Identifying and Managing Respiratory Emergencies, Exams of Nursing

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Ten days after treating a 34-year-old patient with tuberculosis, you are given a tuberculin skin test, which yields a positive result. This MOST likely indicates that:

Select one:

A. the disease is dormant in your body, but will probably never cause symptoms.

B. you are actively infected with tuberculosis and should be treated immediately.

C. you were exposed to another infected person prior to treating the 34-year-old patient.

D. you contracted the disease by casual contact instead of exposure to secretions. ANS: C. you were exposed to another infected person prior to treating the 34-year-old patient.

After sizing up the scene of a patient with a possible infectious disease, your next priority should be to:

Select one:

WEST COAST EMT BLOCK EXAM 2 VERSION B

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PREDICTED

A. contact medical control.

B. notify law enforcement.

C. quickly access the patient.

D. take standard precautions. ANS: D. take standard precautions.

An infectious disease is MOST accurately defined as:

Select one:

A. any disease that enters the body via the bloodstream and renders the immune system nonfunctional.

B. the invasion of the human body by a bacterium that cannot be destroyed by antibiotics or other drugs.

C. a medical condition caused by the growth and spread of small, harmful organisms within the body.

D. a disease that can be spread from one person or species to another through a number of mechanisms. ANS: C. a medical condition caused by the growth and spread of small, harmful organisms within the body.

Assessment of the medical patient is usually focused on the.

Select one:

A. nature of illness

B. field diagnosis

C. associated symptoms

D. medical history ANS: A. nature of illness

Hepatitis B is more virulent than hepatitis C, which means that it:

Select one:

A. is a more contagious type of disease.

B. has a greater ability to produce disease.

C. leads to chronic infection after exposure.

D. is less resistant to treatment. ANS: B. has a greater ability to produce disease.

In 2009, the H1N1 virus accounted for over 200, deaths worldwide in the form of the swine flu. In 1919, a similar outbreak of the H1N1 occurred in the form of the Spanish flu. Starting in Kansas City, the virus spread rapidly worldwide, claiming up to 50 million lives. These are both examples of:

Select one:

A. epidemics.

B. parasitic infection.

C. uncontrolled outbreaks.

D. pandemics. ANS: D. pandemics.

In which of the following situations would it be MOST appropriate to utilize an air medical transportation service?

Select one:

A. 29-year-old woman who is 18 weeks pregnant, has light vaginal bleeding, and stable vital signs

B. 50-year-old conscious woman with severe nausea and vomiting, fever, and chills of 3 days' duration

C. 43-year-old man experiencing a heart attack, and the closest appropriate hospital is 15 minutes away

D. 61-year-old man with signs and symptoms of a stroke and a ground transport time of 50 minutes ANS: D. 61-year-old man with signs and symptoms of a stroke and a ground transport time of 50 minutes

It is especially important to assess pulse, sensation, and movement in all extremities as well as pupillary reactions in patients with a suspected problem.

Select one:

A. endocrine

B. respiratory

C. cardiac

D. neurologic ANS: D. neurologic

Most patients with an infectious disease will have .

Select one:

A. a low blood glucose level

B. abdominal pain

C. seizures

D. a fever ANS: D. a fever

Most treatments provided in the prehospital setting are intended to.

Select one:

A. reduce the need for transport to the hospital

B. confirm the patient's diagnosis

C. address the patient's symptoms

D. correct the patient's underlying problem ANS: C. address the patient's symptoms

The BEST way to prevent infection from whooping cough is to:

Select one:

A. routinely place a surgical mask on all respiratory patients.

B. ask all patients if they have recently traveled abroad.

C. get vaccinated against diphtheria, tetanus, and pertussis.

D. wear a HEPA mask when treating any respiratory patient. ANS: C. get vaccinated against diphtheria, tetanus, and pertussis.

The determination of whether a medical patient is a high-priority or low-priority transport is typically made:

Select one:

A. as soon as the patient voices his or her chief complaint.

B. after the primary assessment has been completed.

C. upon completion of a detailed secondary assessment.

D. once the patient's baseline vital signs are known. ANS: B. after the primary assessment has been completed.

When assessing a patient with a medical complaint, which of the following would MOST likely reveal the cause of the problem?

Select one:

A. Baseline vital signs

B. Index of suspicion

C. Medical history

D. Primary assessment ANS: C. Medical history

When caring for a patient with an altered mental status and signs of circulatory compromise, you should:

Select one:

A. perform a detailed secondary assessment prior to transporting the patient.

B. have a paramedic unit respond to the scene if it is less than 15 minutes away.

C. limit your time at the scene to 10 minutes or less, if possible.

D. transport immediately and begin all emergency treatment en route to the hospital. ANS: C. limit your time at the scene to 10 minutes or less, if possible.

When forming your general impression of a patient with a medical complaint, it is important to remember that:

Select one:

A. most serious medical conditions do not present with obvious symptoms.

B. it is during the general impression that assessment of the ABCs occurs.

C. the conditions of many medical patients may not appear serious at first.

D. the majority of medical patients you encounter are also injured. ANS: C. the conditions of many medical patients may not appear serious at first.

Which of the following conditions is NOT categorized as a psychiatric condition?

Select one:

A. Alzheimer disease

B. Depression

C. Schizophrenia

D. Substance abuse ANS: D. Substance abuse

Which of the following is bacterium resistant to most antibiotics and causes skin abscesses?

Select one:

A. Whooping cough

B. MRSA

C. H1N

D. Avian flu ANS: B. MRSA

Which of the following patients is at greatest risk for complications caused by the influenza virus?

Select one:

A. 50-year-old woman moderate obesity

B. 68-year-old woman with type 2 diabetes

C. 12-year-old child with a fractured arm

D. 39-year-old man with mild hypertension ANS: B. 68-year-old woman with type 2 diabetes

You and your EMT partner arrive at the residence of a 50-year-old man who complains of weakness. Your primary assessment reveals that he is critically ill and will require aggressive treatment. The closest hospital is 25 miles away. You should:

Select one:

A. administer oxygen via nonrebreathing mask and obtain as much of his medical history as possible.

B. manage all threats to airway, breathing, and circulation and consider requesting an ALS unit.

C. load him into the ambulance, begin transport, and perform all treatment en route to the hospital.

D. perform a detailed secondary assessment, assess his vital signs, and then transport rapidly. ANS: B. manage all threats to airway, breathing, and circulation and consider requesting an ALS unit.

You are attending to a 27-year-old male driver of a car. According to his passenger, the patient had been acting strangely while driving, then slumped forward against the steering wheel, apparently unconscious. The car drove off the road and struck a telephone pole. The patient remains unconscious, and physical assessment reveals only a large hematoma on his right forehead with no other physical signs. Your patient is a diabetic who had been under a lot of stress lately and may have missed meals. This is an example of a:

Select one:

A. combination of a psychiatric and trauma emergency.

B. medical emergency.

C. trauma emergency.

D. combination of a medical and trauma emergency. ANS: D. combination of a medical and trauma emergency.

"PASTE" is an alternate assessment tool for.

Select one:

A. respiratory patients

B. seizure patients

C. stroke patients

D. cardiac patients ANS: A. respiratory patients

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 the lung fields. His blood pressure is 90/50 mm Hg and his heart rate is 110 beats/min. In addition to giving him high-flow oxygen, the MOST important treatment for this patient is:

Select one:

A. epinephrine.

B. a beta-antagonist.

C. albuterol.

D. an antihistamine. ANS: A. epinephrine.

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 diminished breath sounds, and tachycardia. What is the MOST likely cause of this patient's condition?

Select one:

A. Spontaneous pneumothorax

B. Exacerbation of his COPD

C. Acute pulmonary embolism

D. Rupture of the diaphragm ANS: A. Spontaneous pneumothorax

A pleural effusion is MOST accurately defined as:

Select one:

A. fluid accumulation outside the lung.

B. diffuse collapsing of the alveoli.

C. a unilaterally collapsed lung.

D. a bacterial infection of the lung tissue. ANS: A. fluid accumulation outside the lung.

Asthma is caused by a response of the:

Select one:

A. immune system.

B. cardiovascular system.

C. endocrine system.

D. respiratory system. ANS: A. immune system.

Crackles (rales) are caused by.

Select one:

A. severe bronchoconstriction

B. mucus in the larger airways

C. narrowing of the upper airways

D. air passing through fluid ANS: D. air passing through fluid

His parents tell you that their son has had a chest infection for the past two days and when they took him to their family doctor, they were told it was likely due to the respiratory syncytial virus (RSV). They have kept him well hydrated, but the infection seems to have gotten worse. On auscultation, you hear decreased air entry bilaterally with fine expiratory wheezes and the occasional coarse wet crackle. Based on this information, your patient is most likely suffering from:

Select one:

A. pertussis.

B. epiglottitis.

C. croup.

D. bronchiolitis. ANS: D. bronchiolitis.

In order for efficient pulmonary gas exchange to occur:

Select one:

A. the percentage of inhaled carbon dioxide must exceed the percentage of inhaled oxygen.

B. there must be low quantities of pulmonary surfactant to allow for full alveolar expansion.

C. oxygen and carbon dioxide must be able to freely diffuse across the alveolar-capillary membrane.

D. the pulmonary capillaries must be completely constricted and the alveoli must be collapsed. ANS: C. oxygen and carbon dioxide must be able to freely diffuse across the alveolar-capillary membrane.

In what area of the lungs does respiration occur?

Select one:

A. Alveoli

B. Bronchi

C. Trachea

D. Capillaries ANS: A. Alveoli

Treatment with continuous positive airway pressure (CPAP) would MOST likely be contraindicated in which of the following situations?

Select one:

A. Pulmonary edema, history of hypertension, and anxiety

B. Difficulty breathing, two-word dyspnea, and tachycardia

C. Conscious and alert patient with an oxygen saturation of 85%

D. Shortness of breath and a blood pressure of 76/ mm Hg ANS: D. Shortness of breath and a blood pressure of 76/56 mm Hg

When auscultating the lungs of a patient with respiratory distress, you hear adventitious sounds. This means that the patient has:

Select one:

A. abnormal breath sounds.

B. diminished breath sounds.

C. normal breath sounds.

D. an absence of breath sounds. ANS: A. abnormal breath sounds.

Which of the following conditions would be LEAST likely to result in hypoxia?

Select one:

A. Pleural effusion

B. Severe anxiety

C. Pulmonary edema

D. Narcotic overdose ANS: B. Severe anxiety

Which of the following is a genetic disorder that predisposes the patient to repeated lung infections?

Select one:

A. Multiple sclerosis

B. Severe acute respiratory syndrome

C. Cystic fibrosis

D. Celiac sprue ANS: C. Cystic fibrosis

Which of the following is MOST characteristic of adequate breathing?

Select one:

A. 22 breaths/min with an irregular pattern of breathing and cyanosis

B. 20 breaths/min with shallow movement of the chest wall and pallor

C. 24 breaths/min with bilaterally equal breath sounds and pink skin

D. 30 breaths/min with supraclavicular retractions and clammy skin ANS: C. 24 breaths/min with bilaterally equal breath sounds and pink skin

Which of the following must be assessed in every respiratory patient?

Select one:

A. Orthostatic vital signs

B. Lung sounds

C. Blood glucose levels

D. Distal pulse, motor, sensation ANS: B. Lung sounds

While auscultating an elderly woman's breath sounds, you hear low-pitched "rattling" sounds at the bases of both of her lungs. This finding is MOST consistent with which of the following conditions?

Select one:

A. Aspiration pneumonia

B. Widespread atelectasis

C. Early pulmonary edema

D. Acute asthma attack ANS: A. Aspiration pneumonia

You are assisting an asthma patient with his prescribed metered-dose inhaler. After the patient takes a deep breath and depresses the inhaler, you should:

Select one:

A. advise him to exhale forcefully to ensure medication absorption.

B. allow him to breathe room air and assess his oxygen saturation.

C. instruct him to hold his breath for as long as he comfortably can.

D. immediately reapply the oxygen mask and reassess his condition. ANS: C. instruct him to hold his breath for as long as he comfortably can.

You are attending to a 3-year-old male patient who is presenting with severe shortness of breath. His parents report that he has had a cough and cold with a low grade fever for the past two days. They became worried today, as his level of distress has increased dramatically. On assessment, the patient is sitting upright and making high-pitched noises with each breath. Based on

this information, the patient is most likely suffering from:

Select one:

A. bacterial infection of the epiglottis.

B. viral infection of the upper respiratory tract.

C. inflammation of the bronchioles.

D. inflammation of the lower respiratory tract and bronchospasm. ANS: B. viral infection of the upper respiratory tract.

You are attending to a 54-year-old female patient in a homeless shelter. The patient tells you that she had the flu a couple of weeks ago, and she has not gotten over it. She has been tired and keeps waking up at night, sweating. She has been coughing up green sputum occasionally and has been experiencing episodes of chest pain that get worse when she breathes. Based on this information, your patient is most likely suffering from:

Select one:

A. chronic obstructive pulmonary disease (COPD).

B. tuberculosis.

C. pneumonia.

D. influenza Type A. ANS: B. tuberculosis.

Your patient has a chronic respiratory condition. His stimulus to breathe is triggered by low oxygen levels in the blood. This is known as the.

Select one:

A. alternate drive

B. CO2 drive

C. hypoxic drive

D. COPD drive ANS: C. hypoxic drive

A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should:

Select one:

A. administer up to three doses of nitroglycerin.

B. administer up to 324 mg of baby aspirin.

C. obtain vital signs and a SAMPLE history.

D. assess the adequacy of his respirations. ANS: D. assess the adequacy of his respirations.

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, her

respirations are 22 breaths/min, and her oxygen saturation is 92%. The patient does not have prescribed nitroglycerin, but her husband does. You should:

Select one:

A. give her one nitroglycerin and reassess her systolic blood pressure.

B. administer oxygen, give her 324 mg of aspirin, and assess her further.

C. obtain a SAMPLE history and contact medical control for advice.

D. give her high-flow oxygen, attach the AED, and transport at once. ANS: B. administer oxygen, give her 324 mg of aspirin, and assess her further.

A dissecting aortic aneurysm occurs when:

Select one:

A. a weakened area develops in the aortic wall.

B. the aorta ruptures, resulting in profound bleeding.

C. the inner layers of the aorta become separated.

D. all layers of the aorta suddenly contract. ANS: C. the inner layers of the aorta become separated.

A patient in cardiac arrest is wearing an external defibrillator vest, which is interfering with effective chest compressions. The EMT should:

Select one:

A. perform ventilations only and allow the vest device to defibrillate.

B. remove the battery from the monitor and then remove the vest.

C. leave the battery attached to the monitor and remove the vest.

D. remove the battery from the monitor and leave the vest in place. ANS: B. remove the battery from the monitor and then remove the vest.

A patient tells you that he has a left ventricular assist device (LVAD). Which of the following conditions should you suspect that he has experienced?

Select one:

A. Thoracic aortic aneurysm

B. Acute myocardial infarction

C. Uncontrolled hypertension

D. Obstructive lung disease ANS: B. Acute myocardial infarction

A patient with atherosclerotic heart disease experiences chest pain during exertion because:

Select one:

A. the ragged edge of a tear in the coronary artery lumen causes local blood clotting and arterial narrowing.

B. tissues of the myocardium undergo necrosis secondary to a prolonged absence of oxygen.

C. the lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.

D. the coronary arteries suddenly spasm and cause a marked reduction in myocardial blood flow. ANS: C. the lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.

After the AED has delivered a shock, the EMT should:

Select one:

A. transport the patient at once.

B. assess for a carotid pulse.

C. immediately resume CPR.

D. re-analyze the cardiac rhythm. ANS: C. immediately resume CPR.

Angina pectoris occurs when:

Select one:

A. myocardial oxygen demand exceeds supply.

B. a coronary artery is totally occluded by plaque.

C. myocardial oxygen supply exceeds the demand.

D. one or more coronary arteries suddenly spasm. ANS: A. myocardial oxygen demand exceeds supply.

Deoxygenated blood from the body returns to the:

Select one:

A. left ventricle.

B. right atrium.

C. right ventricle.

D. left atrium. ANS: B. right atrium.

Most AEDs are set up to adjust the voltage based on the impedance, which is the:

Select one:

A. distance between the two AED pads on the chest.

B. direction that the electrical flow takes in the body.

C. actual amount of energy that the AED will deliver.

D. resistance of the body to the flow of electricity. ANS: D. resistance of the body to the flow of electricity.

Nitroglycerin is contraindicated in patients:

Select one:

A. who have taken up to two doses.

B. who have experienced a head injury.

C. with a systolic blood pressure less than 120 mm Hg.

D. with a history of an ischemic stroke. ANS: B. who have experienced a head injury.

Prior to attaching the AED to a cardiac arrest patient, the EMT should:

Select one:

A. assess for a pulse for 20 seconds.

B. contact medical control.

C. dry the chest if it is wet.

D. perform CPR for 30 seconds. ANS: C. dry the chest if it is wet.

Risk factors for AMI that cannot be controlled include:

Select one:

A. family history.

B. lack of exercise.