NREMT Pocket Prep: Paramedic Exam Questions and Answers, Exams of Advanced Education

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NREMT Pocket Prep (NREMT

PARAMEDIC EXAM) Questions and

Answers

What are the late signs of hemorrhagic shock? - Correct Answers - Rapid breathing, cool clammy skin, dull slightly dilated pupils Is carbon monoxide an internal factor or external factor for respiration? - Correct Answers - External Name 3 of the AHA reccomended managment principles for ROSC patients. - Correct Answers - Initiate Targeted Temperature Management if patient is comatose, Administer colloid/vasopressor to a goal blood pressure of <90 systolic or MAP <65mmHg, and obtain 12-lead. (THINK TAKE PT TO THE MOVIES) According to the NREMT, what is the dose of NARCAN for a patient with suspected opiod overdose? - Correct Answers - Narcan 2mg IN (1mg per nare) Name 3 WMD chemical agent exposures that a paramedic can see symptoms of on scene? - Correct Answers - Pulmonary agents, nerve agents, and vesicant agents. (Vesicant agents include mustard gas and primarily affect DNA to cause cellular damage) Why is an uncuffed ET tube appropriate for a 6 year old child? - Correct Answers - Pediatrics of this age range have a narrowing of the trachea at the level of the cricoid cartilage. Name the major signs of hypothermia. - Correct Answers - Lack of coordination, confusion and memory loss, lack of shivering, weak pulses, slowed speech, drowsiness and very low energy, and slow shallow breathing. What is a naturally occurring steroidal hormone produced by the adrenal cortex to help regulate the sodium/potassium balance in the blood? - Correct Answers - Aldosterone What treatment is indicated for a patient presenting with atrial fibrillation lasting less than 48 hours? - Correct Answers - Synchronized cardioversion What would a paramedic expect to see in a patient with a chronic adrenal dysfunction such as Addison's disease? - Correct Answers - Darkened skin, anorexia, hypoglycemia, nausea, and vomiting.

Patients who present with unusually darkened skin patches, especially in areas such as the underarms and behind the knees, anorexia, hypoglycemia, nausea, and vomiting are most likely suffering from the long-term effects of Addison's disease due to corticosteroid deficiency. Where in the body has a patient been struck if you suspect they are experiencing commotio cordis? - Correct Answers - The chest by a fast moving object (most often in sports; such as a baseball or hockey puck) In dislocations and fractures, splinting is normally done in the position it is found. If circulation is comprimised, a paramedic may attempt to manipulate the injury one time to regain circulation. What is the one anatomical location that is the exception to this rule and therefore contraindicated in the prehospital setting? - Correct Answers - Elbow dislocations and fractures, due to the anatomical position of these injuries. Name 3 common SSRI medications. - Correct Answers - Zoloft (Sertaline), Prozac (Fluoxetine), and Paxil (Paroxetine) Define how to calculate the rate of an irregular rhythm and how and why it should be used. - Correct Answers - The range of an irregular heart rate can be determined by calculating the heart rate of the QRS complexes closest together and the QRS complexes furthest apart. The two rates can be calculated using the block or memory method. Regarding irregular heart rates, how do you perform the 6 second method? How do you perform the 10 second method? *NOTE, NREMT DOES NOT BELIEVE THIS METHOD EXISTS, BUT IT IS GOOD TO KNOW ANYWAY - Correct Answers - Viewing the rhythm strip, on a 6-second strip count the number of QRS complexes and multiply by 10. For a 10 second strip, count the number of QRS complexes and multiply by 6. Why is cystic fibrosis not considered a lower airway infection? - Correct Answers - Cystic fibrosis is caused by genetic factors, not an infection. What three factors effect stroke volume? - Correct Answers - Contractility, afterload, and preload. What is cardiac elasticity? - Correct Answers - Elasticity is the factor that defines how "springy" the cardiac muscle is. It DOES NOT effect stroke volume. Name 3 factors that contraindicate endotracheal intubation. Name 2 things that do not effect indication of intubation. - Correct Answers - Inability to open the patient's mouth, inability to view the glottic opening, and intact gag reflex. Traumatic brain injury and respiratory compromise do not contraindicate intubation. Why should patients receiving hemodialysis receive sodium bicarb and calcium chloride during cardiac arrest? - Correct Answers - Patients in cardiac arrest who have received

their life with sudden-onset dizziness and blurred vision. Bleeding is often sudden and severe with this injury and can be deadly in minutes in some cases. Patients may also have unequal pupillary response and neck stiffness associated with meningeal irritation. Name the volume lost in each of the four classes of hemorrhage. - Correct Answers - Class I >15%, Class II 15-30%, Class III 30-40%, Class IV <40% Patients exposed to a housefire who have inhaled smoke may be exposed to what 3 gases? - Correct Answers - Carbon monoxide, hydrogen sulfate, and hydrogen cyanide. Periumbilical bruising indicates what type of injury? - Correct Answers - Retroperitoneal hemorrhage Which of the following incomplete spinal cord syndromes commonly occurs with hyperextension and/or flexion cervical spine injuries and presents with a greater loss of function in the upper extremities than in the lower extremities? - Correct Answers - Central spinal cord syndrome presents with some hyperextension and/or flexion injuries of the cervical spine. The syndrome is characterized by greater motor impairment in the upper than lower extremities. The signs and symptoms of central spinal cord syndrome include paralysis of both arms with sacral sparing. A patient is trapped in a vehicle in a seated position, and extrication is expected to take 20 minutes or more. Patient is unresponsive, a weak thready carotid pulse, and has no intact gag reflex. What kind of airway is indicated and why? - Correct Answers - King LTD is indicated because it will maintain the airway, and c-spine manipulation must be kept to a minimum. What is Brown-Sequard syndrome? - Correct Answers - Damage to half of spinal cord Loss of pain and temperature sensation on contralateral side of body Loss of proprioception and discriminatory touch on ipsilateral side of body. What is central cord syndrome? - Correct Answers - A kind of incomplete spinal cord injury that limits a portion of the signals transmitted through that portion of the spinal cord, but allows some to pass through. A trauma patient presents with increased blood pressure, bradycardia, reactive pupils, and Cheynne-stokes respirations. What part of the brain is likely damaged? - Correct Answers - Brain stem What medication will decrease cerebral edema and circulating blood volume after the injury? - Correct Answers - Mannitol, a diuretic In regards to increased ICP, what drug may be indicated when attempting to intubate? - Correct Answers - Lidocaine has been shown to control increases in intracranial pressure in closed-head injury patients that may occur during intubation.

When extricating a stable patient from a vehicle seated in the drivers seat and the drivers side door is damaged too much to open, what is the safest way to extricate the patient? - Correct Answers - Open the passenger's side door and extricate the patient through the passenger's side. Interference from other electrical devices will present as what kind of artifact on the EKG? - Correct Answers - 60 cycle interference, appears as fibrillation-type waves between QRS complexes that is too rapid to be caused by a dysrhythmia. What EKG abnormalities are present with WPW syndrome? - Correct Answers - Delta waves (slurred upstroke in the QRS complex), widened QRS complex, and short PR interval (>120ms) How will hip dislocations present? - Correct Answers - Most dislocations at the hip will involve anterior rotation, and shortening of the affected leg with internal rotation. Mesentric ischemia is rare, but when it is present it is caused by what 3 things? - Correct Answers - Arterial thrombosis, arterial embolism, and vasospasm. Satolol is used for what condition, and what drug class is it considered? - Correct Answers - Class III, for wide complex tachycardia Define chronotropic - Correct Answers - rate of heartbeat Define dromotropic - Correct Answers - conductivity of heart Define inotropic - Correct Answers - The strength of the contractility Why is a patient in hypovolemic shock likely to develop increased dyspnea even after bleeding is controlled? - Correct Answers - Loss of erythrocytes decreases the bloods ability to carry oxygen, thus increasing respiratory rate. According to the AHA, what kind of electrical shock is required when a patient presents with monomorphic VTACH? - Correct Answers - Synchronized cardioversion. Defibrillation is indicated when the VTACH is polymorphic, and in cases that one is unable to distinguish the two, treat as polymorphic. What would be the proper way to administer epinephrine to the patient without IV/IO access who is intubated while en route to the hospital? - Correct Answers - Through the patient's ET tube at 2.0-2.5 times the normal dose, diluted in 5-10 mL of sterile water What is true concerning J point elevation? - Correct Answers - The J point elevation is a type of ST segment elevation seen in normal hearts. It is seen in young, healthy adults and typically returns to baseline with exercise. It can be mistaken for a pathologic ST elevation; however, the key difference is a merging of the ST elevation with the T wave during an infarction. In J point elevation the T wave is an independent, normal wave.

What are the "AHA 8 D's" of stroke care? - Correct Answers - Detection: rapid recognition of stroke signs and symptoms Dispatch: early activation and dispatch of EMS by phoning 9- 1 - 1 Delivery: rapid EMS stroke identification, management, triage, transport, and prehospital notification Door: emergent ED/imaging suite triage and immediate assessment by the stroke team Data: rapid clinical evaluation, laboratory testing, and brain imaging Decision: establishing stroke diagnosis and determining optimal therapy selection Drug/Device: administration of fibrinolytic and/or EVT if eligible Disposition: rapid admission to the stroke unit or critical care unit, or emergent interfacility transfer for EVT What is Wolff-Parkinson-White syndrome? - Correct Answers - Congenital malformation resulting in incomplete separation of the atria from the ventricles during foetal maturation This leads to the presence of an extra 'accessory' bundle connecting the ventricles and the atria Because in this accessory bundle there is no AV node to delay conduction a wave of depolarisation reaches the ventricle early pre-excitation occurs. Patients with WPWS present with paroxysmal supra ventricular tachycardia Paroxysmal Superventricular Tachycardia (PSVT) - Correct Answers - dysrhythmia starting in an ectopic focus anywhere above the bifurcation of the bundle of His. PSVT occurs because of a reentrant phenomenon (reexcitation of the atria when there is a one-way block). Usually a PAC triggers a run of repeated premature beats. Paroxysmal refers to an abrupt onset and ending. Termination is sometimes followed by a brief period of asystole (absence of all cardiac electrical activity). Some degree of AV block may be present. At what speed should the EKG machine be set? - Correct Answers - 2 5mm/second Ventricular hypertrophy is caused by: - Correct Answers - Pressure overload You are preparing to perform fluid replacement on an adult trauma patient who lost a significant amount of his circulating blood volume, when you note a systolic change from 100mmHg to 86mmHg. There is no new bleeding, and his abdomen is distended with no signs of bruising, masses, or deformities. Which intravenous fluids would be most appropriate in this situation if the medical command physician recommends a fluid challenge? a) 0.9% Saline b) 0.45% Saline

c) D d) Lactated Ringers Solution - Correct Answers - d) Lactated Ringers Solution A patient is experiencing an anterior myocardial infarction. In which leads are you MOST LIKELY to see evidence of the infarction? - Correct Answers - V3 and V What is agnosia? - Correct Answers - An inability to recognize objects What is aphasia? - Correct Answers - An impairment of language What is dysarthria? - Correct Answers - Presence of slurred speech A patient with increased intercranial pressure to the midbrain will show what signs and symptoms? - Correct Answers - Patients with increased intracranial pressure at the level of the middle brainstem will likely present with a widened pulse pressure, bradycardia, and abnormal posturing (extension). A patient is found unconscious, tachycardia too fast to palpate accurately, and hypotension. EKG shows Torsades de Pointe, what is the most appropriate intervention for this patient? - Correct Answers - A high energy unsynchronized shock (Also acceptable: defibrillation) At what temperature range should a patient be kept if they are recieving Targeted Temperature Management and for how long? What kind of patients should receive this treatment post cardiac arrest? - Correct Answers - 32 degrees C to 36 degrees C for at least 24 hours if found to be comatose post cardiac arrest Active core rewarming procedures are considered invasive and reserved for the controlled environment of the hospital. However, some active core rewarming procedures are acceptable to initiate in the pre-hospital setting. Name one example of invasive active core rewarming that may be done in the prehospital setting? - Correct Answers - Administration of warm IV fluids and humidified O What measure of time on the EKG does the PR segment measure? - Correct Answers - The end of atrial depolarization to the start of ventricular depolarization Describe the procedure for orogastric tube placement in an unresponsive patient. - Correct Answers - The steps for placing an orogastric tube in an unresponsive patient are:

1. Position the head in a slightly flexed position
2. Measure from mouth to ear to xiphoid process
3. Lubricate the tube with water-soluble gel and introduce the tube at the midline; advance it gently into the oropharynx, continuing into the stomach
4. Confirm placement
5. Apply suction to the tube
6. Secure the tube in place