Quiz 2: Scene Size-Up

You arrive at a location and begin to read the scene by: A) approaching the patient. B) observing the immediate surroundings. C) conducting a focused exam. D) addressing life threats.

Which of the following is a potentially life-threatening patient complaint? A) Fractures of the tibia and radius B) Asthma C) Headache D) Chest pain

At the scene of a multiple-vehicle collision, which of the following actions should you take first? A) Wait for additional resources to arrive. B) Treat the most seriously injured patient. C) Quickly scan the scene to count patients. D) Go directly to the first patient you see.

A scene size-up is performed for all of the following reasons EXCEPT: A) to assess the mechanism of injury. B) to assess a baseline mental status. C) to provide information that will guide your medical care. D) to assess the need for additional resources.

Which of the following is usually the best source of information about an alert and oriented patient? A) The patient B) Visual cues C) Diagnostic tests D) Family members

Which of the following is NOT a consideration when evaluating the mechanism of injury? A) Mass and velocity of objects involved B) Whether the mechanism was blunt or penetrating C) Direction of impact D) Whether it is a rural or an urban setting

When approaching a potential crime scene, you should: A) enter the scene if no signs of danger are noted. B) quickly enter the scene, retrieve the victim, and withdraw to the vehicle. C) park away from the scene until the police arrive and secure the scene. D) park and wait in front of the scene so the victim knows you are there.

Which of the following best describes when you should perform a scene size-up? A) Once you arrive at the patient's side B) Throughout your time on the scene C) When you initially arrive at the scene D) As you are leaving the scene

A paramedic should wear a properly fitted HEPA mask when evaluating a patient exhibiting signs and symptoms of: A) influenza. B) asthma. C) COPD. D) tuberculosis.

A car has struck a pedestrian at about 45 mph. While assessing the patient, you note bilateral tibia and fibula fractures. Which of the following best describes why the patient should be transported to a trauma center? A) Pain from the fractures cannot be treated in the prehospital setting. B) Other serious injuries are likely. C) These fractures cannot be treated in a community hospital. D) Fractures always require immediate surgery.

Which of the following is NOT an example of a mechanism of injury? A) An episode of chest pressure B) A fall from a ladder C) A low-speed motor vehicle collision D) A high-velocity gunshot wound

Your patient is a 75-year-old man who is alert and responds to your questions. Which of the following is the best source of information about this patient? A) Family or friends B) The medical record C) The patient D) The physician

A paramedic should wear protective eyewear when caring for a patient who is: A) coughing up blood-tinged sputum. B) complaining of dizziness. C) unresponsive. D) all of the above.

All of the following mechanisms of injury yield a high level of suspicion for life-threatening injury EXCEPT: A) a stab wound distal to the knee. B) a collision between a motorcycle and a pedestrian. C) falling off the top of a 30-foot extension ladder. D) a patient ejection from a motor vehicle after a collision.

Which of the following provides a clue to the nature of an illness? A) Medication bottles on the nightstand B) Length of a knife C) Caliber of ammunition D) Surface on which a patient fell

Which of the following is most likely to result in life-threatening hemorrhage? A) Epistaxis B) Lacerated femoral artery C) Fractured radius and ulna D) Bleeding hemorrhoids

Which of the following factors may influence your index of suspicion of a patient's condition? Select the letter choice with the best combination of the following factors: 1. Age 2) Gender 3) Race 4) Forces involved with the mechanism of injury A) 1, 2, and 4 B) 1, 3, and 4 C) 1, 2, 3, and 4 D) 4 only

Components of a scene size-up include all of the following EXCEPT: A) patient's chief complaint. B) number of patients. C) mechanism of injury. D) dangers to bystanders.

You find an adult patient lying supine on the sidewalk after being struck by a vehicle traveling at 10 mph. The patient is alert with stable vital signs. The mechanism of injury and initial patient presentation are most consistent with suspected: A) pneumothorax. B) closed-head injury. C) abdominal trauma. D) lower extremity trauma.

When responding to calls involving two-vehicle collisions, you must always suspect: A) multiple patients. B) patients with altered mental status. C) flail chest. D) severe lower extremity injuries.

You respond to a scene where gunshots have been heard, and there is a report of a "man down." You should enter the scene when: A) you arrive on the scene. B) dispatch informs you the scene is safe. C) you observe the gunman fleeing the scene. D) police officers arrive and secure the scene.

As the first unit on the scene of a mass-casualty incident, you and your partner should: A) stay together, assuming a joint command role. B) split up, with one assuming a command role, the other a triage role. C) stay together, both locating and triaging patients. D) split up, with both initiating patient triage.

When responding to a domestic dispute, you should: A) have your dispatcher tell the patient to come outside. B) wait for law enforcement to arrive. C) refuse the call unless law enforcement is on the scene. D) determine whether or not the assailant is still on the scene.

Which of the following best describes why you should call for additional assistance when dealing with multiple patients? A) Risks to each provider decrease as more responders arrive on the scene. B) You are responsible only for command and triage. C) You cannot safely and effectively treat all the patients. D) Fair distribution of workload is required by most unions.

You are treating a 27-year-old asthmatic patient outside a bar when a growing crowd becomes hostile and unruly. To protect yourself, your crew, and your patient, you should: A) move the patient into the bar. B) use your vehicle to disperse the crowd. C) exit the scene, leaving the patient behind. D) remove yourselves and the patient from the scene.

Which of the following senses should a paramedic use to recognize hazards at the scene of an emergency? A) Smell B) Hearing C) Sight D) All of the above

A patient with skin described as "clammy" has ________ skin. A) cool and dry B) warm and dry C) warm and moist D) cool and moist

After determining that a patient does not respond to verbal stimuli, your next action would be to: A) place him in the recovery position. B) pinch one of his fingernails. C) insert an oropharyngeal airway. D) apply manual cervical spine stabilization.

Forming a general impression as part of your primary assessment helps you to: A) determine baseline mental status. B) determine general clinical status and priority. C) make a determination about stabilization of the cervical spine. D) estimate vital signs.

The sound of gurgling associated with breathing usually indicates: A) foreign body obstruction of the upper airway. B) fluid in the upper airway. C) thick mucus in the lower airways. D) constriction of the bronchioles.

The purpose of manual stabilization of the cervical spine during the primary assessment of a trauma patient is to: A) allow you to control the patient. B) allow for easier airway manipulation. C) prevent the patient from moving his neck. D) help you avoid litigation.

To assess an infant's airway, you should: A) perform a tongue-jaw lift. B) hyperextend the head and lift the chin. C) perform a jaw-thrust maneuver. D) carefully extend the head and neck.

To determine whether a patient is breathing, you should: A) listen and feel for breathing at the mouth and nose. B) observe for movement of the abdomen. C) apply a pulse oximeter. D) auscultate the chest.

Your patient appears awake, but barely looks at you when you call his name. His airway is open, and he is breathing at 34 times per minute. He appears cyanotic. Which of the following adjuncts is most appropriate at this point? A) Nonrebreather mask B) Bag-valve mask C) Nasopharyngeal airway D) Nasal cannula

When assessing the airway, which of the following actions is NOT appropriate? A) Look for chest rise and fall. B) Feel for air movement. C) Listen for airflow. D) Count the number of breaths over a minute.

You are assessing a 28-year-old man with multiple gunshots to his abdomen. You should expect his skin to be: A) cool and moist. B) hot and moist. C) warm and dry. D) cold and dry.

Mottled, cyanotic, pale, or ashen skin color may indicate any of the following EXCEPT: A) hypertensive crisis. B) impaired blood flow to an extremity. C) significant blood loss. D) loss of spinal cord function.

Steps in assessing circulation during a primary assessment include all of the following EXCEPT: A) controlling major bleeding. B) determining the blood pressure. C) checking for skin signs. D) checking for a radial pulse.

You are assessing an adult patient. When you palpate her wrist to locate a pulse, you do not feel one. You should immediately palpate for a ________ pulse. A) brachial B) femoral C) apical D) carotid

Which of the following statements regarding stridor is TRUE? A) Stridor originates in the lower airways. B) Stridor is seldom of clinical significance. C) The correct treatment of stridor depends on the underlying problem. D) The presence of stridor requires immediate intubation.

Patterns of deterioration in patient condition may include all of the following EXCEPT: A) skin becomes cool, pale, and moist. B) the heart rate significantly increases or decreases. C) the respiratory rate significantly increases or decreases. D) the level of consciousness increases.

During the primary assessment, your patient groans and tries to turn away when you apply a sternal rub. Otherwise, there is no other response. The patient's mental status can best be described as: A) alert. B) responds to painful stimulus. C) responds to verbal stimulus. D) unresponsive.

Your patient is not alert but is responsive to painful stimulus. His airway is patent. He is breathing at eight times per minute. Your next action should be to administer oxygen via a: A) nasal cannula. B) simple face mask. C) nonrebreather mask. D) bag-valve-mask device.

The best method for determining responsiveness to painful stimuli in an infant is to: A) pinch his cheeks. B) pinch his fingernails. C) rub his sternum. D) flick the soles of his feet.

While performing a primary assessment on a trauma patient who has fallen from a roof, you discover absent lung sounds on the right side. Which of the following actions should you take next? A) Assess for signs of a tension pneumothorax. B) Intubate the patient. C) Continue the rapid trauma assessment. D) Decompress the patient's chest.

Signs of inadequate breathing include all of the following EXCEPT: A) presence of bronchovesicular breath sounds. B) retractions of intercostal and supraclavicular tissues. C) nasal flaring. D) accessory muscle use.

What does the "U" in A-V-P-U stand for? A) Unresponsive B) Unconscious C) Uncooperative D) Undetermined

Medical patients with altered mental status are stabilized in a manner similar to that that is appropriate for: A) critical trauma patients. B) any other medical patient. C) a patient complaining of chest pain. D) a patient with isolated extremity trauma.

Devices for maintaining airway patency in a five-year-old patient include all of the following EXCEPT a(n): A) endotracheal tube. B) oropharyngeal airway. C) suction unit. D) pharyngotracheal lumen airway.

In an infant, the heart rate is best detected by either palpating the brachial artery or: A) auscultating the carotid pulse. B) palpating the femoral pulse. C) palpating the carotid pulse. D) auscultating the apical pulse.

Your patient is awake and complaining of chest pain. His airway is patent, and he is breathing at 18 times per minute with adequate tidal volume. What is your next action? A) Administer oxygen at 15 lpm via nonrebreather mask. B) Begin positive pressure ventilations via bag-valve-mask device. C) Insert a nasopharyngeal airway. D) Administer oxygen at 2 lpm via nasal cannula.

Which of the following best describes why patients with serious illnesses or injuries should be transported without delay? A) Definitive care cannot be provided in the prehospital setting. B) Most patients are uncomfortable with the level of care provided by paramedics. C) Paramedics must become available for additional calls as soon as possible. D) The shorter the contact time with the patient, the less the potential for liability.

You locate a 55-year-old woman lying supine on the side of a road. There are no bystanders. You determine that the patient is unresponsive. Which of the following should be your next action? A) Apply a cervical collar. B) Provide high-flow oxygen. C) Open the airway with a jaw-thrust maneuver. D) Intubate the trachea.

Your three-year-old patient opens her eyes and responds when you speak to her. Her mental status is best described as: A) alert. B) responsive to tactile stimuli. C) responsive to verbal stimuli. D) lethargic.

When assessing the chest, you should cover any open wounds you locate with a(n) ________ dressing. A) wet B) occlusive C) antibacterial D) dry gauze

Which of the following problems is it NOT critical to find during the primary assessment? A) Scalp hematoma B) Bright red blood spurting from a thigh wound C) Respiratory distress D) Foreign body airway obstruction

Your patient is unresponsive to painful stimulus and has snoring respirations. What is your next action? A) Check for a pulse. B) Perform a head-tilt, chin-lift maneuver. C) Administer oxygen at 15 lpm. D) Suction.

All of the following are signs of inadequate breathing in an infant EXCEPT: A) cyanosis. B) use of accessory muscles. C) altered mental status. D) a respiratory rate of 32 breaths per minute.

Which of the following statements about airway management is TRUE? A) Immediate intubation is required for all unresponsive patients. B) Dual lumen airways are acceptable for use in children over the age of four years. C) If a patient cannot be intubated because of an intact gag reflex, a dual lumen airway can be used. D) Nasopharyngeal airways are contraindicated in patients with possible basilar skull fracture.

Your patient does not respond to you when you call his name. What should you do next? A) Apply a painful stimulus. B) Continue shouting. C) Assume he is unresponsive. D) Insert an oral airway.

Which of the following conditions is NOT typically associated with wheezing? A) Foreign bodies in the small airways B) Asthma C) Bronchospasm D) Upper airway swelling

In infants, capillary refill is a good incicatior of adequate circulation and can be checked in the: A) limbs. B) dorsum of the hand. C) torso. D) face.

Which of the following sounds can typically be heard without the use of a stethoscope? A) Rhonchi B) Bowel sounds C) Stridor D) Crackles

If an abnormal finding is noted in the patient's respiratory rate or pattern during the chest examination, you should: A) immediately ensure adequate ventilation. B) intervene only if pulse oximetry is less than 85 percent. C) immediately determine the exact cause. D) continue the examination before finding and treating the cause.

Pulse quality refers to: A) rhythm. B) strength. C) location. D) rate.

Your patient is a three-year-old who presents with a fever. His parents state that he has had diarrhea and vomiting for two days. The patient has not eaten in 24 hours. To best evaluate the patient's peripheral perfusion status, you should evaluate his: A) respiratory rate. B) fingertip sensation. C) capillary refill. D) blood pressure.

You are examining a patient's peripheral vasculature when you note that he has no radial pulse. Your next step would be to: A) prepare for immediate transport. B) defibrillate with 200 joules. C) start CPR. D) palpate a carotid pulse.

According to the 2015 AHA guidelines/recommendations, a patient who appears to be unresponsive and not breathing or breathing ineffectively should be assessed using which mnemonic memory aid? A) ABC B) BAC C) CBA D) CAB

Without proper terminology and verbal communications skills, the receiver will be unable to ________ the message. A) decode B) resend C) encode D) receive

The active listening technique of reflection involves: A) repeating the patient's words back to him to check for understanding. B) confronting the patient if you feel he is hiding something relevant. C) not allowing the patient to stray from the current problem. D) asking closed-ended questions to keep the patient on track.

When you detect an inconsistency in a patient's story, which of the following techniques should you use? A) Clarification B) Interpretation C) Confrontation D) Facilitation

When you ask your patient questions to eliminated confusion, you are using the technique called: A) reflection. B) interpretation. C) facilitation. D) clarification.

Which of the following statements regarding patient communication is TRUE? A) Avoid using interpreters. B) Use language appropriate to the patient's level of understanding. C) Cultural differences make no difference in professional communication. D) Use medical terminology to keep things on a professional level.

The history begins with an open-ended question about your patient's: A) general health. B) chief complaint. C) severity of symptoms. D) past medical history.

Which of the following actions can you take to establish rapport with a patient early in the interview? A) Ask as many questions as possible. B) Maintain control of the interview at all times. C) Respond to her condition with empathy. D) Do not show emotion.

Which of the following nonverbal cues demonstrates your sincerity to the patient? A) Offering a comforting touch or shaking the patient's hand B) Averting your gaze to avoid making the patient uncomfortable C) Touching a patient, even though he may appear uncomfortable being touched D) Maintaining a distance of 4 to 6 feet from the patient

Which of the following statements regarding effective history taking is TRUE? A) Use a combination of open- and closed-ended questions. B) Never ask potentially embarrassing questions. C) Always use open-ended questions. D) Always use closed questions.

Encouraging your patient with your body language to provide more information is called: A) interpretation. B) clarification. C) reflection. D) facilitation.

Which of the following establishes the foundation for gathering good information? A) Using active listening B) Providing appropriate reassurance C) Asking only open-ended questions D) Using common sense

Which of the following statements can show your empathy toward the patient? A) "What is your name?" B) "You say that your chest doesn't hurt, but you keep rubbing it." C) "Are you sure that you take a diuretic?" D) "That must have been very difficult."

Which of the following is a challenge to your ability to solicit patient information? A) Complaints of multiple symptoms B) Patient's level of cognitive functioning C) Intoxication D) All of the above

Which of the following actions would you take if confronted with a patient who is silent? A) Assume that the patient is uncooperative. B) Assume that the reason is emotional. C) Encourage the patient to speak. D) Stay silent to show empathy.

Which of the following is an example of a closed question? A) "What is your medical history?" B) "Do you have any medical history?" C) "What were you doing when the pain began?" D) "How would you describe your discomfort?"

When asking about a patient's health status, you should ask about all of the following EXCEPT: A) religious beliefs. B) use of tobacco. C) immunizations. D) surgeries or hospitalizations.

Part of active listening includes maintaining eye contact and using appropriate gestures in a process known as: A) articulation. B) facilitation. C) formulation. D) reflection.

All of the following encourage patient communication EXCEPT: A) using medical jargon. B) asking the patient for clarification. C) maintaining eye contact. D) listening closely to everything the patient says.

Which of the following questions gathers information about a patient's current health status? A) "Where does the pain go?" B) "Do you also feel nauseous?" C) "When did you have your appendix removed?" D) "How many cigarettes do you smoke a day?"

Which of the following qualities should characterize your verbal interaction with a patient when obtaining the history? A) Speak softly. B) Speak loudly. C) Use a calm, reassuring voice. D) Demand the patient's attention.

Which of the following body positions best communicates that you care about your patient's problems? A) Getting as close to the patient as physically possible B) Maintaining a distance of 4 to 6 feet C) Standing next to where the patient is sitting or lying down D) Sitting next to the patient

Which of the following statements does NOT accurately describe depression? A) It is a common medical problem. B) It is commonly misdiagnosed or ignored. C) It often presents with insomnia and physical complaints. D) It is seldom lethal.

Which of the following is an example of an open-ended question? A) "Does your pain radiate to the shoulder?" B) "Where do you hurt?" C) "Do you have any allergies to medicine?" D) "Do you take high blood pressure medicine?"

Which of the following is the best way to address your patient? A) Stay neutral; do not use the patient's name. B) Ask the patient what he would like to be called. C) Avoid using the patient's name by using terms such as "dude" or "partner." D) Always use formal titles such as "Mr. Orphey."

When questioning a teenage female patient complaining of abdominal pain, you should: A) avoid direct questions about possible pregnancy. B) get the parents' consent to ask her about possible pregnancy. C) question her in private. D) question her in the presence of the mother, but not the father.

All of the following actions can help make taking a history on a sensitive subject easier EXCEPT: A) attending a lecture or seminar on these sensitive subjects to learn more about them. B) using euphemisms and metaphors to ask embarrassing questions. C) asking some opening question to these subjects as practice. D) observing experienced clinicians ask these types of questions.

Your partner has just asked Mrs. Jones, "Why didn't you call your physician's office for a prescription refill instead of calling 911?" This illustrates: A) closed questioning. B) empathetic communication. C) an appearance of blaming the patient. D) an attempt to educate the patient.

En route to the hospital, your patient says, "You know, I haven't had a date since my spouse died six years ago. Why don't you take down my phone number and call me?" Which of the following is an appropriate response? A) "I'm sure you understand my situation. I'm here to provide you with medical care and transportation to the hospital. It isn't proper for me to have anything but a professional relationship with you." B) "That is an inappropriate request, and I expect that you'll not make any further suggestions that we might become personally involved." C) "It isn't that I don't find you attractive; I certainly do, but it isn't proper for me to have a personal relationship with a patient." D) "I can't call you because of professional ethics, but my phone number is listed in the book."

Which of the following may result in a failure of communication between a paramedic and a patient? A) External distractions B) Prejudice C) Lack of privacy D) All of the above

An "intimate zone" reflects about how many feet between two people? A) 0 to 1.5 B) 1.5 to 2 C) 2 to 2.5 D) 2.5 to 3

Echoing a patient's message back to him in your own words is a technique known as: A) explanation. B) facilitation. C) reflection. D) clarification.

What questioning style used by the paramedic has the tendency to guide the patient's answers? A) Distracting B) Leading C) Closed D) Open-ended

When in a situation requiring an interpreter, it is important to: A) focus only on the current problem, not the medical history. B) look at the interpreter, not the patient. C) ask only one question at a time. D) only use family members to interpret.

"Public distance" refers to a space of how many feet between people? A) 2 to 3 B) 3 to 6 C) 4 to 12 D) 12 or more

You have overheard a hospital technician in the emergency department talking with a patient who has pancreatic cancer. The technician said, "Don't worry; everything will be all right." This is an example of: A) distraction. B) false reassurance. C) empathy. D) lack of concern.

"Please tell me about your abdominal pain" is an example of a(n) ________ question. A) closed B) distracting C) open-ended D) leading

Which of the following questions would provide the best quality and quantity of relevant information? A) "What time do you normally eat breakfast?" B) "When was the last time you had anything to eat or drink?" C) "What have you had to eat and drink today?" D) "Have you had breakfast?"

When interviewing patients from cultures other than our own, it is difficult for us to avoid interpreting the situation from the viewpoint of our own culture. This is known as: A) cultural imposition. B) racism. C) anthropomorphism. D) ethnocentrism.

You are caring for a sick five-year-old child in the emergency department. The ED physician has ordered some intravenous medication to stop the child from vomiting. Which of the following is the best way to approach the child with the issue of starting an IV? A) "I'm going to give you some medicine in your arm to help you stop throwing up. If you're a good boy and hold really still, it's not going to hurt a bit." B) "I'm going to give you some medicine to help you stop throwing up, but the medicine has to go through a tube and into your arm. So it's going to feel like you're getting a shot, but it will just take a second, and then the medicine will make you feel better." C) "I'm going to start an IV in your arm so I can give you some Phenergan for your nausea and vomiting. Be a big boy and don't cry, okay?" D) Say nothing about the procedure. Once you have everything set up, tell the child, "Let me see your arm," then quickly perform the procedure.

"Social distance" is a distance of ________ feet between people. A) 2 to 3 B) 3 to 6 C) 4 to 12 D) 12 or more

Upon questioning your patient about whether he has been feeling any particular stress lately, he asks, "Do you think I'll have to wait very long in the emergency department?" This is most illustrative of: A) confrontation. B) using avoidance language. C) distancing. D) overuse of professional jargon.

Which of the following responses illustrates the feedback technique of facilitation? A) "You said you weren't having any pain, but I see you're trying not to use your right arm." B) "I see. What happened after that?" C) "I'm not sure I understand. What do you mean when you say, 'It's a hard pain?'" D) "So you got up to go to the bathroom and tripped over something in the hallway?"

Which of the following nonverbal behaviors is likely to help you establish trust and rapport with a patient? A) Using medical terminology to establish your professionalism B) Assuring the patient that now that the ambulance is here everything is going to be okay C) Using an authoritarian tone of voice when addressing the patient D) Walking briskly to the patient without rushing or running

You are called to a scene at which a pedestrian has fallen on the sidewalk. When you arrive, the man is sitting up and appears alert and responsive. However, as you attempt to start your interview in your normal manner, you note that he is reluctant to speak with you. How should you proceed? A) Try to develop rapport by reviewing the reason you were dispatched on the call. B) Call the medical direction physician and allow the patient to speak to him or her. C) Confront the patient with your inability to help him if he does not tell you what is going on. D) Ask the patient to sign a refusal of treatment and transport form.

A five-year-old child is introduced to you as Robert Smith. The proper way for you to address him is: A) "Hey, little guy!" B) "Hi, Bobby." C) "Hello, Mr. Smith." D) "Hi, Robert."

Which of the following responses most clearly illustrates the feedback technique of confrontation? A) "A number of things can cause vomiting. We don't have enough information yet to determine what might be the cause in your situation." B) "I'm not sure I understand what you mean by 'feeling sick.'" C) "So first you vomited, then you began having abdominal pain?" D) "You said you aren't having any pain, but I notice you keep holding your stomach."

When you are taking a history, which of the following should typically drive the evolution of the questions asked of a patient after the first question? A) Patient's medical history B) Information from the patient's family C) Patient's list of medications D) Patient's chief complaint

Which of the following questions is designed to find out about palliation? A) "What were you doing when this pain began?" B) "How long have you been having this pain?" C) "What does the pain feel like?" D) "What makes the pain feel better?"

A practical template for exploring various aspects of a chief complaint is: A) SAMPLE. B) ABCDE. C) OPQRST-ASPN. D) AEIOU-TIPS.

Which of the following words are most likely to accurately represent the patient's chief complaint? A) Chest pain B) Myocardial infarction C) Dyspnea D) Fractured tibia

Questions to ask about a patient's past medical history include all of the following areas EXCEPT: A) surgeries or injuries. B) general state of health. C) adult diseases. D) duration of the pain.

Which of the following statements is TRUE regarding the components of a comprehensive patient history? A) Use only one component, so as to not confuse the patient. B) Use the components that apply to the patient's situation. C) Use all components every time you interview a patient. D) Use the components the patient chooses.

What does the "C" in the CAGE alcohol-screening tool stand for? A) Are you careful when you drink? B) What causes your drinking? C) Are you concerned about your drinking? D) Have you ever felt the need to cut down on your drinking?

A sign or symptom that causes a patient or bystander to request medical help is known as the: A) primary problem. B) present illness. C) associated symptom. D) chief complaint.

Which of the following pieces of information should you record as preliminary data? A) The chief complaint B) Elements of the past history C) Aspects of the present illness D) The patient's age

An example of a primary problem is: A) myocardial infarction. B) leg pain. C) nausea. D) shortness of breath.

Which of the following is the best example of referred pain? A) Right shoulder pain associated with cholecystitis B) Abdominal pain related to pancreatitis C) Flank pain associated with a kidney stone D) Chest pain located under the sternum associated with a cardiac condition

Areas in the patient's current health status include all of the following EXCEPT: A) home situation. B) previous illnesses. C) sleep patterns. D) environmental hazards.

Elements of the patient history include all of the following EXCEPT: A) physical examination. B) present illness. C) current health status. D) preliminary data.

For trauma patients you will use an abbreviated version of the past history known as: A) CAGE. B) HEENT. C) OPQRST-ASPN. D) SAMPLE.

Using knowledge and experience to diagnose patients and plan their treatment is called clinical: A) judgment. B) intuition. C) practice. D) reflection.

Critical thinking is a thought process used to: A) defend one's actions in a CQI review process. B) establish credibility with an emergency physician. C) analyze and evaluate. D) focus on a situation's most important aspect.

Asking a patient, "What were you doing when this problem began?" represents what part of the OPQRST question format? A) P B) Q C) O D) R

Asking a patient, "Does it hurt more when you breathe deeply?" represents what part of the OPQRST question format? A) Q B) O C) R D) P

Asking a patient, "Where does it hurt?" represents what part of the OPQRST question format? A) P B) Q C) O D) R

Asking a patient, "Can you rate your pain on a 0 to 10 scale?" represents what part of the OPQRST question format? A) S B) T C) R D) Q

A patient who appears to be intoxicated has fallen and is complaining of pain in his right arm. He is agitated and loud. Which one of the following is appropriate to your initial approach to taking the history for this patient? A) "If you do not quiet down, I will call the police, and they will arrest you." B) "How much have you had to drink?" C) "I cannot help you if you keep yelling like that!" D) "Stop yelling, or I will have to strap you to the stretcher."

You would like to test a patient's visual acuity, but a visual acuity card or wall chart is not available. You can still test for visual acuity by: A) asking the patient to indicate the farthest object he can see. B) checking the pupils. C) having the patient count your raised fingers. D) covering one eye and testing for light accommodation.

You are able to feel vibrations through the chest wall as your patient speaks. This is called: A) egophony. B) auscultation. C) whispered pectoriloquy. D) tactile fremitus.

The process in which a paramedic places a hand on a body part, then sharply taps a distal knuckle with the tip of another finger, is known as: A) percussion. B) hyperresonance. C) palpation. D) observation.

Asking your patient to recall what he had for a meal earlier in the day would test: A) recent memory. B) remote memory. C) immediate memory. D) long-term memory.

Physical exam techniques include all of the following EXCEPT: A) palpation. B) association. C) auscultation. D) inspection.

Petechiae are skin lesions characterized by: A) reddish lines radiating from a red spot. B) irregular red spots. C) reddish-purple spots less than 0.5 cm in diameter. D) reddish-purple blotches greater than 0.5 cm in diameter.

Which of the following is included in an examination of the cardiovascular system? A) Auscultate for carotid bruits. B) Palpate to check for Murphy's sign. C) Auscultate breath sounds. D) Palpate both carotid arteries simultaneously.

Inspection of the maxillary sinuses is accomplished by: A) palpating under the zygomatic arches. B) obstructing one side of the nares and watching the patient breathe. C) using an otoscope for visualization. D) palpating the nose and septum.

One sign of gonorrhea in males is a(n): A) profuse, yellow discharge. B) white, curdlike discharge. C) scant, clear discharge. D) external pustule.

During a musculoskeletal exam, you find redness of the skin over a nontraumatized joint. Which of the following is LEAST likely to be the cause? A) Rheumatic fever B) Dislocation C) Gout D) Arthritis

During the abdominal exam, areas that are known to be painful or tender should be examined: A) only by a physician. B) at the beginning and end of the exam. C) first. D) last.

Discoloration over the umbilicus, known as ________ sign, is a(n) ________ indicator of intraabdominal bleeding. A) Cullen's; late B) Grey Turner's; early C) Grey Turner's; late D) Cullen's; early

Which of the following best describes the technique of evaluating plantar reflexes? A) Have the patient dorsiflex the foot, then strike the Achilles tendon. B) Stroke the lateral aspect of the sole of the foot from heel to ball, curving medially. C) Tap the patellar tendon just below the edge of the patella. D) Strike the triceps along the posterior aspect of the distal humerus.

To check for symmetrical chest expansion, you should place your hands on the patient's chest, with the thumbs resting on the ________, and ask the patient to inhale. A) costal margins B) nipples C) clavicles D) lateral chest wall

Your patient is complaining of numbness and hand pain that wakes him. Of the following, which is most likely? A) Carpal tunnel syndrome B) Chondromalacia C) Bursitis D) Plantar fasciitis

Which of the following findings is abnormal in a cardiovascular assessment? A) Splitting of the S2 heart sound in children B) Vibrations when palpating the carotid artery C) Jugular venous distension in the supine position D) Visible pulsation of the PMI at the fifth intercostal space, medial to the left midclavicular line

All of the following characteristics indicate a normal appearance to oral mucosa EXCEPT: A) smooth. B) patches of white. C) pink. D) moist.

You have just percussed the patient's chest and heard a loud, booming, low-pitched sound. This indicates: A) atelectasis. B) a normal lung field. C) a hypoinflated lung field. D) a hyperinflated lung field.

A condition marked by exaggerated lumbar concavity is called: A) scoliosis. B) lordosis. C) kyphosis. D) spondylosis.

A light, popping, nonmusical sound heard upon auscultation of the lungs is best described as: A) wheezing. B) crackles. C) stridor. D) rhonchi.

You can test the oculomotor, trochlear, and abducens nerves by: A) shining a light into the pupils and observing constriction of the pupils. B) conducting a visual acuity test. C) evaluating the patient's extraocular movements. D) closing one nostril while presenting a strong smell under the other nostril.

A patient who loses his balance while standing with his eyes closed and feet together for 20 to 30 seconds is exhibiting a positive: A) tilt test. B) Babinski's reflex. C) Romberg test. D) Kehr's sign.

By placing the tip of the index finger in the depression in front of the tragus and asking the patient to open his mouth, the paramedic can evaluate the: A) zygomatic arch. B) sphenoid bone. C) temporomandibular joint. D) external auditory canal.

You are examining a 70-year-old female patient with altered mental status. She is awake and can speak. You detect an odor of acetone and suspect that the patient is suffering from: A) cyanide poisoning. B) alcohol poisoning. C) bowel obstruction. D) diabetic ketoacidosis.

Increased fremitus over part of the patient's chest wall may indicate: A) pneumonia. B) emphysema. C) pleural effusion. D) pneumothorax.

To avoid the carotid sinus, you should palpate for a carotid pulse at the level of: A) Terry's point. B) the cricoid cartilage. C) the sternocleidomastoid muscle. D) carotid bifurcation.

The standard sequence for examining the chest is: A) palpate, percuss, auscultate, inspect. B) inspect, palpate, auscultate, percuss. C) inspect, palpate, percuss, auscultate. D) inspect, auscultate, percuss, palpate.

Which of the following findings is NOT a sign of peritoneal irritation? A) Abdominal pain when the patient coughs B) Rebound tenderness C) Abdominal pain upon light palpation D) DeLorenzo's sign

Select the choice below that best describes the sequence of a joint examination. 1. Palpation 2) Passive range of motion 3) Range of motion against resistance 4) Range of motion against gravity 5) Inspection A) 5, 1, 2, 4, 3 B) 5, 2, 1, 3, 4 C) 2, 3, 4, 5, 1 D) 1, 5, 2, 4, 3

During a neurologic exam, you ask your patient to stick out his tongue. It deviates to the right. This may indicate a lesion to the patient's ________ nerve. A) vagus B) glossopharyngeal C) facial D) hypoglossal

Which of the following guidelines should be observed when examining a one- to three-year-old child? A) Restrain the child if necessary. B) Do not distract the toddler with toys. C) Do the most invasive procedure first in order to get it out of the way. D) Focus on the vital areas as indicated by the chief complaint.

Jugular venous pressure approximates the patient's ________ pressure. A) left atrial B) right ventricular C) left ventricular D) right atrial

Assessing for bronchophony is important if the patient has abnormal or absent lung sounds because its presence can reveal: A) tension pneumothorax. B) breathing obstruction. C) emphysema. D) fluid in the lungs.

Heart sound S2 may be heard at the end of systole by auscultating over the ________ intercostal space. A) second B) sixth C) first D) fifth

The fourth heart sound, S4, is: A) an atrial gallop sound. B) a ventricular gallop sound. C) a high-pitched sound at the base of the heart. D) the "dub" of "dee-lub-dub."

A scalp condition marked by mild flaking of skin is known as: A) psoriasis. B) dandruff. C) seborrheic dermatitis. D) hirsutism.

The loss of muscle tone results in: A) rigidity. B) spasticity. C) paresthesia. D) flaccidity.

Using an otoscope, you can examine the patient for ________ and ________. A) tympanic membrane rupture; color changes B) cranial nerve VIII function; basilar skull fracture C) otitis; mastoiditis D) tinnitus; eustachian tube blockage

Dullness in the chest during percussion of the third to fifth intercostal spaces can be attributed to the location of the: A) spleen. B) heart. C) stomach. D) liver.

When evaluating dorsiflexion, you should instruct the patient to point his: A) foot upward. B) hand downward. C) foot downward. D) hand upward.

Which of the following is an abnormal finding of the pupils? A) Constriction when focusing on a near object B) Both pupils constricting when a penlight is shone in one eye C) Slow but equal reaction to light D) Less than 2 mm difference in size with normal reaction to light

The condition of the nail bed caused by chronic hypoxia associated with cardiopulmonary diseases is called: A) Terry's nails. B) onycholysis. C) clubbing. D) paronychia.

Your patient was in a motor vehicle collision but was not discovered until 3 hours after the event. When you examine her, you discover bilateral discolored skin over the mastoid process. You should suspect: A) temporal bone fracture. B) frontal bone fracture. C) basilar skull fracture. D) a fractured sinus.

While assessing a 23-year-old man with abdominal pain, you note discoloration around the umbilicus. This is known as: A) ascites. B) borborygmi. C) Kernig's sign. D) Cullen's sign.

Pleural effusion is characterized by the presence of: A) fluid in the pleural space. B) atelectasis in the affected area. C) secretions in large airways. D) increased friction between the pleural layers.

A loud, harsh sound over the trachea on auscultation with a stethoscope suggests: A) bronchoconstriction. B) normal air movement. C) pneumothorax. D) foreign body obstruction.

Skin color is best evaluated by observing the: A) limbs and torso. B) dorsum of the hand. C) nail beds and conjunctiva. D) face.

Palpation and inspection of the point of maximal impulse can reveal certain conditions, such as: A) pneumothorax. B) enlarged right ventricle. C) coronary insufficiency. D) cardiac tamponade.

Cyanosis is caused by increased: A) methemoglobin. B) oxyhemoglobin. C) carboxyhemoglobin. D) deoxyhemoglobin.

Moving a finger in an "H" pattern in front of your patient's eyes tests: A) accommodation. B) extraocular muscles. C) visual acuity. D) corneal reflex.

Which of the following sounds is produced when the tricuspid and mitral valves close during systole? A) S4 B) S3 C) S1 D) S2

Which of the following is a normal finding when examining a patient's neck? A) Tracheal tugging B) Visible lymph nodes C) Subcutaneous emphysema D) Movement of the thyroid gland during swallowing

Nasal flaring is an indication of: A) dysfunction of cranial nerve I. B) respiratory distress. C) hypoxia. D) rhinitis.

Which of the following best describes the technique of percussion? A) Using a reflex hammer to produce vibrations B) Pressing the bell of the stethoscope against the skin C) Shining a penlight into the ear to see the eardrum D) Striking the knuckle of one hand with the tip of a finger on the opposite hand

For you to assess for jugular venous distention, your patient should be ________ at a ________-degree angle. A) sitting; 90 B) sitting; 45 C) supine; 45 D) standing; 90

Which of the following is LEAST important to the paramedic when evaluating a patient's skin in an emergency situation? A) Color B) Temperature C) Pigmentation D) Moisture

The sounds auscultated when assessing the blood pressure are the ________ sounds. A) Kobileski B) Korotkoff C) Kunzlemann D) Kernig's

To test an extremity for pain sensation, you should: A) use a sharp object, and have the patient tell you if he feels a sharp or dull sensation. B) firmly pinch a fold of skin over the most sensitive part of the extremity. C) stroke the extremity in a distal-to-proximal direction. D) briskly tap the tendon of the elbow or knee.

Which of the following best describes the correct positioning of a patient for an abdominal exam? A) Lateral recumbent B) Supine with the head flat and legs extended C) Semi-Fowler's position D) Supine with the head and knees supported by pillows

Which of the following best describes the technique for palpating the abdomen for large or deep masses? A) One hand pushing deeply in a quick, smooth motion B) One finger pressing firmly against the abdominal wall C) One hand over another, pushing down slowly D) Both hands side by side over the midline of the abdomen

While you are assessing for Babinski's response, the patient's big toe dorsiflexes and the other toes fan out. This indicates a ________ response, which is ________. A) negative; normal B) positive; abnormal C) negative; abnormal D) positive; normal

Using your sense of touch to gather information about the patient's condition is called: A) auscultation. B) percussion. C) palpation. D) inspection.

A patient experienced a brief loss of consciousness following a blow to the head. During your questioning, she describes a series of events that do not match what observers had noted before the trauma. This might be an example of: A) delusion. B) incoherence. C) mania. D) confabulation.

A patient who is misinterpreting what is happening is experiencing a(n): A) paresthesia. B) hallucination. C) delusion. D) illusion.

Which of the following is included in examination of the mouth? A) Palpating the uvula B) Removing dentures C) Visualizing the larynx D) Looking under the tongue

A condition that makes posterior chest and lung examination difficult is thoracic: A) kyphoscoliosis. B) spondylosis. C) ankylosis. D) lordosis.

Which of the following best describes the pulse pressure? A) The difference between systolic and diastolic blood pressures B) The diastolic pressure plus one-third of systolic pressure C) The sum of systolic and diastolic blood pressures D) The systolic pressure minus one-third of the diastolic pressure

Shining a light onto the iris from the lateral side could cause a crescent-shaped shadow on the medial side if the patient is suffering from: A) hemianopsia. B) glaucoma. C) retinal artery occlusion. D) anisocoria.

Areas of a neurologic exam include all of the following EXCEPT: A) mental status and speech. B) reflexes. C) cranial nerves. D) cranium.

You are assessing a 34-year-old female patient who appears to be in hypovolemic shock. You would expect her pulse to be: A) bradycardic and irregular. B) tachycardic and weak. C) tachycardic and bounding. D) bradycardic and strong.

During the cardiac cycle, the S2 heart sound indicates the ________ of the ________ valves. A) closing; mitral and tricuspid B) opening; aortic and pulmonic C) opening; mitral and tricuspid D) closing; aortic and pulmonic

When checking for skin turgor, you should: A) gently pick up a fold of skin, then release it. B) use the back of your hand to determine temperature. C) press the nail beds, then release. D) palpate the skin for flaking.

A tear in the tracheobronchial tree or a pneumothorax can be characterized by ________ in the neck. A) swollen lymph nodes B) jugular venous distention C) mediastinal deviation D) subcutaneous emphysema

To inspect and examine the anus, a paramedic should place the patient in the ________ position. A) supine B) left lateral recumbent C) kneeling D) prone

The crunching sound that is made when unlubricated skeletal parts rub against each other is called: A) a synovial rub. B) bursal friction. C) crepitus. D) a pleural friction rub.

When auscultating the posterior chest, you should listen: A) only at the apices. B) only at the bases. C) down one side first, then the other. D) from side to side as you proceed down the chest.

A 23-year-old female patient is complaining of lower abdominal and genital pain. Upon examination you find a white, curdlike vaginal discharge. This is most typical of: A) Gardnerella. B) gonorrhea. C) candidiasis. D) herpes simplex.

Components of a general survey include all of the following EXCEPT: A) cardiac monitoring. B) blood pressure. C) medical history. D) the patient's appearance.

When you ask the patient to puff out her cheeks, show her upper and lower teeth, and raise her eyebrows, which cranial nerve are you evaluating? A) VI B) V C) VII D) IX

During ventricular systole, the ventricles contract while the: A) foramen ovale opens. B) tricuspid and mitral valves open. C) pulmonic and aortic semilunar valves close. D) tricuspid and mitral valves close.

You respond to a patient complaining of lower abdominal pain. Upon your arrival, you find a 25-year-old man who also complains of groin pain. After inspecting the penis and scrotum, your next step would be to: A) inspect the glans. B) lift the scrotum and inspect for swelling or lumps. C) palpate the testicles. D) take a urine sample.

When evaluating any patient's genitalia, a paramedic must always: A) maintain privacy. B) use a lubricant. C) be of the same gender as the patient. D) perform a rectal exam, as well.

A 45-year-old patient presents with abdominal pain in the right lower quadrant. Upon auscultation of bowel sounds, you hear high-pitched gurgles and clicks lasting around 10 seconds. This patient may have: A) normal sounds. B) hyperperistalsis. C) borborygmi. D) paralytic ileus.

A complete neurologic exam includes assessment of mental status and speech, the motor and sensory systems, reflexes, and the: A) speed of peripheral nervous conduction. B) tympanic membrane. C) cranial nerves. D) visual acuity.

Normal pediatric respiratory and heart rates ________ as children grow older. A) stay the same B) decrease C) increase D) increase, then decrease

You are examining a 50-year-old male patient complaining of a fever. You inspect the tympanic membrane and note that it is a pearly, translucent gray color. You conclude that the patient has: A) otitis media. B) hemotympanum. C) a buildup of fluid behind the eardrum. D) a normal eardrum.

Rales, or crackles, would be most typically auscultated in patients with which of the following conditions? A) Pulmonary embolus B) Congestive heart failure C) Asthma D) Pneumonia

A patient who is experiencing dysphonia: A) has defective language caused by neurological damage. B) has defective speech caused by motor deficits. C) is speaking clearly and normally. D) has voice changes secondary to vocal cord problems.

An elderly man is complaining of shortness of breath. You discover pitting edema that is 0.5 to 1 inch deep. This is ________ pitting edema. A) +2 B) +4 C) +1 D) +3

You are examining a patient's face. Upon observing the eyes, you notice a droop in the eyelids. This condition is known as: A) nystagmus. B) apoptosis. C) anisocoria. D) ptosis.

Which of the following body systems would you gain the least information about during an abdominal exam? A) Musculoskeletal B) Reproductive C) Cardiovascular D) Digestive

Pain or tenderness on palpation of the tragus could suggest: A) Ménière's disease. B) mastoiditis. C) cerumen impaction. D) perforated tympanic membrane.

While speaking, your patient shifts rapidly from topic to topic without realizing that his thoughts are not connected. This might be a sign of any of the following conditions EXCEPT: A) psychosis. B) schizophrenia. C) manic episodes. D) depression.

A person who has a visual acuity test result of 20/100 can see at ________ feet what a normal person sees at ________ feet. A) 10; 2 B) 20; 100 C) 100; 20 D) 100; 100

Lesions found on the lips may indicate: A) dehydration. B) anemia. C) allergic reaction. D) skin cancer.

What procedure can you perform to determine additional signs of carpal tunnel syndrome? A) Ask the patient to extend his fingers forward for 60 seconds. B) Hold the patient's wrist in acute extension for 60 seconds. C) Ask the patient to gently wave his wrists for 60 seconds. D) Hold the patient's wrist in acute flexion for 60 seconds.

Which of the following statements is FALSE regarding the S3 heart sound? A) It is commonly heard in children. B) It is a high-pitched sound heard at the end of diastole. C) It is the "dee" part of the "lub-dub-dee" cadence. D) It can develop with ventricular failure or ventricular volume overload.

The hard and soft palates are normally colored ________ and ________, respectively. A) white; pink B) pink; white C) white; white D) pink; pink

You are sent to the home of an insulin-dependent diabetic female patient. You ask her to state her name, the month, and her address. This would be an example of assessing the patient's: A) memory and attention. B) general fund of knowledge. C) judgment. D) mood.

The technique of ________ involves careful, noninvasive, informed observation. A) auscultation B) percussion C) inspection D) palpation

Which of the following is NOT analyzed in arterial blood gas tests? A) SaO₂ B) PaO₂ C) pCO₂ D) O₂

You are working in the ED, caring for a 55-year-old female patient with a long history of COPD. She is more short of breath today than usual, and states that she has an increased cough. She has a tympanic temperature of 99.8°F. You have drawn arterial blood gases with the patient on room air; when the report comes back, it shows that the patient has a PaO₂ of 92 mmHg. Which of the following is most likely? A) You have inadvertently drawn a venous sample. B) The patient is critically hypoxic and requires assisted ventilation. C) This is the typical value for this patient. D) The lab performed the test incorrectly.

An arterial blood gas analysis includes all of the following EXCEPT: A) perfusion. B) ventilation. C) electrolyte balance. D) acid-base balance.

Most carbon dioxide from cellular metabolism reaches the alveoli by being transported: A) bound to hemoglobin. B) as bicarbonate ion. C) dissolved in plasma. D) as carbonic anhydrase.

Your patient is a 44-year-old woman, alert and oriented, in moderate distress and complaining of difficulty breathing. She gives a one-week history of fever and malaise, with shortness of breath developing three days ago. She also has left-sided chest pain with deep inspiration and a "phlegmy" cough. Physical examination reveals hot, pale, dry skin, and rhonchi and crackles throughout the left lung. The right lung sounds are clear. HR = 134, BP = 88/64, RR = 24, SaO₂ = 92%. She has a history of two previous myocardial infarctions and takes nitroglycerin as needed. Which of the following is the best course of prehospital management? A) Endotracheal intubation, ventilation with supplemental oxygen, nebulized albuterol and Atrovent, and corticosteroids IV B) Albuterol via nebulizer with 100 percent oxygen C) Oxygen via nonrebreather mask D) Oxygen via CPAP

Capnometry measures the partial pressure of CO₂ in: A) venous blood. B) arterial blood. C) expired air. D) inspired air.

ETCO₂ is recorded during phase ________ of the capnogram. A) I B) II C) III D) IV

Your patient is a 62-year-old woman with a history of COPD. She is slightly more short of breath than usual today. She is alert and speaks three to four words between breaths. Her SpO₂ is 93 percent on room air. Which of the following devices should be used for the administration of oxygen to this patient? A) Nonrebreather mask B) Nasal cannula C) CPAP D) BVM

Your patient is a 15-year-old asthmatic who has been having difficulty breathing for 45 minutes, but does not have his Xopenex inhaler with him. Capnography shows an ETCO₂ of 45 mmHg. What is the best way to interpret this finding? A) This is a normal ETCO₂, indicating that this is a mild asthma attack. B) The patient's ETCO₂ first dropped as he began to hyperventilate but now is rising again and may continue to rise to dangerous levels. C) This is a high ETCO_2, and the patient requires immediate ventilatory assistance to prevent respiratory arrest. D) This is a low ETCO₂, indicating that the patient is hyperventilating, and thus in the early stages of an asthma attack.

In which of the following situations is a significant amount of carboxyhemoglobin most likely to be present? A) A patient who is being treated with nitrites for cyanide poisoning B) A patient with COPD who is short of breath with an SpO₂ of 90 percent C) A patient found unresponsive in an apartment in which there is a gas furnace D) A patient who inhaled anhydrous ammonia fumes

You have applied a CO-oximeter to your patient, and it is displaying an SpCO of 15 percent. Which of the following is the most appropriate interpretation of this finding? A) This is consistent with a fatal level of carbon monoxide poisoning. B) This is a normal reading for a smoker and nothing to worry about. C) This is a normal reading for a nonsmoker and nothing to worry about. D) This is consistent with mild carbon monoxide poisoning.

You are working at the triage desk in the ED when a young man on crutches approaches the desk. He appears moderately short of breath. He states he had a cast put on his left leg seven days ago after surgery for a ruptured Achilles tendon. This morning, while he was watching television, he suddenly became short of breath. He has a history of asthma, for which he takes Xopenex as needed, and is taking Tylenol with codeine for pain related to his surgery. The patient's lung sounds are clear and equal, SpO₂ is 90 percent on room air, heart rate is 100 and regular, respirations are 24 and slightly labored, blood pressure is 128/88 mmHg, and the patient is afebrile. These findings are most consistent with: A) allergic reaction to codeine. B) COPD exacerbated by recent anesthesia. C) pneumonia secondary to recent anesthesia. D) pulmonary embolism associated with immobilization of the lower extremity.

A male patient with an acute exacerbation of his emphysema presents in severe distress with decreased air movement and diffuse inspiratory wheezes in all fields. HR = 132, BP = 142/88, RR =30, SaO₂ = 88%. Which of the following blood gas values is most likely? A) pH of 7.6 B) PO₂ of 100 mmHg C) PCO₂ of 70 mmHg D) PCO₂ of 35 mmHg

The greater the concentration of hydrogen ions in arterial blood, the ________ the pH. A) more erratic B) higher C) more dangerous D) lower

Your patient is a 16-year-old male who attempted suicide. He is unconscious and apneic, lying supine on a garage floor. The family states that they found the patient unconscious in the front seat of a car that was running in an enclosed garage. HR = 70, BP = 100/60, RR = 0. In addition to an IV of normal saline, which of the following is the most appropriate action? A) Intubate, remove the patient from the garage, and transport to a hospital with a hyperbaric chamber. B) Remove the patient from the garage, initiate BVM ventilations with 100 percent oxygen, intubate, and transport to a hospital with a hyperbaric chamber. C) Remove the patient from the garage, initiate BVM ventilations with 100 percent oxygen, intubate, and transport to the nearest facility. D) Remove the patient from the garage, intubate, and transport to the nearest hospital.

Lung perfusion depends on all of the following EXCEPT: A) efficient pumping of blood by the heart. B) intact pulmonary capillaries. C) an intact alveolar membrane. D) adequate blood volume.

Which of the following statements about pulse oximetry is FALSE? A) Oxygen saturation is the percentage of hemoglobin that is bound with some molecular structure. B) Pulse oximetry values can be expected to decrease within seconds in cases of developing hypoxia. C) Pulse oximetry should be used on all patients with respiratory complaints. D) It may be difficult to obtain a reading in patients experiencing peripheral vasoconstriction.

Which of the following is the most important determinant of ventilatory rate? A) Arterial PO₂ B) Venous PCO₂ C) Venous PO₂ D) Arterial PCO₂

Conditions that can cause an inaccurate pule oximetry ready include all EXCEPT? A) The presence of methemoglobinemia B) Hyperfusion C) Anemia D) Shivering

The valve between the right atrium and right ventricle is the ________ valve. A) bicuspid B) pulmonic C) tricuspid D) aortic

Blood entering the left atrium arrives via the: A) bicuspid valve. B) superior and inferior vena cava. C) pulmonary vein. D) pulmonary artery.

The presence of inverted T waves on an ECG indicates: A) myocardial infarction. B) myocardial necrosis. C) myocardial ischemia. D) myocardial instability.

When the ECG paper is traveling at the standard rate of 25 mm/sec, a large box in the horizontal direction equals: A) 0.08 seconds. B) 0.12 seconds. C) 0.20 seconds. D) 0.24 seconds.

There are 15 small boxes between R waves on an ECG tracing. What is the heart rate? A) 150 B) 120 C) 100 D) 20

Which of the following endocrine substances acts as a marker for congestive heart failure? A) BNP B) Angiotensin C) ACTH D) Troponin

To detect life-threatening cardiac dysrhythmias, the paramedic must view the ECG in ________ lead(s). A) two B) one C) three D) twelve

The total duration of ventricular depolarization is represented by the ________ on the ECG. A) QRS duration B) QT interval C) PQ interval D) R-R interval

Which of the following statements concerning Q waves on the ECG is most accurate? A) Q waves are not a normal finding on the ECG. B) The absence of a Q wave is a significant pathophysiological finding. C) A Q wave is significant if it is 0.04 or more seconds wide. D) A Q wave is significant only in the presence of chest pain.

The anterior surface of the heart is best viewed by ECG leads: A) II, III, aVF. B) V1-V4. C) I, aVL. D) aVR, aVL, aVF.

Which of the following is affected by a properly working pacemaker? A) Automaticity B) Stroke volume C) Cardiac rhythm D) Ejection fraction

An ECG monitor is useful for: A) determining cardiac output. B) evaluating the heart's electrical conduction system for abnormalities. C) determining stroke volume. D) evaluating the effectiveness of cardiac contractions.

Which of the following occurs during depolarization of a cardiac cell? A) Sodium moves out of the cell. B) The cell becomes relatively more positively charged. C) Potassium moves into the cell. D) The cell becomes negatively charged.

Your patient is a 73-year-old man who is sitting in a recliner, cyanotic, pulseless, and apneic. The patient's skin is cool and dry. The patient's wife last saw him an hour and a half ago. Which of the following should you do first? A) Check for rigor mortis. B) Start CPR. C) Attach the monitor/defibrillator. D) Inform the patient's wife that he is dead and nothing can be done for him.

The QRS complex represents: A) ventricular depolarization. B) atrial repolarization. C) atrial depolarization. D) ventricular repolarization.

The lead to the left of the sternum at the fourth intercostal space is: A) V1. B) V2. C) V3. D) V4.

The SA and AV nodes are perfused by the ________ artery. A) anterior descending B) right coronary C) left coronary D) circumflex coronary

The mitral valve is open during: A) systole. B) cardiac standstill. C) diastole. D) repolarization.

Which of the following is the correct sequence of cardiac electrical activity? 1. AV node 2) Internodal pathways 3) Bundle of His 4) SA node 5) Purkinje fibers 6) Bundle branches A) 1, 2, 4, 3, 6, 5 B) 4, 1, 2, 3, 6, 5 C) 1, 2, 4, 3, 5, 6 D) 4, 2, 1, 3, 6, 5

A 12-lead ECG that reveals slight ST segment elevation; Q waves in leads II, III, and aVF; and ST elevation in V1 and V2 most indicate which of the following? A) The patient is experiencing myocardial ischemia in her inferior wall that is extending into the septum. B) The patient is experiencing myocardial injury in her lateral wall. C) The patient has had a myocardial infarction in her inferior wall and is experiencing ischemia extending into the right ventricle. D) The patient is experiencing ischemia and injury in her left ventricle and septum.

An elevation of the ST segment is associated with: A) hyperkalemia. B) left ventricular hypertrophy. C) slowed conduction through the AV node. D) myocardial injury.

On a properly calibrated ECG machine, 1 mV is equivalent to a height of ________ boxes. A) five small B) ten small C) one large D) four large

Which of the following is LEAST urgent when evaluating a patient suspected of suffering an acute myocardial infarction? A) Blood pressure B) ECG C) Pulse oximetry D) Breath sounds

Which of the following is a traumatic mechanism by which a myocardial injury can be produced? A) Blunt chest trauma B) Penetrating chest trauma C) Traumatic brain injury D) Rapid deceleration

A 12-lead ECG that reveals ST elevation in all of the precordial leads most indicates myocardial: A) injury to the right ventricle, left ventricle, and septum. B) injury to the right ventricle and septum. C) infarction to the left and right ventricles. D) ischemia to the left ventricle and septum.

Which of the following can be determined by lead II cardiac monitoring? A) Positive deflection B) Chamber enlargement C) Axis deviation D) Presence of a myocardial infarction, but not its location

An action potential begins in a myocardial cell when ________ enters the cell, giving it a ________ charge. A) calcium; positive B) sodium; positive C) sodium; negative D) calcium; negative

Slowing of the electrical impulse at the AV node is necessary to allow time for the ________ to fill with blood. A) coronary sinus B) coronary arteries C) ventricles D) atria

At standard speed, a 1 mm box on ECG paper represents ________ seconds. A) 0.12 B) 0.04 C) 0.08 D) 0.1

Ventricular repolarization of the myocardium is represented by the: A) T wave. B) beginning of the QRS complex to the apex of the T wave. C) ST segment. D) isoelectric line.

Artifacts such as muscle tremors can make assessment of cardiac rhythm difficult because: A) an artifact can obscure the underlying rhythm. B) an artifact can cause the pacer to fire prematurely. C) the pacemaker may confuse the artifact with an electrical impulse and not fire. D) the QRS complexes may be obscured by the pacer spikes.

There are three large boxes between R waves on an ECG tracing. What is the heart rate? A) 50 B) 75 C) 150 D) 100

Which of the following arteries supplies blood primarily to the left ventricle and posterior wall? A) Right coronary B) Left coronary C) Posterior descending D) Marginal

The middle tissue layer of the heart is the: A) epicardium. B) endocardium. C) myocardium. D) pericardium.

The precordial leads provide a view of the: A) lateral plane of the heart, including part of the right ventricle, most of the left ventricle, and the septum. B) horizontal plane of the heart, including the right ventricle and right atrium. C) inferior portion of the heart, including the entire right ventricle. D) horizontal plane of the heart, including the left ventricle and septum.

A 45-year-old man is alert and oriented, complaining of chest pain. He describes a two-day history of worsening pain, described as a burning sensation below his left breast that radiates across his chest. He states that the pain seems to get better right after eating, but then worsens again. Medical history includes myocardial infarction, hypertension, and type 2 diabetes. His medications include Inderal, Vasotech, Glucotrol, and Lopid. Physical examination reveals cool, dry skin; clear lungs; and no JVD or peripheral edema. HR = 102, BP = 132/86, RR = 12, SaO₂ = 98%. The patient is on oxygen by nasal cannula at 4 liters per minute. Which of the following should be done next? A) Give 81 mg aspirin by mouth. B) Start precautionary IV of normal saline and transport. C) Give 0.4 mg nitroglycerin sublingually. D) Do a 12-lead ECG.

Which of the following describes the ability of a cardiac cell to propagate the electrical impulse to another cell? A) Conductivity B) Contractility C) Excitability D) Automaticity

When oxygen is not bound to the iron molecule of hemoglobin, the iron molecule is in the ferrous (Fe²⁺) charge state, rather than when oxygen changes the charge of iron to the ferric (Fe³⁺) state. A dangerous form of hemoglobin that is unable to oxidize is: A) methemoglobin (MetHb). B) deoxyhemoglobin (DeoHb). C) oxyhemoglobin (OxHb). D) carboxyhemoglobin (COxHb).

A patient who has SpMet readings of 40 percent would be expected to have signs and symptoms of methemoglobinemia, such as: A) all signs and symptoms normal-asymptomatic. B) headache, dyspnea, confusion, weakness, and chest pain. C) cyanosis, but otherwise asymptomatic. D) fatality.

The normal range of hemoglobin (Hb) levels in the adult male patient would be closest to: A) 9.9-14.5 g/dL. B) 9.9-14.5 mg/dL. C) 14-17.4 g/dL. D) 14-17.4 mg/dL.

Which of the following cells released from the islets of Langerhans produce glucagon, which increases the blood glucose levels? A) Alpha cells B) Beta cells C) Gamma cells D) Delta cells

Which of the following cells released from the islets of Langerhans produce insulin, which decreases the blood glucose levels? A) Alpha cells B) Beta cells C) Gamma cells D) Delta cells

Which of the following cells released from the islets of Langerhans produce somatostatin, which inhibits production of glucagon and insulin? A) Alpha cells B) Beta cells C) Gamma cells D) Delta cells

The color of the blood tube that is usually first in sequence for filling and is without an anticoagulant (used for blood typing and cross-matching) is: A) blue. B) green. C) red. D) gray.

Which of the following cardiac enzymes and biomarkers is NOT measured and analyzed to help confirm a myocardial infarction? A) Creatine kinase (CK-II MB) B) Myoglobin C) Troponin I D) B-natriuretic peptide (BNP)

Which of the following uses for ultrasound is NOT indicated in the prehospital setting? A) Suprapubic, to identify the outline of the urinary bladder and uterus B) Cardiac, to identify the cardiac wall motion and pericardial space C) Umbilical, to identify the gestation age and sex of the fetus D) Left upper quadrant, to identify the diaphragm and the spleen

Forming a general impression as part of your primary assessment helps you to: A) determine baseline mental status. B) determine general clinical status and priority. C) make a determination about stabilization of the cervical spine. D) estimate vital signs.

Which of the following is the sequence of steps when assessing a major trauma patient? 1. Secondary assessment 2) Primary assessment 3) Reconsider mechanism of injury 4) History 5) Vital signs 6) Detailed physical exam A) 2, 5, 3, 1, 4 B) 2, 3, 1, 5, 4 C) 2, 6, 5, 3, 4 D) 2, 1, 3, 4, 5

A fast, systematic assessment designed to identify other life-threatening injuries after the primary assessment is the: A) 1-minute exam. B) rapid secondary assessment. C) focused physical exam. D) detailed physical exam.

Which of the following statements best describes proper history-taking technique in the assessment of a major trauma patient? A) Perform the history before assessing the patient. B) Complete a rapid history by using the SAMPLE acronym. C) Collect a comprehensive health history. D) Medical history is not a significant issue in the trauma patient and can be skipped.

Which of the following patient conditions requires immediate transport? A) Neck pain following a motor vehicle collision B) Unresponsiveness to painful stimuli after ALS interventions C) Narcotic overdose D) Wrist fracture with diminished distal sensation

A 60-year-old man presents with altered mental status. There is no evidence of trauma. Which of the following is most likely to give you specific information about the underlying cause of the patient's condition? A) Pulse oximetry B) A Babinski reflex C) End-tidal carbon dioxide monitoring D) Blood glucose determination

Evaluation of the pelvis in the rapid trauma assessment includes pressing on the symphysis pubis in which direction? A) Inferiorly B) Posteriorly C) Laterally D) Medially

You are en route to a hospital with a patient who appears stable following a motor vehicle collision. To detect changes in the patient's condition, you should do which of the following during transport? A) Detailed physical examination B) Neurological assessment C) Repeat the primary assessment D) Rapid trauma assessment

Special emphasis should be placed on which of the following during your rapid secondary assessment? A) Mental status B) Cranial nerve function C) Cardiovascular and respiratory systems D) Areas suggested by the chief complaint

You are evaluating a patient who was a restrained driver of a motor vehicle that crashed into the median barrier at 40 mph. He is awake, alert, and oriented, complaining of neck and back pain. There is a bruise across his upper abdomen in the shape of the seat belt. Based on this information, you should assume he is a ________ trauma patient, and transport him to ________. A) major; the closest hospital B) minor; the closest hospital C) minor; the patient's hospital of choice D) major; a trauma center

Which of the following best describes why a focused history is important in responsive medical patients? A) It supports diagnostic impression. B) It allows treatments to be initiated immediately. C) It helps to formulate a field diagnosis. D) It identifies signs of medical complications.

Why is a detailed physical exam rarely performed on critical trauma patients in the prehospital setting? A) It produces too much patient anxiety. B) It is used only on medical patients. C) The rapid trauma assessment performs the same function. D) It usually yields little immediately useful information.

Which of the following may indicate either cardiac tamponade or tension pneumothorax? A) Cushing's reflex B) Hypertension C) Subcutaneous emphysema D) Distended neck veins

Patterns of deterioration in patient condition may include all of the following EXCEPT: A) skin becomes cool, pale, and moist. B) the heart rate significantly increases or decreases. C) the respiratory rate significantly increases or decreases. D) the level of consciousness increases.

The careful, thorough process of eliciting a patient's history and conducting a physical exam is known as the: A) primary survey. B) rapid medical assessment. C) secondary assessment. D) ongoing assessment.

Which of the following will provide the LEAST information about a patient complaining of abdominal pain? A) Checking for unusual breath odors B) Looking for Cullen's sign C) Assessing reaction of the pupils to light D) Performing a tilt test