EMT Practice: Systems, Safety and Care Part 12

Which of the following groups are most likely to commit suicide?

- Teenage girls (any ethnicity)

- White males older than 85 years

- African American women older than 65 years

- College-educated males aged 45-65 years

Which of the following would be part of the "S" component of the GEMS diamond?

- Hazardous living conditions

- Polypharmacy

- Activities of daily living

- Normal changes of aging

On auscultation of a patient's lungs, you hear crackles. These lung sounds are caused by air passing through what?

- Thick secretions in the airways

- Fluid in the alveoli

- Inflamed airways

- Constricted airways

Which of the following questions should you ask if you suspect a patient may have congestive heart failure?

- "In what position do you normally sleep?"

- "How many hours of sleep do you get each night?"

- "How many pillows do you sleep on?"

- "Do you take any medication to help you sleep at night?"

During the natural process of aging, the number of functional cilia in the respiratory system decreases, resulting in:

- air-trapping within the alveoli.

- a decreased ability to cough.

- an increased risk of COPD.

- baseline respiratory distress.

An 84-year-old male fell a week ago and has been bedridden since then. Today, he presents with an altered mental status. His skin is pale and cold and his respirations are rapid and shallow. The EMT should suspect:

- acute hyperglycemia.

- a subdural hematoma.

- a systemic infection.

- hypovolemic shock.

Because of the complexity of the older patient and the vagueness of his or her complaint, you should:

- rely exclusively on family members for the medical history.

- perform a rapid assessment on all geriatric patients you treat.

- limit your physical examination to the area of pain or injury.

- attempt to differentiate between chronic and acute problems.

Poor maintenance of home, poor personal care, and dietary neglect are all possible indicators of ____________ elder abuse.

- psychological

- emotional

- physical

- financial

The stooped posture of some older people, which gives them a humpback appearance, is called:

- miosis.

- kyphosis.

- scoliosis.

- arthritis.

Common causes of depression in the elderly include all of the following, EXCEPT:

- alcohol abuse and dependence.

- chronic medical conditions.

- an acute onset of dementia.

- prescription medication use.

Clouding of the lenses of the eyes is called:

- conjunctivitis.

- cataracts.

- retinitis.

- glaucoma.

Talking about an elderly patient in front of him or her to other members of the family:

- is usually beneficial because the patient's cognitive skills are typically impaired.

- may cause the patient to think that he or she has no say in making decisions.

- will anger the patient and result in his or her refusal to accept care or transport.

- often causes the patient to become paranoid and untrusting of your help.

An abdominal aortic aneurysm:

- can sometimes be palpated as a mass in the groin area.

- is often the result of hypertension and atherosclerosis.

- is usually not repairable, even if discovered early.

- causes dull pain that often radiates to the shoulders.

When immobilizing a patient with a kyphotic spine to a long backboard, the EMT would MOST likely have to:

- use a scoop stretcher instead of a log roll.

- place blankets behind the patient's head.

- secure the patient's head before the torso.

- force the head into a neutral alignment.

Blood levels of medications may rise in the elderly, sometimes to toxic levels. This is MOST likely due to:

- pancreatic failure.

- intentional overdose.

- renal insufficiency.

- splenic dysfunction.

Sedentary behavior while healing from a hip fracture would MOST likely predispose the older patient to:

- pneumonia.

- heart failure.

- osteoporosis.

- ischemic stroke.

To minimize distractions and confusion when assessing an older patient, you should:

- perform a physical exam and then talk to the patient.

- elevate your voice and speak directly to the patient.

- have only one EMT speak to the patient at a time.

- dismiss the family members from the room or area.

You are assessing a 70-year-old female who complains of intense thirst, frequent urination, and dizziness. She has a history of type 2 diabetes, heart disease, rheumatoid arthritis, and gout. Her blood glucose reads "high." She is conscious, but confused. Her blood pressure is 92/52 mm Hg, her pulse rate is 130 beats/min and weak, and her respirations are 22 breaths/min and shallow. This patient's clinical presentation is MOST consistent with:

- hyperosmolar hyperglycemic nonketotic syndrome.

- acute renal failure with associated hyperglycemia.

- hyperglycemia with moderate dehydration.

- diabetic ketoacidosis.

The leading cause of death in the geriatric patient is:

- hypertension.

- altered mental status.

- arthritis.

- heart disease.

A 77-year-old female presents with an acute onset of altered mental status. Her son is present and advises that she has a history of hypertension, atrial fibrillation, type 2 diabetes, and glaucoma. He further advises that she takes numerous medications and that she is normally alert. When you assess this patient, it is important to note that:

- because of her age and medical history, you should suspect Alzheimer disease.

- dementia typically presents as an acute onset of deterioration of cognitive function.

- her mental status is likely the result of hypoglycemia and you should give her sugar.

- the patient is experiencing delirious behavior, which suggests a new health problem.

Which of the following observations or statements represents the "E" in the GEMS diamond?

- The patient's residence is cold due to a malfunctioning heater.

- A patient is assisted with his or her activities of daily living.

- The patient's medications have not been filled in 2 months.

- Elderly patients present atypically and deserve your respect.

In contrast to younger patients, older patients are more prone to a decrease in blood pressure (BP) upon standing because:

- any change in position causes blood to be shunted to the brain.

- their red blood cells are destroyed at a faster than normal rate.

- the body is less able to adapt the BP to rapid postural changes.

- the aging process results in an overall increase in blood volume.

A specific legal document that directs relatives and caregivers regarding the medical treatment that may be given to patients who cannot speak for themselves is called a(n):

- physician directive.

- statute of care.

- advance directive.

- power of attorney.

The EMT should suspect left-sided heart failure in the geriatric patient who presents with:

- fever and a cough that produces green sputum.

- jugular venous distention and peripheral edema.

- tachypnea and paroxysmal nocturnal dyspnea.

- swelling of the lower extremities and weakness.

Which of the following techniques should you use when you are communicating with a patient who has autism?

- Speak normally and provide simple, one-step directions.

- Exaggerate your lip movements.

- Speak loudly into the patient's ear.

- You and your partner should talk to the patient together.

What does the TEAM approach stand for?

- Treat, Evaluate, Administer, Monitor

- Test Extension and Abduction Motion

- Trust Every Available Member

- Take Evasive Action Monitoring

Nerve damage to the inner ear results in what?

- Otitis media

- Sensorineural deafness

- Conductive hearing loss

- Tinnitus

You are at the home of an elderly man who has a tracheostomy tube and is on mechanical ventilation. His ventilator has malfunctioned. Once you disconnect the ventilator, what should you do?

- Deliver 100% oxygen through a nonrebreathing mask.

- Transport the patient to a critical care facility immediately.

- Use a nasal cannula to deliver oxygen.

- Deliver oxygen using a face mask over the stoma.

A patient with epilepsy is likely to have which of the following medical devices?

- LVAD

- Central venous catheter

- Shunt

- Vagus nerve stimulator

Which of the following is the best source of information when you are dealing with an autistic patient?

- Medical control

- The attending doctor

- The patient him/herself

- Family members/caregivers

Which of the following mnemonics is helpful when you are dealing with a tracheostomy tube obstruction?

- DUMBELS

- PEARRL

- DOPE

- PASTE

What does the Emergency Medical Treatment and Active Labor Act (EMTALA) dictate?

- All patients are allowed the right to treatment and/or transport.

- All health care facilities must provide a medical assessment and treatment, regardless of the patient's ability to pay.

- All health care facilities must provide a medical assessment and treatment, regardless of the patient's mental or physical limitations.

- All EMTs must have a basic level of training in order to administer aid to a patient in the field.

When treating a patient with spina bifida, which of the following is most likely to produce anaphylaxis?

- Aspirin

- Latex

- Sulfa drugs

- Iodine

What is the best position in which to transport an obese patient?

- Prone

- With the feet elevated

- Supine

- With the head elevated

Common complications associated with central venous catheters include all of the following, EXCEPT:

- a local infection.

- bleeding around the line.

- clotting of the line.

- rupture of a central vein.

A person is said to be obese when he or she is ________ over his or her ideal weight.

- 10% or more

- 30% or more

- 20% or more

- 40% or more

Spina bifida is defined as:

- congenital inflammation of the spinal cord, usually in the neck.

- a birth defect caused by incomplete closure of the spinal column.

- chronic pressure on the brain caused by excess cerebrospinal fluid.

- a birth defect in which the child is born without spinal vertebrae.

When caring for a patient who is visually impaired, it is important to:

- tell him or her what is happening, identify noises, and describe the situation and surroundings.

- stand to the side of the patient when speaking if his or her peripheral vision is impaired.

- leave items such as canes and walkers at the residence if the patient will be carried on a gurney.

- allow a service dog to remain with the patient at all times, even if the patient is critically ill.

A surgical procedure that creates an opening between the intestine and the surface of the body that allows for elimination of waste products is called a(n):

- colostomy.

- gastrostomy.

- intestinal shunt.

- gastric stoma.

A 13-year-old child is on a home ventilator. The parents called because the mechanical ventilator is malfunctioning and the child has increasing respiratory distress. You should:

- reset the ventilator by unplugging it for 30 to 60 seconds.

- place a call to the home health agency treating this patient.

- disconnect the ventilator and apply a tracheostomy collar.

- attempt to troubleshoot the mechanical ventilator problem.

According to the Emergency Medical Treatment and Active Labor Act (EMTALA):

- all health care facilities must provide a medical assessment and required treatment, regardless of the patient's ability to pay.

- all health care facilities are legally obligated to provide assessment and care only if the patient is critically ill or injured.

- a patient maintains the legal right to recant his or her consent to emergency treatment, even after signing in to the emergency department.

- a health care facility has the right to refuse assessment and treatment to a patient, but only if his or her condition is not deemed critical.

According to the "E" in the DOPE mnemonic, which of the following actions should you perform to troubleshoot inadequate ventilation in a patient with a tracheostomy tube?

- Check the mechanical ventilator for malfunction.

- Attempt to pass a suction catheter into the tube.

- Look for blood or other secretions in the tube.

- Listen to breath sounds to assess for a pneumothorax.

Which of the following statements regarding interaction with the caregiver of a child or adult with special health care needs is correct?

- In most cases, it is more appropriate for the EMT to contact medical control prior to speaking with the patient's primary caregiver.

- Before performing an assessment of the patient's ABCs, the EMT should ask the caregiver about the patient's medical condition.

- In general, the EMT should only speak with a certified home health care provider because he or she is the expert on the patient's illness.

- Communication with the patient's caregiver or family members is important because they are the most familiar with the patient's condition.

A 70-year-old male complains of shortness of breath. During your assessment, you note that he has bilateral hearing aids. When you ask him questions related to his chief complaint, he does not answer you. You can hear a whistling sound coming from his hearing aids. You should:

- remove both of his hearing aids and use pencil and paper to communicate.

- try repositioning the hearing aid or remove it and turn down the volume.

- remove his hearing aids, turn up the volume, and replace them in his ears.

- recognize that the batteries in his hearing aids are probably depleted.

Which of the following statements regarding patients with intellectual disabilities is correct?

- An intellectual disability differs from mental retardation in that it is the result of a congenital abnormality.

- Most patients with intellectual disabilities have normal cognitive function, but abnormal physical features.

- Speaking with the patient's family is the least effective way to determine how much the patient understands.

- Patients with intellectual disabilities are susceptible to the same disease processes as other patients.

The purpose of a ventricular peritoneum shunt is to:

- monitor pressure within the skull in patients with a head injury.

- prevent excess cerebrospinal fluid from accumulating in the brain.

- divert excess cerebrospinal fluid to the ventricles of the brain.

- remove fluid from the abdomen of patients with right-sided heart failure.

You are assessing a 440-lb man who complains of shortness of breath and lower back pain. The patient is conscious and alert, his blood pressure is 148/98 mm Hg, and his heart rate is 120 beats/min. Your MOST immediate action should be to:

- perform a secondary assessment, focusing on his respiratory system and back.

- ask a member of your team to locate the best route to move him to the ambulance.

- avoid placing him in a supine position if possible and administer oxygen.

- notify the receiving facility and advise them of the patient's weight and status.

Down syndrome is a genetic defect that occurs as the result of:

- a separation of chromosome 21.

- a sperm that contains 24 chromosomes.

- a triplication of chromosome 21.

- an extra pair of chromosomes.

Which of the following would be the MOST practical method of communicating with a hearing-impaired patient until his or her hearing aids can be located?

- Using a piece of paper and writing utensil to ask questions

- Attempting to use body language to determine the problem

- Contacting dispatch and requesting a sign language interpreter

- Using a high-pitched voice while speaking directly into the ear

Cerebral palsy is characterized by poorly controlled ________ movement.

- extremity

- body

- eye

- neck

Because a tracheostomy tube bypasses the nose and mouth:

- secretions can build up in and around the tube.

- the risk of a local infection is significantly high.

- severe swelling of the trachea and bronchi can occur.

- bleeding or air leakage may occur around the tube.

Which of the following statements regarding autism is correct?

- Impairment of motor activity is a classic sign of autism.

- The majority of patients with autism do not speak at all.

- Autism affects females four times greater than males.

- Most cases of autism are diagnosed by 3 years of age.

Which of the following conditions would MOST likely be encountered in a patient with cerebral palsy?

- Seizure disorder

- Paralysis

- Brain tumors

- Type 2 diabetes

Under what circumstances is a left ventricular assist device used?

- To permanently replace the function of one or both of the ventricles

- To ensure that the ventricles contract at an adequate and consistent rate

- To reduce ventricular pumping force in patients with aortic aneurysms

- As a bridge to heart transplantation while a donor heart is being located

The six-pointed Star of Life emblem identifies vehicles that meet which of the following criteria?

- Meet federal specifications as licensed or certified ambulances

- Are staffed by a minimum of one certified advanced EMT (AEMT)

- Are equipped with supplies to manage mass-casualty situation

- Are operated federally certified ambulance operators

If you are on an emergency call with your warning lights and siren turned on, you may be allowed to do which of the following?

- Pass a stopped school bus with the stop sign out.

- Drive faster than the posted speed limit.

- Drive against the flow of traffic on an interstate in the left lane.

- Proceed through a red traffic light or stop sign without stopping.

Keeping a safe distance between your vehicle and the one in front of you, checking for tailgaters behind your ambulance, and being aware of objects in your mirror's blind spots are considered maintaining what?

- A buffer zone

- An evasion zone

- A cushion of safety

- Open space

If you arrive on the scene of a mass-casualty incident, what is the first thing you should do?

- Ask for additional resources.

- Begin treating patients.

- Direct traffic until law enforcement arrives.

- Declare the area a crime scene.

To ensure you have enough reaction time to avoid hitting a motorist who does not move over, you should drive, at minimum, how many seconds behind vehicles traveling at an average speed?

- 8

- 2

- 4

- 6

When responding to a scene where smoke or possible hazardous materials are present, how should you park?

- Uphill and downwind

- Downhill and upwind

- Uphill and upwind

- Downhill and downwind

What are the recommended dimensions for a landing zone for a medivac helicopter?

- 100 x 100 feet

- 150 x 150 feet

- 60 x 60 feet

- 80 x 80 feet

If you are signaled by the medivac crew to approach a medivac helicopter that has landed on uneven ground, from which direction should you approach the aircraft?

- From the front

- From the downhill side of the aircraft

- From the rear

- From the uphill side of the aircraft

When driving an ambulance, what is the safest path when cornering?

- Enter low, apex high, and exit high

- Enter high and exit low

- Enter high, apex low, and exit high

- Enter low and exit low

A jump kit contains everything you might need in the first 5 minutes with a patient, including which of the following?

- An AED

- Long backboard

- A CPR board

- A BVM

The process of removing dirt, dust, blood, or other visible contaminants from a surface or equipment is called:

- cleaning.

- sterilization.

- high-level disinfection.

- disinfection.

A type _____ ambulance features a conventional, truck cab-chassis with a modular ambulance body that can be transferred to a newer chassis as needed.

- III

- IV

- II

- I

General guidelines for safe ambulance driving include all of the following, EXCEPT:

- avoiding one-way streets whenever possible.

- avoiding routes with heavy traffic congestion.

- assuming that other drivers will not see you.

- regularly using the siren as much as possible.

While en route to a call for a patient in cardiac arrest, you approach a stopped school bus with its red warning lights flashing. You should:

- stop and wait until the warning lights stop flashing.

- pass the bus only after all the children have exited.

- back up and take an alternate route to the scene.

- slowly and carefully pass the bus on the left side.

In which of the following situations would the EMTs MOST likely utilize a police escort?

- The call is dispatched as an unresponsive patient with CPR in progress.

- The EMTs are transporting a critical pediatric patient through traffic.

- The weather is treacherous and there are numerous roads washed out.

- The EMTs are unfamiliar with the location, but the police officer knows the area.

A medical transport helicopter is incoming and you are responsible for setting up the landing zone (LZ). You should:

- ask bystanders to stand at all four corners of the LZ.

- use weighted cones to mark all four corners of the LZ.

- use yellow caution tape to mark of the LZ perimeter.

- place four flares 100 feet apart in an "X" pattern.

The LEAST practical place to store a portable oxygen cylinder is:

- in the driver's compartment.

- near the side or rear door.

- on the ambulance stretcher.

- inside the jump kit.

You have just delivered a major trauma patient to the hospital. Shortly after departing the hospital, dispatch advises you of another call. The back of the ambulance is contaminated with bloody dressings and is in disarray, and you are in need of airway equipment and numerous other supplies. You should:

- advise the dispatcher that you are out of service and to send another unit.

- have your partner quickly clean the ambulance as you proceed to the call.

- quickly proceed to the call and clean and restock the ambulance afterwards.

- proceed to the call, functioning only as an emergency medical responder.

Hydroplaning of the ambulance on wet roads would MOST likely occur at speeds of greater than _____ mph.

- 30

- 15

- 10

- 20

When arriving at the scene of an overturned tractor-trailer rig, you note that a green cloud is being emitted from the crashed vehicle. The driver is still in the truck; he is conscious but bleeding profusely from the head. After notifying the hazardous materials team, you should:

- quickly gain access to the patient.

- park downhill from the scene.

- position the ambulance upwind.

- ask the driver to exit the vehicle.

For every emergency request, the dispatcher should routinely gather and record all of the following information, EXCEPT the:

- caller's phone number.

- nature of the call.

- location of the patient(s).

- patient's medical history.

The use of lights and siren on an ambulance:

- allows other drivers to hear and see you from a great distance.

- legally gives the emergency vehicle operator the right of way.

- is required any time a patient is being transported to the hospital.

- signifies a request for other drivers to yield the right of way.

Common safety equipment carried on the ambulance includes all of the following, EXCEPT:

- turnout gear.

- hazardous materials gear.

- safety goggles.

- face shields.

Immediately upon arriving at the scene of an emergency call involving a traumatic injury, you should notify the dispatcher of your arrival and then:

- observe the scene for safety hazards.

- carefully assess the mechanism of injury.

- determine if additional units are needed.

- quickly gain access to the patient.

Which of the following is an example of regional equipment or supplies?

- DuoDote Auto-Injector

- Oral glucose

- Vacuum splint

- Inhaled bronchodilator

The MOST common and usually the most serious ambulance crashes occur at:

- intersections.

- railroad crossings.

- stop signs.

- stop lights.

Maintaining a cushion of safety when operating an ambulance means:

- driving at the posted speed limit, regardless of the patient's condition, and routinely using your lights and siren when driving on a freeway.

- remaining in the far right-hand lane when transporting a critical patient and refraining from passing other motorists on the left side.

- keeping a safe distance between your ambulance and the vehicles in front of you and remaining aware of vehicles potentially hiding in your mirrors' blind spots.

- driving about 2 to 3 seconds behind any vehicles in front of you and exceeding the posted speed limit by no more than 20 to 25 mph.

Equipment and supplies that are carried on an ambulance should be stored:

- as directed by the EMS system's medical director.

- according to the urgency and frequency of their use.

- based on recommendations of the health department.

- in locked or secured cabinets in order to prevent theft.

When approaching a helicopter, whether the rotor blades are moving or not, you should:

- carefully approach the aircraft from the rear unless a crew member instructs you to do otherwise.

- remember that the main rotor blade is flexible and can dip as low as 5¢ to 6¢ from the ground.

- never duck under the body or the tail boom because the pilot cannot see you in these areas.

- approach the aircraft from the side because this will make it easier for you to access the aircraft doors.

During the transport phase of an ambulance call, it is MOST important to:

- converse with the patient and provide reassurance.

- complete the run form before arrival at the hospital.

- reassess the patient only if he or she deteriorates.

- reassess unstable patients at least every 15 minutes.

Where should you park the ambulance when responding to a vehicle crash involving a hazardous material spill?

- Downhill and downwind from the hazard

- Uphill and downwind from the hazard

- Uphill and upwind from the hazard

- Downhill and upwind from the hazard

As an EMT, what is your main role at the scene of an accident involving extrication of the patient?

- To extricate the patients

- To assess and provide immediate medical care

- To provide safe entrance and access to the patients

- To provide traffic control and direction

Which of the following is an example of simple access?

- Removing the windshield

- Opening a rear door

- Breaking a side window

- Prying open a door

In an instance of multiple casualties, how should patient care be initiated?

- Only after all patients have been triaged

- In the order you reach each patient

- Based on the mechanism of injury

- In the order of age beginning with the youngest

During which phase of extrication should you don proper protective gear (PPE)?

- En route

- Patient removal

- Upon arrival

- During hazard control

You are assessing a female patient as the extrication team gets ready to roll up the dashboard to remove her. The patient has multiple fractures in her left arm. What should you do?

- Apply a rigid splint before she is removed.

- Apply an air splint before she is removed.

- Leave the arm alone until the patient has been extricated.

- Secure the injured arm against her body.

You have tried to gain simple access to a crashed vehicle but the doors are all jammed. What is your next step?

- Break the window farthest away from the patient.

- Break the front windshield.

- Break the window closest to the patient.

- Use the "jaws of life" to jimmy the driver's side door.

At what point should you begin your primary assessment of a patient who has been entrapped?

- After the patient has been extricated from the wreckage

- Before extrication begins

- Once the patient has been moved to the safe zone

- En route to the ED

What should you do if you find a patient entrapped in a vehicle who is in need of CPR?

- Perform CPR during the extrication process.

- Apply a bag-valve mask (BVM).

- Perform rapid extrication techniques.

- Apply manual stabilization until the patient can be extricated.

How far away should you park your ambulance from the site of a cave-in or trench collapse?

- 1000 feet

- 20 feet

- 500 feet

- 100 feet

Once entrance and access to the patient have been provided, you should:

- perform a primary assessment.

- allow extrication to commence.

- administer high-flow oxygen.

- begin treating his or her injuries.

When functioning at the scene of a motor vehicle crash in which a patient will require complex extrication, you should enter the vehicle and provide care to the patient:

- after receiving approval from the incident commander.

- only after you believe the vehicle has been stabilized.

- only if the patient has experienced a major injury.

- after rescue personnel have cut the battery cables.

Upon arrival at a search-and-rescue incident, the EMS crew should _________.

- prepare the equipment to carry to the patient.

- split up and request a search grid

- provide the incident commander with the crew's names and certification level(s)

- begin searching for the patient

If a technical rescue team is required at the scene, but is not present when you arrive, you should:

- check with the incident commander to ensure that the team is en route.

- remain with your ambulance until the rescue team arrives at the scene.

- don personal protective equipment and begin the rescue process.

- have fire personnel initiate the rescue process if they are at the scene.

Upon arriving at the scene of a motor vehicle crash, you can see three patients, one who is entrapped in his car and two who have been ejected from their vehicle. You should:

- immediately request additional resources.

- call medical control for further direction.

- request law enforcement for traffic control.

- begin triage to determine injury severity.

The rescue team is in the process of extricating a 40-year-old male from his truck. The patient's wife, who was uninjured in the crash, is calmly observing the extrication and asks you if her husband will be all right. You should:

- ensure that she is in a safe area, away from the scene.

- allow her to observe the extrication and keep her calm.

- allow her to talk to her husband during the extrication.

- ask her follow-up questions about the details of the crash.