Identifying and Managing Respiratory and Cardiovascular Emergencies, Exams of Basic Electronics

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EMT Basic Exam 4

1. In a healthy individual, the brain stem stimulates breathing on the basis of: A. decreased oxygen levels. B. increased carbon dioxide levels. C. increased oxygen levels. D. decreased carbon dioxide levels. ANS: B. increased carbon dioxide levels.
2. Which of the following is MOST characteristic of adequate breathing? A. 22 breaths/min with an irregular pattern of breathing and cyanosis

B. 24 breaths/min with bilaterally equal breath sounds and pink skin C. 20 breaths/min with shallow movement of the chest wall and pallor D. 30 breaths/min with supraclavicular retractions and clammy skin ANS: B. 24 breaths/min with bilaterally equal breath sounds and pink skin

3. Acute pulmonary edema would MOST likely develop as the result of: A. severe hyperventilation. B. right-sided heart failure. C. toxic chemical inhalation. D. an upper airway infection. ANS: C. toxic chemical inhalation.
4. A 30-year-old male presents with acute shortness of breath, widespread hives, and facial swelling. He denies any past

medical history and takes no medications. During your assessment, you hear wheezing over all lung fields. His blood pressure is 90/50 mm Hg and his heart rate is 110 beats/min. In addition to giving him 100% oxygen, the MOST important treatment for this patient is: A. epinephrine. B. albuterol.

C. an antihistamine. D. a beta-antagonist. ANS: A. epinephrine.

5. A 59-year-old male with a history of emphysema complains of an acute worsening of his dyspnea and pleuritic chest pain following a forceful cough. Your assessment reveals that he has a barrel-shaped chest, unilaterally dimin- ished breath sounds, and tachycardia. What is the MOST likely cause of this patient's condition? A. spontaneous pneumothorax B. rupture of the diaphragm C. exacerbation of his COPD D. acute pulmonary embolism ANS: A. spontaneous pneumothorax
6. You are dispatched to a residence for a 67-year-old female who was awak- ened by shortness of breath and sharp chest pain. Her husband tells you that she was recently discharged

from the hospital after having hip surgery. Your assessment reveals dried blood around her mouth, facial cyanosis, and an oxygen saturation of 88%. This patient's presentation is MOST consistent with: A. acute pulmonary edema. B. spontaneous pneumothorax. C. acute pulmonary embolism. D. right-sided heart failure. ANS: C. acute pulmonary embolism.

7. A 60-year-old male presents with acute respiratory distress. He is conscious and alert, has pink and dry skin, and has respirations of 24 breaths/min with adequate depth. Which of the following treatment modalities is MOST appropriate for this patient? A. oxygen via a nasal cannula, vital signs, and prompt transport to the hospital

B. assisted ventilation with a bag-mask device and a head-to-toe exam C. positive-pressure ventilations and immediate transport to the closest hos- pital D. oxygen via nonrebreathing mask and a focused secondary assessment ANS: D. oxygen via nonrebreathing mask and a focused secondary assessment

8. You receive a call for a 70-year-old female with respiratory distress. Her husband tells you that she has congestive heart failure; however, he does not think that she has been taking her medications as prescribed. The patient is laboring to breathe, appears tired, and has cyanosis around her lips. You should: A. obtain a complete list of all of her medications. B. administer oxygen via a nonrebreathing mask. C. assist her ventilations with a bag-mask device.

D. apply a pulse oximeter and obtain vital signs. ANS: C. assist her ventilations with a bag-mask device.

9. A conscious and alert 29-year-old female with a history of asthma complains of difficulty breathing that began after her morning jog. The temperature outside is 40°F (5°C). On exam, you hear bilateral expiratory wheezing. After providing 100% oxygen, you should: A. call medical control and ask how to proceed with treatment. B. place her in a recumbent position to facilitate breathing. C. determine if she has been prescribed a beta-agonist inhaler. D. contact medical control and administer an antihistamine. ANS: C. determine if she has been prescribed a beta-agonist inhaler.
10. A 22-year-old female patient is complaining of dyspnea and numbness and tingling in her hands and feet after an argument with her fiancé. Her

respirations are 40 breaths/min. You should: A. have her breathe into a paper or plastic bag. B. provide reassurance and give oxygen as needed. C. position her on her left side and transport at once. D. request a paramedic to give her a sedative drug. ANS: B. provide reassurance and give oxygen as needed.

11. You are dispatched to an apartment complex where a 21- year-old female has apparently overdosed on several narcotic medications. She is semicon- scious and has slow, shallow respirations. You should: A. insert an oropharyngeal airway and perform oral suctioning. B. insert a nasopharyngeal airway and begin assisted ventilation. C. place her in the recovery position and monitor for vomiting. D. apply oxygen via a nonrebreathing mask and transport at

once. ANS: B. insert a nasopharyngeal airway and begin assisted ventilation.

12. An acute myocardial infarction (AMI) occurs when: A. myocardial tissue dies secondary to an absence of oxygen. B. the entire left ventricle is damaged and cannot pump blood. C. the heart muscle progressively weakens and dysfunctions. D. coronary artery dilation decreases blood flow to the heart. ANS: A. myocardial tissue dies secondary to an absence of oxygen.
13. Angina pectoris occurs when: A. myocardial oxygen demand exceeds the supply.

B. one or more coronary arteries suddenly spasm. C. a coronary artery is totally occluded by plaque. D. myocardial oxygen supply exceeds the demand. ANS: A. myocardial oxygen de- mand exceeds the supply.

14. A 67-year-old female presents with difficulty breathing and chest discom- fort that awakened her from her sleep. She states that she has congestive heart failure, has had two previous heart attacks, and has prescribed nitroglyc- erin. She is conscious and alert with adequate breathing. Her blood pressure is 94/64 mm Hg and her heart rate is 120 beats/min. Treatment for this patient includes: A. oxygen at 4 L/min via nasal cannula. B. nitroglycerin for her chest pain. C. ventilations with a bag-mask device. D. placing her in an upright position. ANS: D. placing her in an upright position.
15. You are assessing a 49-year-old man who complains of chest pressure that began the night before. He is conscious, but

anxious, and tells you he has a history of angina and hypertension. After applying high-flow oxygen, you expose his chest to auscultate his lungs and note that he has a nitroglycerin patch on his right upper chest. His skin is cool and pale, his blood pressure is 78/50 mm Hg, and his pulse is 110 beats/min and irregular. You should: A. ask him if the nitroglycerin patch he is wearing has improved his chest pressure, complete your secondary assessment, and transport promptly. B. move the nitroglycerin patch to the other side of his chest in case you need to apply the AED, keep him warm, and transport without delay. C. immediately remove the nitroglycerin patch, apply the AED in case he develops cardiac arrest, and transport to the closest hospital.

D. remove the nitroglycerin patch, place him in a supine position and elevate his lower extremities, and prepare for immediate transport. ANS: D. remove the nitroglycerin patch, place him in a supine position and elevate his lower extremities, and prepare for immediate transport.

16. A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should: A. obtain vital signs and a SAMPLE history. B. administer up to 324 mg of baby aspirin. C. assess the adequacy of his respirations. D. administer up to three doses of nitroglycerin. ANS: C. assess the adequacy of his respirations.
17. A 66-year-old female with a history of hypertension and diabetes presents with substernal chest pressure of 2 hours' duration. Her blood pressure is 140/90 mm Hg, her pulse is 100 beats/min and irregular, and her respirations are 22 breaths/min with adequate depth. The patient does not have prescribed nitroglycerin, but her husband does. You should: A. administer oxygen, give her 324 mg aspirin, and assess her

further. B. give her one nitroglycerin and reassess her systolic blood pressure. C. give her 100% oxygen, attach the AED, and transport immediately. D. obtain a SAMPLE history and contact medical control for advice. ANS: A. admin- ister oxygen, give her 324 mg aspirin, and assess her further.

18. Which of the following is of LEAST pertinence when obtaining medical history information from a patient complaining of chest discomfort? A. presence of personal risk factors B. family history of hypertension

C. history of previous heart attack D. history of cigarette smoking ANS: B. family history of hypertension

19. During your treatment of a woman in cardiac arrest, you apply the AED, analyze her cardiac rhythm, and receive a "no shock advised" message. This indicates that: A. the AED has detected asystole. B. the AED detected patient motion. C. she has a pulse and does not need CPR. D. she is not in ventricular fibrillation. ANS: D. she is not in ventricular fibrillation.
20. You are dispatched to a convenience store for a patient who passed out. Upon arriving at the scene, you find two bystanders performing CPR on the patient, a 58-year-old male. Your initial action should be to: A. have the bystanders stop CPR and assess the patient. B. assess the effectiveness of the bystanders' CPR.

C. request a paramedic unit and quickly attach the AED. D. quickly attach the AED and push the analyze button. ANS: A. have the bystanders stop CPR and assess the patient.

21. A 67-year-old female with severe chest pain becomes unresponsive, pulse- less, and apneic during transport. You should: A. stop the ambulance, begin CPR, and attach the AED as soon as possible. B. perform CPR for 1 to 2 minutes and then analyze her rhythm with an AED. C. defibrillate with the AED while continuing transport to the hospital.

D. alert the receiving hospital and perform CPR for the duration of the trans- port. ANS: A. stop the ambulance, begin CPR, and attach the AED as soon as possible.

22. Which of the following statements regarding nitroglycerin is correct? A. A maximum of five nitroglycerin doses should be given to a patient. B. The potency of nitroglycerin is increased when exposed to light. C. Nitroglycerin usually relieves anginal chest pain within 5 minutes. D. Nitroglycerin should be administered between the cheek and gum. ANS: C. Nitroglycerin usually relieves anginal chest pain within 5 minutes.
23. A dissecting aortic aneurysm occurs when: A. the inner layers of the aorta become separated. B. the aorta ruptures, resulting in profound bleeding.

C. all layers of the aorta suddenly contract. D. a weakened area develops in the aortic wall. ANS: A. the inner layers of the aorta become separated.

24. Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who: A. have had a stroke in the past. B. regularly take illegal drugs. C. have chronic hypertension. D. are older than 40 years of age. ANS: C. have chronic hypertension.
25. Cardiogenic shock following AMI is caused by: A. a profound increase in the patient's heart rate.

B. hypovolemia secondary to severe vomiting. C. widespread dilation of the systemic vasculature. D. decreased pumping force of the heart muscle. ANS: D. decreased pumping force of the heart muscle.

26. The myocardium receives oxygenated blood from the , which originate(s) from the. A. aorta, inferior vena cava B. coronary arteries, aorta C. coronary sinus, vena cava D. vena cava, coronary veins ANS: B. coronary arteries, aorta
27. The left ventricle has the thickest walls because it: A. receives blood directly from the systemic circulation. B. pumps blood to the lungs to be reoxygenated. C. pumps blood into the aorta and systemic circulation. D. uses less oxygen than other chambers of the heart. ANS: C.

pumps blood into the aorta and systemic circulation.

28. The electrical impulse generated by the heart originates in the: A. sinoatrial (SA) node. B. bundle of His. C. atrioventricular (AV) node. D. coronary sinus. ANS: A. sinoatrial (SA) node.
29. You are assessing a 49-year-old man who, according to his wife, experi- enced a sudden, severe headache and then passed out. He is unresponsive

and has slow, irregular breathing. His blood pressure is 190/ mm Hg and his pulse rate is 50 beats/min. His wife tells you that he has hypertension and diabetes. He has MOST likely experienced: A. acute hypoglycemia. B. a ruptured cerebral artery. C. a complex partial seizure. D. an occluded cerebral artery. ANS: B. a ruptured cerebral artery.

30. The MOST significant risk factor for a hemorrhagic stroke is: A. hypertension. B. heavy exertion. C. diabetes mellitus. D. severe stress. ANS: A. hypertension.
31. A generalized seizure is characterized by:

A. severe twitching of all the body's muscles. B. a blank stare and brief lapse of consciousness. C. a core body temperature of greater than 103°F (40°C). D. unconsciousness for greater than 30 minutes. ANS: A. severe twitching of all the body's muscles.

32. Which of the following MOST accurately describes what the patient will experience during the postictal state that follows a seizure? A. a gradually decreasing level of consciousness

B. hyperventilation and hypersalivation C. a rapidly improving level of consciousness D. confusion and fatigue ANS: D. confusion and fatigue

33. Status epilepticus is characterized by: A. generalized seizures that last less than 5 minutes. B. profound tachycardia and total muscle flaccidity. C. prolonged seizures without a return of consciousness. D. an absence seizure that is not preceded by an aura. ANS: C. prolonged seizures without a return of consciousness.
34. You arrive at a local grocery store approximately 5 minutes after a 21-year-old female stopped seizing. She is confused and disoriented; she keeps asking you what happened and tells you that she is thirsty. Her brother, who witnessed the seizure, tells you that she takes phenytoin (Dilantin) for her seizures, but has not taken it in a few days. He also tells you that she has diabetes. In addition to applying high-flow oxygen, you should: A. place her in the recovery position and transport her with lights

and siren. B. give her small cups of water to drink and observe for further seizure activity. C. monitor her airway and breathing status and assess her blood glucose level. D. administer one tube of oral glucose and prepare for immediate transport. ANS: C. monitor her airway and breathing status and assess her blood glucose level.

35. You are caring for a semiconscious man with left-sided paralysis. His airway is patent and his respirations are 14 breaths/min with adequate tidal volume. Treatment for this patient should include: A. assisted ventilation with a bag-mask device, right lateral recumbent posi- tion, and transport.

B. an oral airway, assisted ventilation with a bag-mask device, Fowler's posi- tion, and transport. C. oxygen via a nonrebreathing mask, left lateral recumbent position, and transport. D. oxygen via a nonrebreathing mask, supine position with legs elevated 63 to 123, and transport:.C. oxygen via a nonrebreathing mask, left lateral recumbent position, and transport.

36. What Glasgow Coma Scale (GCS) score would you assign to a patient who responds to painful stimuli, uses inappropriate words, and maintains his or her arms in a flexed position? A. 10 B. 6 C. 8 D. 9 ANS: C. 8
37. A 58-year-old male presents with confusion, right-sided weakness, and slurred speech. His wife is present and is very upset. As your partner is applying oxygen, it is MOST important for you to:

A. ask his wife when she noticed the symptoms. B. obtain a complete set of baseline vital signs. C. list all of the patient's current medications. D. administer glucose to rule out hypoglycemia. ANS: A. ask his wife when she noticed the symptoms.

38. You are assessing the arm drift component of the Cincinnati Prehospital Stroke Scale on a 60-year-old woman. When she holds both of her arms out in front of her and closes her eyes, both of her arms immediately fall to her sides. You should: