EMT Practice: Systems, Safety and Care Part 11

A fracture is MOST accurately defined as a(n):

- disruption in the midshaft of a bone.

- total loss of function in a bone.

- break in the continuity of the bone.

- abnormality in the structure of a bone.

Crepitus and false motion are:

- positive indicators of a fracture.

- most common with dislocations.

- only seen with open fractures.

- indicators of a severe sprain.

During your secondary assessment of a 30-year-old male who fell 25 feet, you note crepitus when palpating his pelvis. Your partner advises you that the patient's blood pressure is 80/50 mm Hg and his heart rate is 120 beats/min and weak. After completing your assessment, you should:

- log roll the patient onto a long backboard and transport at once.

- perform a focused physical exam with emphasis on the pelvis.

- defer spinal immobilization and transport to a trauma center.

- stabilize the pelvis with a pelvic binder and protect the spine.

Which of the following musculoskeletal injuries would MOST likely result in deformity?

- Hairline fracture

- Displaced fracture

- Severe strain

- Moderate sprain

Hypothermia is diagnosed when the core body temperature falls below what temperature?

- 92°F (33.3°C)

- 95°F (35°C)

- 90°F (32.2°C)

- 98°F (36.7°C)

Shivering stops and muscle activity ceases once the body's core temperature reaches what?

- 95°F (35°C)

- 85°F (29.4°C)

- 90°F (32.2°C)

- 80°F (26.7°C)

Rough handling of a patient with severe hypothermia may cause which of the following dysrhythmias?

- Sinus tachycardia

- Sinus bradycardia

- Asystole

- Ventricular fibrillation

In the context of an environment that is 90°F with 85% humidity, what does moist, pale, cool skin indicate?

- The body can no longer regulate core temperature.

- Core body temperature and ambient temperature are equal.

- The patient is hypothermic.

- There has been excessive fluid and salt loss.

What is often the first sign of heat stroke?

- Low pulse rate and blood pressure

- Change in behavior

- Muscle cramps

- Profuse sweating

In which of the following environmental emergencies are you most likely to encounter laryngospasm?

- After being bitten by a coral snake

- Drowning

- Hyperthermia

- A tick bite

What is the most dangerous, and most common, emergency in scuba diving?

- Diving reflex

- Air embolism

- Decompression sickness

- Drowning

You are treating a patient who was climbing a 10,000-foot mountain when he began to experience a severe, constant, throbbing headache; ataxia; and extreme fatigue. He is nauseated and, as you assess him, he loses consciousness. Which of the following should you suspect?

- Mountain sickness

- HACE

- Rocky Mountain spotted fever

You suspect that the patient you are treating was bitten by a rattlesnake. What should you do first?

-Catch the snake so you can take it to the ED.

- Apply ice to the wound.

- Place the patient is a supine position.

- Apply suction to the wound to suck out the venom.

A person who stands outside in windy, wintry weather and wears only lightweight clothing is experiencing heat loss mainly by what method?

- Conduction

- Convection

- Evaporation

- Respiration

You receive a call to a residence for a sick patient. Upon your arrival, you find the patient, a 53-year-old diabetic male, lying down on his front porch. His wife tells you that he had been mowing the lawn in the heat for the past 3 hours. The patient is confused and has hot, moist skin. His pulse is weak and thready, and his blood pressure is 90/50 mm Hg. You should:

- perform a head-to-toe assessment and look for signs of trauma.

- load him into the ambulance and begin rapid cooling interventions.

- place him in a sitting position and have him drink 1 L of water.

- administer one tube of oral glucose and reassess his mental status.

You respond to a local lake where a diver complains of difficulty breathing that occurred immediately after rapidly ascending from a depth of approximately 30 feet. On assessment, you note that he has cyanosis around his lips and has pink froth coming from his nose and mouth. You should:

- suction his mouth and nose, apply high-flow oxygen, monitor the patient's breath sounds for a pneumothorax, and contact medical control regarding transport to a recompression facility.

- place him in a semi-sitting position, suction his mouth and nose, apply a continuous positive airway pressure (CPAP) device, and transport to the closest emergency department.

- position him supine with his head elevated 30°, suction his mouth and nose, hyperventilate him with a bag-valve mask, and contact medical control for further guidance.

- suction his mouth and nose, keep him supine and elevate his legs to prevent air bubbles from entering his brain, administer high-flow oxygen, and transport to a hyperbaric chamber.

You are transporting a 28-year-old man with a frostbitten foot. The patient's vital signs are stable and he denies any other injuries or symptoms. The weather is treacherous and your transport time to the hospital is approximately 45 minutes. During transport, you should:

- protect the affected part from further injury.

- cover his foot with chemical heat compresses.

- rewarm his foot in 102°F to 104°F (38.9°C to 40°C) water.

- administer oxygen via a nonrebreathing mask.

Common signs and symptoms of heat exhaustion include all of the following, EXCEPT:

- nausea.

- headache.

- tachycardia.

- hot, dry skin.

The venom of a black widow spider is toxic to the:

- renal system.

- respiratory system.

- nervous system.

- cardiovascular system.

A 30-year-old male was rescued after being lost in the woods for approximately 18 hours. The outside temperature is 30°F (-1°C). He is immediately placed in the warmed ambulance, where you perform a primary assessment. He is unresponsive, pale, and apneic. You should:

- apply chemical heat packs to his groin and axillae.

- apply an AED and assess his cardiac rhythm.

- assess for a carotid pulse for up to 60 seconds.

- open his airway and give two rescue breaths.

Which of the following MOST accurately describes hyperthermia?

- The body eliminates more heat than it can generate.

- Heat evaporates a significant amount of body water.

- The core body temperature exceeds 99.5°F (37°C).

- The body is exposed to more heat than it can lose.

Hypothermia occurs when the core body temperature falls below:

- 88°F (31°C).

- 98°F (37°C).

- 90°F (32°C).

- 95°F (35°C).

The body's natural cooling mechanism, in which sweat is converted to a gas, is called:

- radiation.

- evaporation.

- conduction.

- convection.

In contrast to Lyme disease, Rocky Mountain spotted fever:

- presents with flu-like symptoms and a bull's-eye rash.

- may be confused with rheumatoid arthritis.

- causes painful joint swelling after a few days or weeks.

- can cause paralysis and cardiorespiratory collapse.

Drowning is MOST accurately defined as:

- water in the lungs following submersion in water.

- death from suffocation after submersion in water.

- temporary survival after submersion in water.

- death beyond 24 hours after submersion in water.

Burns associated with lightning strikes are typically:

- superficial.

- full-thickness.

- third-degree.

- partial-thickness.

When a warm hand is immersed in water that is 70°F (21°C), heat is transferred from the hand to the water through a process called:

- convection.

- evaporation.

- conduction.

- radiation.

Most of the serious injuries associated with scuba diving are caused by:

- cold water temperature.

- alcohol consumption.

- too rapid of an ascent.

- too rapid of a descent.

The EMT must assume that any unwitnessed water-related incident is accompanied by:

- an air embolism.

- possible spinal injury.

- alcohol intoxication.

- cold-water immersion.

The MOST prominent symptom of decompression sickness is:

- tightness in the chest.

- dizziness and nausea.

- difficulty with vision.

- abdominal or joint pain.

You and your partner respond to a park where several people were reportedly struck by lightning. When you arrive, you find three patients. The first patient is lying supine on the ground; he is unresponsive and does not appear to be breathing. The second patient is ambulatory, appears confused, and is holding his arm against his chest. The third patient is sitting on the ground holding the sides of his head. After calling for backup, you should:

- immediately begin CPR on the unresponsive patient, but cease resuscitation efforts if there is no response after 5 minutes of treatment.

- focus your initial treatment efforts on the patients who are conscious because the unresponsive patient is likely in irreversible cardiac arrest.

- assess the unresponsive patient's pulse, begin CPR starting with chest compressions if he is pulseless, and attach the AED as soon as possible.

- recognize that the patients who are conscious are at high risk for developing cardiac arrest and quickly assess them for potentially life-threatening injuries.

A 31-year-old male was bitten on the leg by an unidentified snake. The patient is conscious and alert and in no apparent distress. Your assessment of his leg reveals two small puncture marks with minimal pain and swelling. In addition to administering oxygen and providing reassurance, further care for this patient should include:

- supine positioning, splinting the leg, and transporting.

- transporting only with close, continuous monitoring.

- elevating the lower extremities and giving antivenin.

- applying ice to the wound and transporting quickly.

Which of the following is an early sign of pit viper envenomation?

- Signs and symptoms of hypoperfusion

- General weakness and diaphoresis

- Local swelling and ecchymosis

- Syncope and bleeding at distal sites

All of the following terms refer to a body part that is cold but not frozen, EXCEPT:

- frostbite.

- trench foot.

- immersion foot.

- frostnip.

Which of the following is a normal change in pregnancy?

- Decreases in blood volume

- Tightening of joints

- Blood clotting decreases

- Increased respiratory rates and decreased minute volumes

When transporting a pregnant patient in her third trimester, how should you position her?

- On her right side

- Supine

- Fowler position

- On her left side

When does the onset of labor begin?

- When the woman has the urge to push

- When the amniotic sac ruptures

- When the fetus enters the birth canal

- When uterine contractions begin

If amniotic fluid is green, what does this signify?

- Maternal infection

- Premature rupture of the placenta

- The presence of meconium

- Prolonged gestation

As you are delivering the head during birth, you observe the umbilical cord is wrapped once around the neck. What should you do?

- Ask the patient not to push, and prepare for immediate transport.

- Try to slip the cord gently over the head.

- Clamp and cut the cord, and remove the cord from around the neck.

- Pull on the cord to speed the delivery.

What would the Apgar score be for a newborn whose body is pink but whose hands and feet are cyanotic, has a pulse rate of 98 bpm, cries but does not recoil from stimulus, resists attempts to straighten hips and knees, and has slow respirations?

- 4

- 8

- 6

- 10

If a newborn's heart rate is 75 bpm, what should you do?

- Keep the newborn warm and assess him/her continuously.

- Begin assisted ventilation with a BVM and room air.

- Begin chest compressions.

- Begin assisted ventilation with a BVM and 100% oxygen.

What is a primary characteristic of eclampsia?

- Severe, persistant headache

- Hypotension

- Bleeding

- Seizures

Which of the following is a sign that delivery is imminent?

- Crowning

- Bloody show

- Contractions

- Lightening

The answer to which of the following questions will help you determine whether delivery for this patient is imminent?

- Is this your first baby?

- Do you use drugs or drink alcohol?

- Do you know if there is a chance of multiple deliveries?

- Have you had a previous complicated pregnancy?

When preparing a pregnant patient for delivery, you should position her:

- in a supine position with her legs spread.

- in a sitting position with her hips elevated 12 inches.

- on her left side with the right leg elevated.

- on a firm surface with her hips elevated 2 to 4 inches.

A 26-year-old female who is 34 weeks pregnant is experiencing a seizure. Her husband tells you that her blood pressure has been high and that she had been complaining of a headache for the past few days. You should:

- insert an oral airway and ventilate her with a bag-valve mask.

- place her on her side, administer high-flow oxygen, and transport.

- elevate her legs to improve brain perfusion and keep her warm.

- administer oral glucose for presumed hypoglycemia and transport.

By the 20th week of pregnancy, the uterus is typically at or above the level of the mother's:

- superior diaphragm.

- xiphoid process.

- pubic bone.

- belly button.

A pregnant trauma patient may lose a significant amount of blood before showing signs of shock because:

- blood is shunted to the uterus and fetus during major trauma.

- pregnancy causes vasodilation and a lower blood pressure.

- pregnant patients can dramatically increase their heart rate.

- pregnant patients have an overall increase in blood volume.

Following delivery of a full-term baby, you have properly cared for the baby and have clamped and cut the umbilical cord. During transport, you note that the mother is experiencing moderate vaginal bleeding. You should:

- elevate her legs 6 to 8 inches and cover her with a blanket.

- carefully insert a sterile trauma dressing into her vagina.

- place her legs together and position her on her left side.

- firmly massage the uterine fundus with a circular motion.

A mother who is pregnant with her first baby is typically in the first stage of labor for approximately:

- 16 hours.

- 4 hours.

- 10 hours.

- 8 hours.

You are attending to a 23-year-old female patient who is 16 weeks pregnant with her second child. The patient has apparently fallen and sustained an injury to her upper right arm. When you ask about the incident history, the patient is reluctant to explain what happened and becomes very quiet. Based on this information, you should:

- immediately remove the patient from the environment and transport.

- ask more detailed questions and press the issue until you have a more detailed understanding of the incident.

- contact police and remain at the scene until they arrive and escort you to the hospital.

- continue your care in a private area, document any details regarding the scene and the incident, and reassure her as you provide care.

You and your partner are both male and are attending to a 28-year-old female patient complaining of diffuse abdominal pain. The patient is 34 weeks pregnant with her first child. The patient refuses to allow you to examine her, and her husband informs you that their culture does not allow males to examine or care for pregnant women. You should:

- respect the patient's wishes, ensure that the appropriate documentation is completed, and transport the patient.

- insist that the patient requires proper care and that requires an adequate physical assessment and that you cannot be responsible for the outcome.

- inform the patient that by calling for an ambulance, she is agreeing to the care provided and continue with your assessment and management.

- call for the police to ensure that patient assessment is carried out.

The presence of meconium in the amniotic fluid indicates:

- that full newborn resuscitation will be needed.

- that the baby's airway may be obstructed.

- that the fetus is at least 4 weeks premature.

- an expected finding in full-term infants.

A nuchal cord is defined as an umbilical cord that:

- has separated from the placenta.

- is lacerated due to a traumatic delivery.

- is wrapped around the baby's neck.

- has abnormally developed blood vessels.

The amniotic fluid serves to:

- insulate and protect the fetus.

- remove viruses from the fetus.

- assist in fetal development.

- transfer oxygen to the fetus.

Common interventions used to stimulate spontaneous respirations in the newborn include all of the following, EXCEPT:

- suctioning of the upper airway.

- positive-pressure ventilations.

- some form of tactile stimulation.

- thorough drying with a towel.

A history of pelvic inflammatory disease or tubal ligations increases a woman's risk for:

- gestational diabetes.

- preeclampsia.

- an ectopic pregnancy.

- placenta previa.

From what internal female organ is the fetus expelled during delivery?

- Cervix

- Vagina

- Uterus

- Perineum

Which of the following questions is of LEAST pertinence when determining whether a mother will deliver her baby within the next few minutes?

- "Do you feel the need to push?"

- "When are you due?"

- "Have you had a sonogram?"

- "Is this your first baby?"

When determining the frequency of contractions, you should time the contractions from the:

- start of one to the end of the next.

- end of one to the end of the next.

- start of one to the start of the next.

- end of one to the start of the next.

If a baby is born at 7:52, the second Apgar score should be calculated at:

- 7:53.

- 8:00.

- 7:59.

- 7:57.

During your visual inspection of a 25-year-old woman in labor, you see the baby's head crowning at the vaginal opening. What should you do?

- Place your fingers in the vagina to assess for a nuchal cord.

- Maintain firm pressure to the head until it completely delivers.

- Apply gentle pressure to the baby's head as it delivers.

- Tell the mother not to push and transport her immediately.

Three days after delivering her baby, a 30-year-old woman complains of a sudden onset of difficulty breathing. Her level of consciousness is decreased and she is tachycardic. The EMT should suspect:

- acute pulmonary edema.

- spontaneous pneumothorax.

- pulmonary embolism.

- intrauterine bleeding.

Your 22-year-old patient is in active labor. Upon visual inspection, you note that the infant's leg is protruding from the vagina. Appropriate management of this situation includes:

- carefully attempting to push the infant's leg off of the umbilical cord.

- placing the mother in a recumbent position and rapidly transporting.

- placing the mother supine with her head down and pelvis elevated.

- gently pulling on the infant's leg in an attempt to facilitate delivery.

With which age group should you talk to the child, not just the parent, while taking the medical history?

- Preschooler

- Toddler

- Adolescent

- School-age

Which of the following is true about a child's breathing?

- A child's oxygen demand is about the same as that of an adult.

- The trachea is proportionally larger in an infant, leading to a greater potential for choking.

- Older children experience intercostal muscle fatigue more quickly than younger children.

- Because less air is exchanged with each breath, detection of poor air movement or complete absence of breath sounds can be difficult.

What does the PAT assess?

- Appearance, work of breathing, circulation

- Tone, interactiveness, consolability, look, speech/cry

- Alert, responsive, unresponsive

- Airway, breathing, circulation

What should you use the Wong-Baker FACES scale to determine?

- Motor response

- LOC

- Work of breathing

- Pain level

What does respiratory syncytial virus (RSV) cause?

- Bronchiolitis

- Pneumonia

- Pertussis

- Epiglottitis

You are assessing a 6-year-old boy who has a fever of 102 and is showing signs of altered LOC. He is complaining of pain when he tries to turn his head. What condition should you suspect?

- Meningitis

- Spinal cord injury

- Anaphylactic

- Febrile seizure

In a normal adult, greater than 30% to 40% of blood volume loss significantly increases the risk of shock. What is the threshold of blood volume loss in children?

- 30%

- 25%

- 50%

- 45%

You are using JumpSTART in a triage situation involving several children. How would you rate a patient who is breathing spontaneously, has a peripheral pulse, and is appropriately responsive to painful stimuli?

- Red tag

- Green tag

- Yellow tag

- Black tag

You are responding to a 9-1-1 call where the mother reported finding her 3-month-old daughter cyanotic and unresponsive in her crib. When you stimulate the child, she responds. This is an example of what condition?

- Shaken baby syndrome

- Apparent life-threatening event

- SIDS

- Febrile seizure

If a pediatric patient begins seizing again during your care, which of the following would be your treatment priority?

- Providing rapid transport

- Stopping the seizure

- Securing and clearing the airway

- Maintaining the patient's body temperature

You are dispatched to a residence for a child with respiratory distress. The patient, an 18-month-old female, is tachypneic, has sternal retractions, and is clinging to her mother. Her skin is pink and dry, and her heart rate is 120 beats/min. The MOST appropriate treatment for this child includes:

- administering blow-by oxygen and transporting the child with her mother.

- requesting a paramedic ambulance to insert an advanced airway device.

- separating the child from her mother and providing ventilatory assistance.

- allowing the child to remain with her mother and applying a nasal cannula.

Signs and symptoms of meningitis in the infant or child include all of the following, EXCEPT:

- altered mental status.

- sunken fontanelles.

- headache and fever.

- a stiff or painful neck.

A 2-year-old female has experienced a seizure. When you arrive at the scene, the child is conscious, crying, and clinging to her mother. Her skin is hot and moist. The mother tells you that the seizure lasted approximately 5 minutes. She further tells you that her daughter has no history of seizures, but has had a recent ear infection. You should:

- suspect that the child has meningitis and transport at once.

- allow the mother to drive her daughter to the hospital.

- place the child in cold water to attempt to reduce her fever.

- cool the child with tepid water and transport to the hospital.

When a child is struck by a car, the area of greatest injury depends MOSTLY on the:

- speed at which the car was traveling when impact occurred.

- age of the child and the size of the car that struck him or her.

- size of the child and the height of the bumper upon impact.

- height of the child and the speed at which the car was traveling.

When questioning the parent of a child who ingested a poisonous substance, which of the following questions would be of LEAST pertinence initially?

- Why did your child ingest the poison?

- What time did the ingestion occur?

- Do you know what substance was ingested?

- Have you noticed any signs or symptoms?

Burns in children are commonly caused by all of the following, EXCEPT:

- exposure to caustic chemicals.

- scalding water in a bathtub.

- entrapment in a structural fire.

- hot items on a stovetop.

Pale skin in a child indicates that the:

- oxygen content in the blood is decreased.

- blood vessels near the skin are constricted.

- child is in severe decompensated shock.

- child's core body temperature is elevated.

Common causes of seizures in children include all of the following, EXCEPT:

- poisonings or ingestion.

- electrolyte imbalances.

- hyperglycemia.

- infection.

When assessing an 8-year-old child, you should:

- talk to the child, not just the caregiver.

- rely solely on the parent for information.

- refrain from taking a blood pressure.

- use a toe-to-head assessment approach.

While triaging patients at the scene of a motor-vehicle crash, you encounter a 5-year-old child who is unresponsive and apneic. After positioning his airway, you should:

- deliver 5 rescue breaths.

- palpate for a carotid pulse.

- categorize him as deceased.

- categorize him as immediate.

An infant with severe dehydration would be expected to present with:

- excessive tearing.

- moist oral mucosa.

- absent urine output.

- bulging fontanelles.

A viral infection that may cause obstruction of the upper airway in a child is called:

- croup.

- asthma.

- bronchitis.

- epiglottitis.

Infection should be considered a possible cause of an airway obstruction in an infant or child, especially if he or she presents with:

- drooling or congestion.

- acute respiratory distress.

- skin that is cool and dry.

- extreme restlessness.

When caring for a female child who has possibly been sexually abused, you should:

- immediately report your suspicions to the parents.

- have a female EMT remain with her if possible.

- encourage the child to urinate and take a shower.

- carefully examine the genitalia for signs of injury.

The purpose of the pediatric assessment triangle (PAT) is to:

- determine if the child's vital signs are within the age-appropriate limits.

- gather critical data by performing a rapid hands-on assessment of the child.

- facilitate a rapid head-to-toe assessment of the child by visualization only.

- allow you to rapidly and visually form a general impression of the child.

The first month of life after birth is referred to as the:

- neonatal period.

- start of infancy.

- premature phase.

- toddler period.

A 5-year-old child has had severe vomiting and diarrhea for 4 days. Which of the following assessment findings would be the MOST indicative of decompensated shock?

- Respiratory rate of 30 breaths/min

- Blood pressure of 70/40 mm Hg

- Capillary refill time of 4 seconds

- Pulse rate greater than 120/min

Which of the following statements regarding sudden infant death syndrome (SIDS) is correct?

- SIDS is most commonly the result of an overwhelming infection.

- The cause of death following SIDS can be established by autopsy.

- Certain cases of SIDS are predictable and therefore preventable.

- Death as a result of SIDS can occur at any time of the day or night.

Which of the following findings is LEAST suggestive of child abuse?

- Consistency in the method of injury reported by the caregiver

- Evidence of alcohol consumption or drug use at the scene

- An unexplained delay in seeking medical care after the injury

- Burns to the hands or feet that involve a glove distribution

Unless he or she is critically ill or injured, you should generally begin your assessment of a toddler:

- at the feet.

- at the head.

- en route to the hospital.

- in the ambulance.

Which interview technique should you use when addressing a geriatric patient?

- Have both you and your partner ask question.

- Speak loudly and slowly.

- Refer to the patient by his first name.

- Listen carefully to the answers the patient provides.

You are assessing an 80-year-old patient who explains that he was awakened by a sudden feeling of suffocation and respiratory distress. What are his symptoms a characteristic of?

- Orthopnea

- Paroxysmal nocturnal dyspnea

- Exertional dyspnea

- Intermittent sleep apnea

Which of the following is a nonpreventable factor in stroke?

- Age

- Hypertension

- Obesity

- Atrial fibrillation

In arteriosclerosis, overproduction of abnormal collagen and decreased quantities of elastin lead to what?

- Decreased coronary artery perfusion

- Increased coronary artery perfusion

- Narrowing pulse pressure

- Hypotension

Which of the following is true regarding delirium?

- It has a slow onset of progressive disorientation.

- It is a result of an irreversible metabolic disorder.

- It is rare in older hospitalized patients.

- Memory remains intact.

You are working on a geriatric patient who reports severe abdominal pain radiating through her back and flank. She also reports discomfort in her right leg and your assessment reveals a diminished pulse in the extremity. What should you suspect?

- Peptic ulcer disease

- Venous stasis

- Pulmonary embolism

- Abdominal aortic aneurysm