed to maintain adequate perfusion, emotional support, and prompt transport

116. A 30F presents with bright red vaginal bleeding and severe abdominal pain. She tells you that she is 35 weeks pregnant and that this episode began suddenly about 30 minutes ago. She further tells you that she has not felt the baby move in over an hour. As your partner is treating the patient for shock, you obtain her medical history. The patient tells you that she has HTN and admits to using cocaine throughout her pregnancy. What should you suspect? - CORRECT ANSWER- - Abruptio placenta
117. A 30F is 35 weeks pregnant is pulseless and apneic. As CPR is initiated, you or another team member should: - CORRECT ANSWER- - Manually displace her uterus to the left
118. After delivering a baby and clamping and cutting the cord, you note that the end of the umbilical cord attached to the baby is bleeding. You should: - CORRECT ANSWER- - Tie or clamp the cord proximal to the first clamp and reexamine it.
119. During your visual exam of a woman in active labor, you see a loop of the umbilical cord protruding from her vagina. She is in the middle of a strong contraction, as you can see the baby's head just beyond the cord. You should immediately: - CORRECT ANSWER- - Instruct her to pant during the contraction
120. A 10 year old child fell approximately 15 feet from a balcony, landing on a sidewalk. He is conscious and alert, and complains of pain to the right side of his body. After completing your primary survey, you should: - CORRECT ANSWER- - Provide any immediately needed care, preform a rapid assessment, apply spinal precautions and transport
121. A 13 year old, 40lb girl is experiencing an acute asthma attack that has been unresponsive to three puffs of her albuterol inhaler. She is conscious and alert, but is

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