Emergency Care (EMT), 13th Edition Test Bank

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ExamName___________________________________MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.1)Which of the following BEST describes a communication system capable of identifying the numberand location of the phone from which a caller is calling?1)A)Enhanced 911B)Advanced 911C)Data display 911D)Priority dispatch 911Answer:AExplanation:A)CORRECT. An enhanced 911 system has the capability of automatically identifyingthe caller's phone number and location.B)INCORRECT. Advanced 911 is an emergency texting system rather than a systemfor locating callers.C)INCORRECT. Data display 911 does not refer to a system capable of identifying acaller's location.D)INCORRECT. Priority dispatch 911 would refer more to an internalcommunication center protocol than a system for displaying locations and phonenumbers.2)Which of the following is the most common gateway for hospital services for patients who needemergency medical assistance?2)A)Emergency medical dispatch centerB)Emergency medical services systemC)Surgical services departmentD)Emergency departmentAnswer:DExplanation:A)INCORRECT. An emergency medical dispatch center coordinates transports to thehospitals, but is not involved in determining or promoting specific hospitalservices.B)INCORRECT. The EMS system is not generally involved with hospital servicesother than the emergency department.C)INCORRECT. Although an important component of a hospital's services, not allemergency medical patients will require surgery.D)CORRECT. The emergency department serves as the gateway for the rest of theservices offered by a hospital.3)The National Registry of Emergency Medical Technicians (NREMT) was founded to establishwhich of the following?3)A)Quality oversight of emergency medical services practicesB)Quality improvement and quality assurance programs for emergency medical servicesC)An education curriculum for EMT coursesD)National standards for emergency medical services personnelAnswer:DExplanation:A)INCORRECT. The NREMT created the standards used for modern EMS, but theorganization does not oversee or determine the quality of provided services.B)INCORRECT. The NREMT developed the professional standards for emergencycare personnel, but is not involved in quality improvement or any assurance of thecare provided.C)INCORRECT. Although EMT course curricula are based on the standardsprovided by the NREMT, the National Registry was not founded to create them.D)CORRECT. In 1970, the National Registry of Emergency Medical Technicians(NREMT) was founded to establish national standards within the industry.1

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4)What is NOT one the common settings that an EMT may work in?4)A)Ambulance servicesB)Rural/wilderness settingsC)Fire departmentsD)HospitalsAnswer:DExplanation:A)INCORRECT. One common setting that EMTs work in is ambulance services.B)INCORRECT. One common setting that EMTs work in is rural/wilderness settings.C)INCORRECT. One common setting that EMTs work in is fire departments.D)CORRECT. EMTs do not work in a hospital.5)What BEST describes the level of EMS training that emphasizes use of advanced airway devicesandsomeprehospital medication administration?5)A)Advanced EMTB)EMTC)Emergency Medical ResponderD)ParamedicAnswer:AExplanation:A)CORRECT. The Advanced EMT (AEMT) provides basic-level care andtransportation as well as some advanced-level care, such as use of advancedairway devices, monitoring of blood glucose levels, and administration of somemedications, which may include intravenous and intraosseous administration.B)INCORRECT. EMTs provide basic-level medical and trauma care but cannotmanage advanced airways or administer medications.C)INCORRECT. The first level of EMS training (Emergency Medical Responder) isprimarily focused on activating the EMS system and immediate care forlife-threatening injuries.D)INCORRECT. The Paramedic performs all of the skills of the EMT and AEMT plusadvanced-level skills. The Paramedic provides the most advanced level ofprehospital care.6)Which of the following agencies is responsible for establishing EMS system assessment programs?6)A)Department of Health and Human Services (HHS)B)National Highway Traffic Safety Administration (NHTSA)C)United States Health Services Agency (HSA)D)National Transportation Safety Board (NTSB)Answer:BExplanation:A)INCORRECT. The Department of Health and Human Services (HHS) is notresponsible for EMS system assessment programs.B)CORRECT. The National Highway Traffic Safety Administration (NHTSA)Technical Assistance Program has established assessment programs with setstandards for EMS systems.C)INCORRECT. The United States Department of Health and Human Services has nooversight of EMS systems.D)INCORRECT. The National Transportation Safety Board (NTSB) does not establishEMS system assessment programs.2

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7)Upon arrival at the hospital, the EMT advises hospital personnel of the patient's condition,observations from the scene, treatment rendered, and other pertinent data to assure continuity ofcare. This process is known as which of the following?7)A)Definitive careB)Transfer of careC)End of tourD)Breach of dutyAnswer:BExplanation:A)INCORRECT. Definitive care refers to the type of care ultimately needed by apatient, not to the process of transferring the patient to hospital staff.B)CORRECT. Providing the receiving hospital staff with information on the patient'scondition, observations of the scene, and other pertinent data so that there will becontinuity of care is part of thetransfer of careprocess.C)INCORRECT. The end of tour generally refers to the end of a scheduled EMS shiftand is not related to patient care.D)INCORRECT. A breach of duty occurs when an EMT has a responsibility to carefor a patient and does not follow through.8)What is the minimum level of certification required of ambulance personnel responsible for directpatient care?8)A)Emergency Medical TechnicianB)Emergency Ambulance DriverC)Emergency Medical ResponderD)Advanced EMTAnswer:AExplanation:A)CORRECT. In most areas, the Emergency Medical Technician (EMT) is consideredthe minimum level of certification for ambulance personnel.B)INCORRECT. Most ambulance personnel are expected to be at the EMT level orhigher.C)INCORRECT. An Emergency Medical Responder (EMR) is below the EMTcertification level, and below the minimum usually expected for ambulancepersonnel.D)INCORRECT. Advanced EMTs have a higher level of certification than what iscommonly required as the minimum for ambulance personnel.3

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9)You and your new EMT partner arrive first on the scene of a single car rollover on the shoulder of abusy highway. You pull off in a safe location and just as you stop the ambulance, your partnerthrows the passenger door open, steps out of the truck, and begins jogging through the scattereddebris toward the overturned car. You shout for him to stop and he looks back at you, but thencontinues to the vehicle and begins assessing the driver. Later, as you are restocking in theambulance bay of the local trauma center your partner tells you that he thinks you actedunprofessionally by shouting at him. What is thebestway to respond?9)A)An EMT should never hurry to assist a patient.B)The On-Duty Supervisor should be called.C)New EMTs should expect partners to yell at them occasionally.D)Shouting was an attempt to protect the EMT from a potentially unsafe scene.Answer:DExplanation:A)INCORRECT. Emergency medical care sometimes does require responders to actquickly, but never when it places others on scene in danger.B)INCORRECT. It is important for EMT partners to be able to communicateeffectively and professionally when debriefing calls. Generally, a Supervisorshould only become involved if the EMTs cannot resolve a conflict themselves or ifthey need a specific question answered.C)INCORRECT. Although sometimes the noise level of a situation requiresresponders to raise their voices to be heard, expecting to be yelled at simplybecause one is a new EMT is not professional or correct.D)CORRECT. Quickly entering a dangerous scene without taking proper precautionswill create additional risks. A professional EMT should always be concerned aboutthe safety of everyone on scene; not just themselves and the patients, but otherresponders as well. In this case, shouting at the EMT was an appropriate attempt toprevent him from entering an unsafe situation.10)Which of the following is a personal trait an EMT should demonstrate?10)A)Strong communicationB)Good eyesightC)Self-starterD)Strong studentAnswer:CExplanation:A)INCORRECT. Strong communication is obviously important for an EMT, but it istheresultof certain personal traits (respectful, able to listen, controlled in tone, etc.)Nnot a personal trait itself.B)INCORRECT. Good eyesight is a criticalphysicaltrait for an EMT to have.C)CORRECT. One of the personal traits of an effective EMT is that of being aself-starter.D)INCORRECT. Being a strong student is a good quality, butpersonal traitsrelate tothe behavior and demeanor of the EMT, not her strength in a particular task.4

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11)Which of the following BEST describes a person who speaks up on behalf of the patient andsupports his cause?11)A)GuardianB)AdvocateC)AssistantD)RepresentativeAnswer:BExplanation:A)INCORRECT. A guardian is generally someone who is legally responsible for apatient, whether or not they support or advocate for them.B)CORRECT. EMTs should be advocates for their patients, speaking up for them andsupporting them in getting appropriate care.C)INCORRECT. A person who assists a patient with tasks may not necessarily speakup for the patient or support them in seeking better care.D)INCORRECT. The term "representative" does not indicate the same level ofpersonal involvement in a patient's care and outcome as an "advocate" has. EMTsshould always see themselves as advocates for their patients.12)The application of oxygen for a patient who is short of breath without having to contact thephysician in the emergency department is an example of which of the following?12)A)Standards of careB)Breach of dutyC)On-line medical directionD)Standing ordersAnswer:DExplanation:A)INCORRECT. Standards of care refer to the expected actions of an EMT ascompared to a reasonable person with the same level of training and in the samesituation. It is not related to the authorization of specific skills.B)INCORRECT. A breach of duty occurs when an EMT has a responsibility to carefor a patient and does not follow through.C)INCORRECT. On-line medical directions are orders from an on-duty physiciangiven by radio or phone.D)CORRECT. Standing orders are physician issued policies or protocols thatauthorize EMTs to perform particular skills in certain situations.13)Which of the following is a physical trait necessary for performing the duties of an EMT?13)A)Ability to speak clearlyB)Ability to remain calm in stressful situationsC)Ability to lift and carry 200 poundsD)Nonjudgmental and fairAnswer:AExplanation:A)CORRECT. An important requirement of an EMT is to have the physical ability togive and receive oral and written instructions.B)INCORRECT. An EMT's ability to remain calm in stressful situations is a criticalpersonal trait.C)INCORRECT. An EMT would not be expected to lift or carry over 125 pounds, so itwould not be considered a necessary ability to carry 200 pounds.D)INCORRECT. Being nonjudgmental and fair are important personal attributes foran EMT to have, but they are not physical traits.5

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14)What BEST describes the level of EMS training that emphasizes activation of the EMS system andprovides immediate care for life-threatening problems?14)A)Emergency Medical DispatcherB)EMTC)Emergency Medical ResponderD)Cardiac care responderAnswer:CExplanation:A)INCORRECT. The Emergency Medical Dispatcher is responsible for coordinatingthe appropriate EMS response and potentially providing important instructions tothe person calling for assistance.B)INCORRECT. EMTs provide basic-level medical and trauma care andtransportation to a medical facility.C)CORRECT. The emphasis of an Emergency Medical Responder is on activating theEMS system and providing immediate care for life-threatening injuries,controlling the scene, and preparing for the arrival of the ambulance.D)INCORRECT. A cardiac care responder is not a recognized level of EMS training.15)Which of the following is a role of the EMT in the quality improvement process?15)A)Writing complete patient care reportsB)Assuring personal safetyC)Critiquing performance of one's partnerD)Taking responsibility for the actions of one's partnerAnswer:AExplanation:A)CORRECT. Since much of an EMS system's clinical quality improvement datacomes from patient care documentation, ensuring that each report is complete andaccurate is a very important part of an EMT's involvement in quality improvement.B)INCORRECT. Although assuring personal safety is a very important responsibilityfor EMTs, it is not a role in the quality improvement process. Continuingeducation, equipment maintenance, gathering feedback from patients and hospitalstaff, preparing complete and accurate patient documentation, and gettinginvolved in the EMS system's structured quality improvement program are allexamples of roles for the EMT in a QI process.C)INCORRECT. Critiquing the performance of other emergency responders is not aprimary role for EMTs in the quality improvement process. An EMT can best assistthe process by preparing carefully written documentation, being involved in thesystem's quality improvement process, obtaining feedback from patients andhospital staff, maintaining equipment, and continuing his education.D)INCORRECT. The primary roles of an EMT in quality improvement include;preparing carefully written documentation, involvement in the system's qualityimprovement process, obtaining feedback from patients and hospital staff,maintaining equipment, and continuing education. Taking responsibility for theactions of others is not a part of the quality improvement process.6

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16)What level of emergency medical training provides the most advanced pre-hospital care?16)A)Advanced EMTB)ParamedicC)Emergency Medical TechnicianD)Emergency Medical ResponderAnswer:BExplanation:A)INCORRECT. The AEMT provides basic-level care and transportation as well assome advanced-level care in the pre-hospital setting.B)CORRECT. The Paramedic performs all of the skills of the EMT and AEMT plusadvanced-level skills. The Paramedic provides the most advanced level ofprehospital care.C)INCORRECT. EMTs provide basic-level medical and trauma care andtransportation to a medical facility.D)INCORRECT. Emergency Medical Responders are trained to activate the EMSsystem, provide immediate care for life-threatening injuries, control the scene, andprepare for the arrival of the ambulance.17)After delivering a patient to the emergency department, you discuss with hospital staff the detailsof your care and ask for suggestions to improve your care. This is an example of your role in whichof the following?17)A)Continuing educationB)Transfer of careC)Quality improvementD)Patient advocacyAnswer:CExplanation:A)INCORRECT. Continuing education is ongoing structured training designed tosupplement the EMT's original course.B)INCORRECT. Transfer of care is the process of turning care of a patient over tothose with higher levels of training.C)CORRECT. Continuous self-review through numerous means with the purpose ofidentifying aspects of the system that require improvement is known as qualityimprovement.D)INCORRECT. A patient advocate is the person who speaks up for the patient andpleads her cause.18)Which of the following refers to a program or process for evaluating and improving theeffectiveness of an EMS system?18)A)Total quality systemB)Quality improvementC)Process Improvement Plan (PIP)D)System effectiveness managementAnswer:BExplanation:A)INCORRECT. The term "total quality system" does not refer to a program forimproving the effectiveness of EMS systems.B)CORRECT. Quality improvement (QI) consists of continuous self-review with thepurpose of identifying aspects of the EMS system that require improvement, withsubsequent action plans to make subsequent changes.C)INCORRECT. A program or process for evaluating and improving theeffectiveness of an EMS system is not referred to as a Process ImprovementProgram.D)INCORRECT. System effectiveness management does not refer to a program ofevaluating and improving an EMS system.7

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19)The EMT's role in the quality improvement process includes becoming involved in the qualityprocess, keeping carefully written documentation, obtaining feedback from patients and thehospital staff, continuing your education, and which of the following?19)A)Being a member of the QI committeeB)Providing quality careC)Maintaining your equipmentD)Writing protocols and standing ordersAnswer:CExplanation:A)INCORRECT. Although it can be beneficial, being a member of the QI committee isnot an expected role for an EMT in the quality improvement process.B)INCORRECT. Providing quality care is an expectation of all EMTs, but it not partof the quality improvement process.C)CORRECT. Maintaining equipment properly is an important role the EMT plays inthe quality improvement process.D)INCORRECT. The Medical Director is responsible for writing protocols andstanding orders.20)You and your EMT partner are assigned to spend a day at the senior center where you are toinspect the rooms and common areas for fall hazards. Your partner is upset that he is not in theambulance where the "action is." He complains that "looking for loose rugs" is a waste of his time.What would be the best response to his complaints?20)A)Injury prevention in the community is an important component of EMS.B)It minimizes the number of 911 calls late at night.C)It is good practice for the next emergency call.D)It makes the taxpayers happy.Answer:AExplanation:A)CORRECT. Illness and injury prevention is an important component of EMS asEMTs are always in the field, and the role of EMS in public health is expected toonly increase in the future.B)INCORRECT. Blood pressure screening clinics do not impact the number of latenight 911 calls.C)INCORRECT. EMTs should already have competency in blood pressure techniquesprior to hosting any screening clinics.D)INCORRECT. Although community relations are important, it is not the primaryreason for checking blood pressures.21)Which of the following is a personality trait required of EMTs?21)A)Ability to dominate the patientB)Awareness of problems with color visionC)Control of personal habitsD)Ability to lift and carry 125 poundsAnswer:CExplanation:A)INCORRECT. Although the ability to dominate others may be considered apersonality trait, it is not one required to be an EMT.B)INCORRECT. Awareness of a physical problem, such as color vision, is not relatedto the qualities that make up a person's character.C)CORRECT. To reduce the chances of providing improper care or causing patientdiscomfort, EMTs should be able to control their personal habits appropriately.D)INCORRECT. A physical ability is not a personality trait.8

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22)Which of the following is a component of patient advocacy?22)A)Granting patient wishes and not reporting spousal abuse to the authoritiesB)Building rapport with the patient during transport to the hospitalC)Immobilizing the neck of a patient with a possible spinal injuryD)Providing oxygen to a patient that is short of breathAnswer:BExplanation:A)INCORRECT. Patient advocacy isnotsupporting a patient whose wishes willultimately be harmful or against the law.B)CORRECT. Building rapport with the patient is a critical component of advocacy.Without it, the EMT won't be able to know the patient's needs or challengesenough to effectively speak on their behalf.C)INCORRECT. This is simply an example of patient care. Advocacy is working tounderstandthe patient so that the EMT can speak up for them and promote theirneeds.D)INCORRECT. Advocacy is about truly understanding the patient and speaking upfor them to promote the best care possible, not simply providing an intervention.23)To be compassionate and empathetic, to be accurate with interviews, and to inspire confidence areall examples of which of the personal traits of a quality EMT?23)A)Emotionally stableB)Able to listen to othersC)Judgmental but fairD)PleasantAnswer:BExplanation:A)INCORRECT. Emotional stability is the ability to overcome the unpleasant aspectsof an emergency so that needed care may be rendered and any uneasy feelings thatexist afterward may be resolved.B)CORRECT. To be compassionate and empathetic, to be accurate with interviews,and to inspire confidence are examples of the ability to listen to others.C)INCORRECT. Being nonjudgmental and fair means treating all patients equallyregardless of race, religion, or culture.D)INCORRECT. Inspiring confidence and helping to calm the sick and injured areexamples of being pleasant.24)Which of the following BEST describes a list of steps the EMT should perform while assessing andmanaging emergency medical situations?24)A)On-line medical directionB)ProtocolsC)Standard operating proceduresD)Standing ordersAnswer:BExplanation:A)INCORRECT. On-line medical direction consists of orders from the on-dutyphysician given directly to an EMT in the field by radio or telephone.B)CORRECT. Protocols, which are developed by an agency's Medical Director, arelists of steps for assessment and interventions to be performed in differentsituations.C)INCORRECT. Standard operating procedures are a collection of policies aroundEMS agency operations and generally do not apply specifically to medicalassessment or management.D)INCORRECT. Standing orders, also called off-line medical direction, allow EMTsto give certain medications or perform certain procedures without speaking to theMedical Director or another physician.9

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25)Which of the following is the primary responsibility of the EMT?25)A)Maintain personal health and safetyB)Provide emergency careC)Protect and stabilize the patientD)Communicate with other responders on the sceneAnswer:AExplanation:A)CORRECT. It is not possible to help a patient if you are not physically capable orare injured while performing your job, so yourfirstresponsibility is to keepyourself healthy and safe.B)INCORRECT. Providing emergency care is the EMT'spurpose, but maintaining herown personal health and safety is the EMT's primaryresponsibility.C)INCORRECT. Although protecting and stabilizing the patient is an importantaspect of the EMT's job, maintaining personal health and safetyfirstis the priority.D)INCORRECT. Communicating with other emergency responders is necessary foreffective scene safety and coordination, but thefirstpriority for any EMT is toensure their own health and safety.26)Who is responsible for on-scene safety of EMS providers?26)A)Triage officerB)All crew membersC)Traffic directorD)Law enforcementAnswer:BExplanation:A)INCORRECT. The triage officer is not solely responsible for the on-scene safety ofEMS providers.B)CORRECT. It is the responsibility of all EMS crew members to keep themselves,the patient(s), and bystanders safe.C)INCORRECT. The on-scene safety of EMS providers is not the responsibility of atraffic director.D)INCORRECT. Law enforcement personnel can be an important part of scene safety,but they are not necessarily responsible for the safety of EMS crews.27)You have just come on duty. The EMT on the previous shift complains to you that the QI managerwas giving him grief because he did not document three sets of vital signs on the patient record.The EMT is angry and does not understand why documenting three sets of vital signs is soimportant. What is the best answer you could give him?27)A)Vital signs are something you have to fill out because the state requires it.B)It is important you show the QI manager that you are a team player.C)The report looks better when all the boxes are filled out.D)The recording of three sets of vital signs demonstrates that you were trending the patient'scondition.Answer:DExplanation:A)INCORRECT. The local or state governmental authority may or may not requirethree sets of vital signs; regardless, this should not be the primary reason todocument them.B)INCORRECT. Teamwork is an important trait in an EMT, but is not the drivingfactor for recording vital signs.C)INCORRECT. QI is not concerned with how the report looks, but rather that theinformation in the report is complete and accurate.D)CORRECT. Recording three sets of vital signs demonstrates that the EMT isreassessing the patient at the appropriate periodic intervals, which is importantwhen providing care for a patient.10

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28)What BEST defines the evaluation of the patient's condition in order to provide emergency care?28)A)Medical interventionB)Patient advocacyC)Patient accessD)Patient assessmentAnswer:DExplanation:A)INCORRECT. A medical intervention is the care provided once what is wrongwith the patient has been determined.B)INCORRECT. Patient advocacy is speaking up for the patient.C)INCORRECT. Patient access means getting to the patient's location.D)CORRECT. Patient assessment is used to find out enough about what is wrongwith your patient to be able to provide the appropriate emergency care.29)In 1966 the National Highway Safety Act charged which of the following agencies with thedevelopment of emergency medical service standards?29)A)U.S. Department of Homeland SecurityB)U.S. Department of the InteriorC)U.S. Department of TransportationD)U.S. Department of Health ServicesAnswer:CExplanation:A)INCORRECT. Although the U.S. Department of Homeland Security is tasked withprotecting the nation from threats, it was established in 2002 and did not exist in1966. It was the U.S. Department of Transportation that was charged withdeveloping EMS standards.B)INCORRECT. The U.S. Department of the Interior is charged with the managementand conservation of federal land and the country's natural resources. TheDepartment of Transportation was charged with developing EMS standards.C)CORRECT. In 1966 the National Highway Safety Act charged the United StatesDepartment of Transportation (DOT) with developing EMS standards andassisting the states to upgrade the quality of their prehospital emergency care.D)INCORRECT. Although the U.S. Department of Health and Human Services ischarged with protecting the health of all Americans, the United States Departmentof Transportation was assigned the task of developing emergency medical servicestandards.30)During the new employee orientation, the training officer meets with the new EMTs and explainsto them the monthly training schedule and the classes they must attend for EMT recertification.One of the new EMTs asks the training officer why they have to keep taking EMT courses if theyalready passed the EMT examination. What is the best answer?30)A)EMS is constantly evolving in response to evidence-based research.B)It looks good to a jury should the service be sued.C)EMTs forget everything once they pass the EMT exam.D)The state requires the training.Answer:AExplanation:A)CORRECT. Evidence-based scientific research is what drives changes in EMS.New and improved treatment techniques are derived from this research and theEMT needs to keep abreast of these dynamic changes to his profession.B)INCORRECT. Although continuing education can demonstrate to a jury that theservice is providing adequate training, one of the goals of continuing education isto prevent lawsuits from happening in the first place, rather than to look good oncea lawsuit has been filed.C)INCORRECT. Continuing education does provide EMTs with a good review ofrarely used material; however, it is not accurate that EMTs forget everything oncethey pass the EMT exam.D)INCORRECT. Although continuing education is mandated by most states, it is notthe reason continuing education is performed.11

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31)A fellow EMT is talking with the Medical Director at a staff meeting. The EMT states that theneighboring ambulance service is carrying special clotting bandages for serious bleeding wounds.The special bandages cost five times as much as the regular bandages, but the EMT claims theywork ten times better. The EMT wants the Medical Director to approve the bandages for use intheir ambulances. The Medical Director responds to the EMT by saying he will not approve thebandages until he can prove they are worth the additional cost. How can the EMT best prove theworth of the special bandages?31)A)Perform a literature search to see what studies have been done on the special bandages andreport the findings to the Medical Director.B)Call the manufacturer of the special bandage and request literature to give to the MedicalDirector.C)Order a small number of the special bandages and compare them side-by-side to the regularbandages.D)Have a member of the other ambulance service call the Medical Director to provide firsthandinformation on how the special bandages are much better.Answer:AExplanation:A)CORRECT. Finding objective, unbiased, evidence-based research that validates theclaims of the special bandage is the only way to actually prove that the specialbandages are superior.B)INCORRECT. Literature from the manufacturer is designed to sell the bandagesand will only present the positives of the bandages without any negativeinformation.C)INCORRECT. Product testing of the bandages is a good idea to determine how thebandages will work for that particular service, but does not provide proof that theyare actually better.D)INCORRECT. Firsthand accounts or anecdotal information do not provide anyactual scientific proof that the special bandages are superior.32)You respond to a 35-year-old male patient who fell 50 feet from a bluff. Your authority to provideemergency care is an extension of the Medical Director's license to practice medicine. You are actingas a(n) ________ of the Medical Director.32)A)designated agentB)subordinateC)employeeD)extensionAnswer:AExplanation:A)CORRECT. An EMT at a basic or advanced level is operating as a designated agentof the Medical Director.B)INCORRECT. Being a subordinate of the Medical Director does not provide anyauthority to provide emergency care.C)INCORRECT. An EMS system's Medical Director does not directly employ EMTs,and simply being an employee does not provide the authority to provide care.D)INCORRECT. An EMT does not provide care as an extension of the MedicalDirector.12

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33)Why is it important for EMTs to participate in quality improvement programs?33)A)To identify problems and develop a plan to prevent their recurrenceB)To ensure that individuals making false calls for EMS are prosecutedC)To identify problem employees and create a corrective action planD)To ensure adequate personnel are available for emergenciesAnswer:AExplanation:A)CORRECT. EMS quality improvement programs consist of continuous self-reviewwith the purpose of identifying aspects of the system that require improvement.Once a problem is identified, a plan is developed and implemented to preventfurther occurrences of the same problem. It is critical that EMTs participate in thisprocess because they usually have the best visibility to challenges within thesystem and can provide valuable insight into how to improve.B)INCORRECT. The aim of any EMS quality improvement program is to continuallyimprove the care and operations within the system — not to identify challengeswith particular individuals in the community. EMTs play a critical part in qualityimprovement by identifying areas in need of improvement, participating in theimprovement process and supporting the changes.C)INCORRECT. EMTs should participate in Quality Improvement (QI) programs toassist in bettering their EMS systems and processes, not to pinpoint and createaction plans for specific individuals.D)INCORRECT. An EMT's participation in an EMS quality improvement program isnot necessarily about adequate staffing. It is about the EMT helping to identify andfixanycomponents in the system that cause inefficiencies and challenges to patientcare.34)You and another new EMT are studying your local protocols. The other EMT notices that you maygive oral glucose without utilizing on-line medical control, but you must get an on-line order froma physician before assisting a patient in taking his nitroglycerin for chest pain. The EMT asks youwhy some drugs require on-line medical control while others do not. What is the best answer togive him?34)A)Glucose is only sugar so it cannot hurt the patient.B)The physician does not trust EMTs.C)The physician wants to be sure it is appropriate for the patient.D)The patient's nitroglycerin might be expired.Answer:CExplanation:A)INCORRECT. Although glucose is sugar and relatively safe, it can be harmful ifgiven to an unresponsive patient. But ultimately, this answer does not explain whynot to give nitroglycerin without a physician's order.B)INCORRECT. The reason protocols are written is not because physicians do nottrust EMTs; they are written because EMTs do not have the advanced training thatphysicians have.C)CORRECT. Nitroglycerin, although indicated for most chest pain patients, is notappropriate for all cardiac patients. The physician, with his advanced training, isbetter suited to make that determination.D)INCORRECT. Although medications may be expired, this does not requirecontacting medical control to confirm.13

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35)What has the modern emergency medical services (EMS) system been developed to provide?35)A)Prompt emergency responseB)Prehospital careC)Safe emergency transportationD)Trained medical personnelAnswer:BExplanation:A)INCORRECT. Prompt responses are an important part of any EMS system, but notwhat they were specifically developed to provide.B)CORRECT. In 1966 the National Highway Safety Act charged the United StatesDepartment of Transportation (DOT) with assisting the states in upgrading thequality of their prehospital emergency care.C)INCORRECT. Safe emergency transportation is only part of what modern EMSsystems were developed for.D)INCORRECT. Modern EMS systems were designed to provide more than justtrained medical personnel.36)A written authorization for an EMS provider to perform a particular skill in a specific situation isa(n):36)A)standard of care.B)standing order.C)on-line protocol.D)direct medical order.Answer:BExplanation:A)INCORRECT. Standard of care refers to the expected actions of an EMT ascompared to a reasonable person with the same level of training and in the samesituation. It is not related to the authorization of specific skills.B)CORRECT. A standing order is a policy or protocol issued by a Medical Directorthat authorizes EMTs and others to perform particular skills in certain situations.C)INCORRECT. Any "on-line" direction indicates a verbal order from a physician toan EMT, usually by phone or radio.D)INCORRECT. A direct medical order would generally come from a physician in aspecific situation and is considered "on-line" direction.14

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37)Which of the following BEST describes the purpose of the modern emergency medical services(EMS) system?37)A)To have trained personnel knowledgeable in all aspects of prehospital careB)To have trained personnel respond quickly and provide emergency care on the scene, duringtransport, and at the hospitalC)To have trained personnel understand the limitations of their training and "do no harm,"while providing prompt transport to the hospitalD)To have trained personnel capable of assessing and caring for injured and ill patients on thesceneAnswer:BExplanation:A)INCORRECT. Although knowledge is an important aspect of an emergency careprovider's job, the modern Emergency Medical Services (EMS) system wasspecifically developed to get trained personnel to patients as quickly as possibleand to provide emergency care on the scene, en route to the hospital, and at thehospital until care is assumed by the hospital staff.B)CORRECT. The modern Emergency Medical Services (EMS) system has beendeveloped to get trained personnel to patients as quickly as possible and toprovide emergency care on the scene, en route to the hospital, and at the hospitaluntil care is assumed by the hospital staff.C)INCORRECT. Although understanding limitations and doing "no harm" areimportant aspects of an emergency care provider's job, the modern EmergencyMedical Services (EMS) system was developed to get trained personnel to patientsas quickly as possible and to provide emergency care on the scene, en route to thehospital, and at the hospital until care is assumed by the hospital staff.D)INCORRECT. In addition to having trained personnel able to help patients onscene, the modern Emergency Medical Services (EMS) system also aims to providethat same assistance while en route to the hospital and at the hospital until hospitalstaff can take over care.38)Who assumes the ultimate responsibility for patient care rendered by the EMT?38)A)Director of quality assuranceB)EMTC)Medical DirectorD)EMS supervisorAnswer:CExplanation:A)INCORRECT. In every EMS service or agency, the Medical Director is ultimatelyresponsible for the patient care provided by the EMTs.B)INCORRECT. Since every EMT operates under the license of the EMS service'sMedical Director it is the Medical Director,not the EMT, who is ultimatelyresponsible for the patient care.C)CORRECT. The Medical Director of an EMS agency or service is ultimatelyresponsible for all patient care because the EMTs work under the MedicalDirector's license.D)INCORRECT. Although an EMS supervisor can be involved, the EMS service'sMedical Director assumes ultimate responsibility for the care provided by an EMT.15

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39)Which of the following groups is credited with developing the earliest documented emergencymedical service?39)A)The SpanishB)The FrenchC)The MayansD)The EgyptiansAnswer:BExplanation:A)INCORRECT. The Spanish did not develop the first documented emergencymedical service; the French did in the 1700s.B)CORRECT. The earliest documented emergency medical service was in 1790 whenthe French began transporting wounded soldiers from the scenes of battle towaiting physicians.C)INCORRECT. The earliest documented emergency medical service was in Francein 1790, nearly a thousand years after the Mayan civilization disappeared.D)INCORRECT. Although known for progress in technical areas, the Egyptians werenot responsible for the first documented emergency medical service. In 1790, theFrench first began transporting wounded soldiers away from battlefields and towaiting medical care.40)Centralized coordination of emergency medical access, transportation, and care most refers towhich of the following?40)A)Resource managementB)Central deploymentC)Emergency preparedness planD)Trauma systemAnswer:AExplanation:A)CORRECT. Resource management refers to the centralized coordination of anemergency response so that all victims have equal access to basic emergency careand are transported by certified personnel, in a licensed and equipped ambulance,to an appropriate facility.B)INCORRECT. The centralized coordination of emergency medical access,transportation, and care within an EMS system is not referred to as centraldeployment.C)INCORRECT. Emergency preparedness plans are usually developed to guide theactions of a specific group of people at the outset of an emergency, with the goal ofprotecting people and/or property. They generally will not address the specifics ofmedical care or transport.D)INCORRECT. A trauma system is an organized, coordinated effort betweenfacilities and responders within a defined geographic area to deliver a full range ofcare to injured patients. It does not address the coordination of basic (non-trauma)emergency care or transportation.41)Which of the following best describes training that supplements the EMT's original training andthat is usually taken in regular intervals?41)A)RecertificationB)EMT training programC)Distance educationD)Continuing educationAnswer:DExplanation:A)INCORRECT. Recertification refers to the renewal of an EMT certificate, notspecifically to regular ongoing training.B)INCORRECT. An EMT training program is the initial certification course, not thesupplemental training that follows it.C)INCORRECT. Distance education refers to thewaytraining or courses aredelivered, not specifically to the topic.D)CORRECT. Ongoing education that supplements an EMT's original training iscalled Continuing Education (CE).16

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Answer KeyTestname: C11)A2)D3)D4)D5)A6)B7)B8)A9)D10)C11)B12)D13)A14)C15)A16)B17)C18)B19)C20)A21)C22)B23)B24)B25)A26)B27)D28)D29)C30)A31)A32)A33)A34)C35)B36)B37)B38)C39)B40)A41)D17

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ExamName___________________________________MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.1)Which of the following does NOT occur during inspiration?1)A)Chest cavity increases in sizeB)Intercostal muscles contractC)Diaphragm lowersD)Diaphragm relaxesAnswer:DExplanation:A)INCORRECT. During inhalation, the ribs move upward and outward; theexpanding size of the chest cavity then causes air to flow into the lungs.B)INCORRECT. During the process of inspiration, the intercostal muscles contract.C)INCORRECT. The diaphragm lowers during inspiration.D)CORRECT. The diaphragm does not relax during inspiration; it contracts toexpand the size of the chest cavity.2)Which of the following is the most proper dose of inhaled medication the EMT can assist thepatient with administering?2)A)One sprayB)As needed until respiratory status improvesC)The number of sprays directed by medical controlD)Two spraysAnswer:CExplanation:A)INCORRECT. Each patient situation is different, and one spray may not beadequate.B)INCORRECT. Sometimes the inhaled medication will not be effective, andcontinuing to administer it indefinitely is not proper patient care.C)CORRECT. EMTs should always follow medical direction (whether verbal orwritten in standing orders) when assisting patients with inhaled medication.D)INCORRECT. Two sprays may work with some patients but not with others.3)In which of the following circumstances is medical direction necessary when assisting a patientwith the use of a prescribed inhaler?3)A)Patient has already overused the inhaler before your arrival.B)Medical control is not necessary since assistance with inhaled medications is in the EMTscope of practice.C)Medical control is necessary in all situations in which an EMT assists with a prescribedinhaler.D)The inhaler belongs to another family member, not the patient.Answer:CExplanation:A)INCORRECT. Patient use of the inhaler prior to EMS arrival does not negate therequirement for medical direction before assisting the patient with using it again.B)INCORRECT. Assisting a patient with a prescribed inhaler without medicaldirection is not within an EMT's scope of practice.C)CORRECT. EMTs will need to get permission from medical direction beforehelping any patient use an inhaler. This can be accomplished by phone/radio or bystanding order, depending on local protocols.D)INCORRECT. An inhaler prescribed to someone other than the patient shoulddefinitely not be administered without specific medical direction.1

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4)Your patient is a 15-year-old male with a history of multiple prior hospitalizations for asthma.Upon your arrival the patient responds only to painful stimuli and is making very weakrespiratory effort. Which of the following should you do next?4)A)Contact medical control.B)Assist the patient's ventilations with a bag-valve-mask device and supplemental oxygen.C)Assist the patient with his inhaler.D)Check the patient's oxygen saturation level.Answer:BExplanation:A)INCORRECT. There is no specific reason to contact medical control, and delayingcare would be detrimental.B)CORRECT. This patient needs immediate ventilatory assistance with supplementaloxygen.C)INCORRECT. It would be ineffective to help an unresponsive, inadequatelybreathing patient with an inhaler.D)INCORRECT. Obtaining a pulse oximetry reading on this patient would not be apriority.5)Your patient is a 24-year-old woman with asthma who is struggling to breathe and is veryagitated. She has cyanosis of her lips and nail beds, and is cool and clammy to the touch. When youattempt to assist her ventilations with a bag-valve-mask device, she becomes combative andrepeatedly pushes the mask away from her face. Which of the following is the BEST option?5)A)Use a nasal cannula to administer supplemental oxygen.B)Wait for the patient's level of consciousness to decrease so that she can no longer resist yourattempts to ventilate.C)Have your partner restrain the patient's hands so you can ventilate her.D)Begin transport immediately and contact medical control for advice.Answer:DExplanation:A)INCORRECT. Although better than no supplemental oxygen, applying a nasalcannula to this patient is not the EMT's best option.B)INCORRECT. Allowing a patient to become unresponsive before providing care isdangerous and not appropriate care.C)INCORRECT. Restraining a patient to provide ventilations is never appropriate.D)CORRECT. In the rare circumstance when a patient with inadequate breathing isconscious enough to fight artificial ventilation, transport immediately and consultmedical direction.2

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6)While assessing the airway of a pediatric patient, you will notice that it is different than that of anadult. Which of the following is one of those differences?6)A)The chest wall is softer, making it easier for the chest to expand.B)The tongue is smaller, taking up less room in the mouth and allowing larger objects toocclude the airway.C)The cricoid cartilage is less developed, reducing the possibility that it can be completelyoccluded.D)The trachea is smaller, softer, and more flexible, allowing it to be more easily obstructed.Answer:DExplanation:A)INCORRECT. With the pediatric chest wall being softer and weaker than anadult's, chest expansion can be more difficult which is why children depend moreon the diaphragm for breathing.B)INCORRECT. A child's tongue is proportionally larger than that of an adult.C)INCORRECT. The underdeveloped parts of a pediatric airway generally increasethe chances of occlusion.D)CORRECT. A pediatric patient's trachea is softer and more flexible than that of anadult, making proper airway positioning critical; bending the pediatric trachea toomuch can result in collapse and will obstruct breathing.7)What condition is when there is an infection in one or both lungs caused by bacteria, viruses, orfungi?7)A)PneumoniaB)Pulmonary embolismC)Pulmonary edemaD)AsthmaAnswer:AExplanation:A)CORRECT. Pneumonia is an infection of one or both lungs caused by bacteria,viruses, or fungi.B)INCORRECT. A pulmonary embolism is when a blood clot, air, or fat gets stuck inthe blood vessels and blocks and artery in the lungs.C)INCORRECT. Pulmonary edema is when fluid accumulates in the lungs,preventing them from breathing adequately.D)INCORRECT. Asthma is a chronic disease that has episodic exacerbation or flares.During an asthma attack, the small bronchioles that lead to the air sacs of the lungsbecome narrowed because of contractions of the muscles that make up the airway.8)While caring for a 3-year-old child, you should be concerned if his respiratory rate exceeds________ breaths per minute.8)A)16B)30C)20D)24Answer:BExplanation:A)INCORRECT. A 3-year-old child is breathing normally if the rate is above 16 perminute.B)CORRECT. If a 3-year-old patient is breathing faster than 30 times per minute,there would be reason for concern.C)INCORRECT. It is normal for toddlers to breathe faster than 20 times per minute.D)INCORRECT. A 3-year-old patient with a respiratory rate of 24 or even a littlehigher would not necessarily be reason for concern.3

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9)You are responding to a 54-year-old female patient in respiratory distress. The patient is on homeoxygen by nasal cannula at 1 lpm. The patient has diminished lung sounds bilaterally withwheezes. She appears malnourished and has a barrel chest. What condition do you suspect?9)A)Congestive heart failureB)AsthmaC)Chronic obstructive pulmonary diseaseD)BronchitisAnswer:CExplanation:A)INCORRECT. Congestive heart failure would have crackles (rales) or some form ofwet lung sounds.B)INCORRECT. Asthma patients do not have barrel chests and are usually not onhome oxygen.C)CORRECT. Home oxygen administration and barrel chests are the classic signs ofemphysema, which is one disease in the COPD classification. Patients withexacerbation of COPD have lung sounds that are diminished and/or have wheezes.D)INCORRECT. Bronchitis is an acute infection that presents with green-oryellow-tinged phlegm and fever.10)Which of the following istrueconcerning expiration?10)A)The chest cavity increases in size.B)The intercostal muscles contract to force air out of the lungs.C)The diaphragm moves upward.D)The ribs move upward and outward.Answer:CExplanation:A)INCORRECT. Expiration occurs when the chest cavity gets smaller.B)INCORRECT. When the intercostal muscles contract, air is pulled into the lungs.C)CORRECT. The diaphragm contracts and moves downward during inspirationand upward during expiration.D)INCORRECT. The ribs move upward and outward duringinspiration.11)You are ventilating a 6-year-old child and note that his heart rate has decreased from 70 to 54.Which of the following is NOT appropriate?11)A)Check the flow of oxygen reaching the bag-valve-mask device.B)Increase the force of ventilations.C)Insert an oropharyngeal airway and continue ventilating.D)Notify medical control that the patient's condition has improved.Answer:DExplanation:A)INCORRECT. Since the response to ventilation is inadequate, it would beappropriate to reassess the equipment to see if something is not working correctly.B)INCORRECT. This patient is obviously not getting adequate respirations;increasing the force of ventilations may help.C)INCORRECT. Since the ventilations are not adequate, better airway managementmay improve the outcome.D)CORRECT. A decreasing heart rate while ventilating a pediatric patient is actuallya deterioration of the patient's condition.4

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12)The EMTs should provide patients with viral respiratory infections:12)A)antibiotics.B)a prescribed inhaler.C)a small-volume nebulizer.D)oxygen.Answer:DExplanation:A)INCORRECT. Because a viral respiratory infection is viral so antibiotics do nothelp and should not be given. In fact, giving this type of patient antibiotics couldactually make things worse by promoting antibiotic resistance.B)INCORRECT. A prescribed inhaler is given to a patient with asthma, not a viralrespiratory infection.C)INCORRECT. A small-volume nebulizer is given to a patient with asthma, not aviral respiratory infection.D)CORRECT. The EMT should administer oxygen to this patient and care for thepatient as with any other patient with respiratory distress.13)Which of the following sounds may be heard in lower respiratory obstruction?13)A)SnoringB)WheezingC)CrowingD)StridorAnswer:BExplanation:A)INCORRECT. Upper airway obstructions, usually due to the tongue or other tissuewill cause snoring respirations.B)CORRECT. Wheezes are high-pitched sounds created by air moving throughnarrowed passages in the lower airway.C)INCORRECT. Crowing sounds are associated with upper airway obstructions.D)INCORRECT. Stridor is described as a harsh, high-pitched breath sound which isusually caused by an upper airway problem.14)When should the EMT most likely expect to hear wheezes in a patient complaining of shortness ofbreath secondary to an asthma attack?14)A)In between breathsB)While holding his breathC)While breathing inD)While breathing outAnswer:DExplanation:A)INCORRECT. There is generally never a sound heard between breaths.B)INCORRECT. If there is no movement of air in the lower airway, no wheezeswould be present.C)INCORRECT. When auscultating an asthma patient, wheezes are not commonlyheard during inspiration.D)CORRECT. Asthma emergencies usually cause patients to struggle when exhaling,which is often accompanied by wheezing sounds.5

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15)You are called to the scene of a 45-year-old nonsmoker male with a history of asthma inrespiratory distress. You find him lying supine on the couch. The patient is lethargic but cananswer all your questions appropriately. He is diaphoretic, and complains of being cold, coughing,and having difficulty breathing for the past 3 days. His vital signs are blood pressure of 110/70,heart rate of 116, respiratory rate of 24, oxygen saturation of 93%, and temperature of 100.6°F. Youhear rhonchi in the left lobes and he is coughing up yellow-tinged sputum. What condition do yoususpect?15)A)AsthmaB)PneumoniaC)COPDD)Silent myocardial infarctionAnswer:BExplanation:A)INCORRECT. Rhonchi lung sounds are not indicative of asthma.B)CORRECT. Pneumonia has rhonchi lung sounds that can be one-sided or bilateralwith fever, and yellow-or green-tinged sputum.C)INCORRECT. Chronic bronchitis is a form of COPD with similar symptoms;however, the patient has no COPD history and he is not a smoker. The symptomsare also acute, beginning only 3 days ago versus a chronic etiology.D)INCORRECT. Myocardial infarction patients generally do not have fever oryellow-tinged phlegm. Abnormal lung sounds with heart failure from amyocardial infarction will usually be crackles (rales) that are audible on both sides.16)A patient who has shallow, slow, irregular gasping breaths is said to have ________ respirations.16)A)agonalB)Kussmaul'sC)central neurogenicD)Cheyne-StokesAnswer:AExplanation:A)CORRECT. The shallow, slow, and irregular gasps that occur just beforerespiratory arrest are referred to as agonal respirations.B)INCORRECT. Kussmaul's respirations are related to conditions such as diabeticketoacidosis (DKA) and present as deep and labored breaths.C)INCORRECT. Central neurogenic respirations are a type of hyperventilationrelated to reduced carbon dioxide levels.D)INCORRECT. Cheyne-Stokes respirations follow a repeating pattern of deep, fastbreaths followed by slow, shallow breaths.17)Which of the following respiratory rates should be cause for alarm in a 2-month-old child?17)A)32 breaths/minB)40 breaths/minC)28 breaths/minD)16 breaths/minAnswer:DExplanation:A)INCORRECT. A respiratory rate of 32 would be in the normal range for a2-month-old patient.B)INCORRECT. Although it seems rapid, a respiratory rate of 40 in an infant patientwould be considered normal.C)INCORRECT. Infants normally breathe faster than adults; 28 breaths per minutewould not be abnormal.D)CORRECT. 16 breaths per minute would be too slow for a normal infant.6

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18)Which of the following BEST defines inadequate breathing?18)A)Wheezing noises when breathingB)Breathing faster than normalC)Breathing that is insufficient to sustain lifeD)Breathing slower than normalAnswer:CExplanation:A)INCORRECT. The best definition of inadequate breathing is not related to thebreath sounds.B)INCORRECT. A patient that is breathing faster than a normal rate is notnecessarily breathing inadequately.C)CORRECT. Inadequate breathing is best defined as breathing that is insufficient tosustain life.D)INCORRECT. The speed of a patient's breathing relates to the adequacy ofrespiration, but it does not define it.19)Which of the following is a benefit of using small-volume nebulizers for the treatment ofrespiratory problems?19)A)The patient can easily carry this equipment in a purse or pocket.B)Nebulized medications have fewer side effects than aerosolized medications from an inhaler.C)They will work even when the patient's ventilations are inadequate.D)They allow greater exposure of the patient's lungs to the medication.Answer:DExplanation:A)INCORRECT. Small-volume nebulizers are not as conveniently carried as inhalers;they require the assembly of several pieces, liquid medication, and an oxygensource.B)INCORRECT. The medication is essentially the same and will produce the sameside effects.C)INCORRECT. Nebulizers still depend on the patient being able to effectivelyinhale the medication.D)CORRECT. Nebulizers produce a constant flow of medication that the patient canbreathe over the span of several minutes, introducing more medication into thepatient's lungs.20)Your patient is a 60-year-old female with a sudden onset of severe difficulty breathing. She has noprior history of respiratory problems. Which of the following should be done before applyingoxygen by nonrebreather mask?20)A)Listen to the patient's breath sounds.B)Check the patient's oxygen saturation level.C)Obtain a history of the present illness.D)None of the aboveAnswer:DExplanation:A)INCORRECT. Withholding oxygen to listen to this patient's breath sounds wouldserve no purpose.B)INCORRECT. There would be no benefit to the patient or the EMT by obtaining apulse oximeter reading before providing oxygen.C)INCORRECT. Obtaining the patient's history before providing oxygen would bepoor patient care.D)CORRECT. None of the options provided would be more important thanproviding high-concentration oxygen to this patient.7

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21)What is the primary effect on the body when an EMT assists a patient with a prescribed inhaler ifthe patient is short of breath?21)A)Increased contraction of the diaphragmB)Relaxation of the bronchiolesC)Dissolved mucus in the airwaysD)Decreased heart rateAnswer:BExplanation:A)INCORRECT. A prescribed inhaler will not directly cause more contractions of thepatient's diaphragm.B)CORRECT. The inhalers contain a drug that dilates, or enlarges, the air passages,making breathing easier.C)INCORRECT. Inhalers do not dissolve mucus.D)INCORRECT. The primary effect of a prescribed inhaler is not a decrease in heartrate, although it may be a secondary effect.22)What is NOT one of the symptoms of a pulmonary embolus?22)A)sudden onset of sharp chest painB)anxietyC)pain and swelling in one or both legsD)sudden calmnessAnswer:DExplanation:A)INCORRECT. A typical patient experiencing signs and symptoms of a pulmonaryembolus will have a sudden onset of sharp chest pain.B)INCORRECT. A typical patient experiencing signs and symptoms of a pulmonaryembolus will be anxious.C)INCORRECT. A typical patient experiencing signs and symptoms of a pulmonaryembolus will have pain and swelling in one or both legs.D)CORRECT. While the signs and symptoms of a patient experiencing a pulmonaryembolus are extremely varied, the patient is not likely to be calm but insteadexperiencing anxiety.23)Which of the following is proper when assisting a patient with the use of a prescribed inhaler?23)A)Do not use the patient's inhaler, because you do not know how the medication has beenstored.B)Make sure that the inhaler has been kept in the refrigerator.C)Have the patient inhale deeply before delivering the spray.D)Have the patient hold the inhaled medication in his lungs as long as possible.Answer:DExplanation:A)INCORRECT. If the inhaler has been prescribed to the patient, appears to be ingood working order, and the patient is having difficulty breathing, there is nogood reason to withhold it.B)INCORRECT. Inhalers should be stored and used at room temperature.C)INCORRECT. The patient should be instructed to exhale fully just before using theinhaler.D)CORRECT. After the patient inhales, make sure he holds his breath as long aspossible so the medication can be absorbed.8

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24)Which of the following patients with difficulty breathing should NOT receive supplementaloxygen?24)A)An infant whose eyes may be damaged by excessive oxygen administrationB)A patient whose oxygen saturation level is 100% on room airC)A patient with a chronic lung disease who may have a hypoxic driveD)None of these patients should have oxygen withheld.Answer:DExplanation:A)INCORRECT. Oxygen administration in the relatively brief time that an EMT willbe caring for a patient will not cause ocular damage to an infant.B)INCORRECT. If the patient is having difficulty breathing, oxygen should beapplied regardless of the pulse oximeter reading.C)INCORRECT. A COPD patient with a hypoxic drive will generally only havetrouble with supplemental oxygen over an extended time period, such as during ahospital stay. In the prehospital setting, standard oxygen therapy should never bewithheld from COPD patients.D)CORRECT. None of the options provided describe a situation where supplementaloxygen would be contraindicated.25)Which of the following is a sign of adequate artificial ventilations in a pediatric patient?25)A)Pulse rate slows down.B)Pulse rate increases.C)You notice cyanosis developing around the mouth.D)The breath is delivered easily.Answer:BExplanation:A)INCORRECT. A slowing pulse rate is a good sign when ventilating an adultpatient, but not a pediatric one.B)CORRECT. Pediatric patients often quickly develop bradycardia with respiratoryfailure, so adequate ventilations will actually increase the pulse rate.C)INCORRECT. The development of cyanosis is a definite indicator that ventilationsare not adequate.D)INCORRECT. The mechanical ease of ventilations is unrelated to the adequacy ofthem.26)Your patient is a 30-year-old female who may have overdosed on antidepressant medications. Onyour arrival, she is lying supine on her bed with her head on a pillow. She is unresponsive topainful stimuli and is snoring. She appears to be pale and her skin is cool and clammy. Whatshould you do first?26)A)Apply oxygen by nonrebreather mask.B)Check the patient's pulse.C)Insert an oropharyngeal airway.D)Remove the patient's pillow.Answer:DExplanation:A)INCORRECT. Although the patient may benefit from supplemental oxygen,providing it would not be the first priority in this situation.B)INCORRECT. Although the patient is unresponsive, it is apparent that she still hascirculation; it would serve no purpose to check her pulse as the first step.C)INCORRECT. This unresponsive patient does require airway management, butinserting an OPA would not be the first step.D)CORRECT. The patient's snoring respirations indicate an occluded airway.Removing the pillow and opening her airway using a head-tilt, chin-lift would bethe first priorities.9

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27)Today patients with cystic fibrosis are surviving to:27)A)toddler years.B)infancy.C)older adulthood.D)adulthood.Answer:DExplanation:A)INCORRECT. Most cystic fibrosis patients are young, but they can typically livebeyond being a toddler.B)INCORRECT. Most cystic fibrosis patients are young, but they can typically livebeyond being an infant.C)INCORRECT. While patients with cystic fibrosis, on average they are not living tobe an older adult.D)CORRECT. Although most patients with cystic fibrosis are children, many of thesepatients are now surviving to adulthood, something that was almost unheard of ageneration ago.28)You are first on the scene of a 61-year-old female in need of assistance with her respirations. Youhave a pocket mask with supplemental oxygen. How can you determine that your artificialventilation is effective?28)A)Patient's pulse returns to normal.B)You assure oxygen is being delivered at 15 liters per minute.C)You are assisting respirations at 10 breaths per minute.D)Patient's skin color remains the same.Answer:AExplanation:A)CORRECT. When artificial ventilation is performed properly, the patient's heartrate will return to normal.B)INCORRECT. The efficacy of assisted ventilations is not determined by the oxygenflow rate.C)INCORRECT. When providing an adult patient with artificial ventilation, the EMTshould maintain a rate of 12 breaths per minute.D)INCORRECT. If a cyanotic patient's skin color does not improve, it indicatesinadequate ventilation.29)Your patient is a 6-year-old male who appears very anxious, is using increased effort duringexpiration, and has a fever. He is wheezing and has a respiratory rate of 34. The patient's skin isvery warm and dry. He does not have any cyanosis. The child is drooling and his mother states thathe complained of a sore throat and pain on swallowing earlier in the afternoon. Which of thefollowing conditions is most likely causing the patient's distress?29)A)COPDB)EpiglottitisC)PneumoniaD)Cystic fibrosisAnswer:BExplanation:A)INCORRECT. COPD will not generally develop in pediatric patients and thecondition described in the scenario is acute, not chronic.B)CORRECT. This patient's presentation (especially the drooling) should make theresponding EMT suspect epiglottitis.C)INCORRECT. Other than respiratory difficulty, this patient is exhibiting none ofthe signs and symptoms of pneumonia.D)INCORRECT. This patient is not displaying the signs and symptoms of cysticfibrosis.10

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30)A ________ device works by blowing oxygen or air continuously at a low pressure to prevent apatient's alveoli from collapsing.30)A)COPD (Chronic Obstructive Pulmonary Disease)B)CPAP (Continuous Positive Airway Pressure)C)NonrebreatherD)FROPVD (Flow-Restricted, Oxygen Powered Ventilation Device)Answer:BExplanation:A)INCORRECT. COPD is a medical condition, not a device.B)CORRECT. A CPAP device works by blowing oxygen or air continuously at a lowpressure into the airway, which prevents the alveoli from collapsing at the end ofexhalation, and it can also push fluid out of the alveoli back into the capillaries thatsurround them.C)INCORRECT. A nonrebreather mask does deliver oxygen, but it does not createenough pressure to affect the alveoli.D)INCORRECT. A Flow-Restricted, Oxygen-Powered Ventilation Device (FROPVD)does force oxygen into the patient's lungs when triggered, but not continuously.31)Which of the following is the primary cause of COPD?31)A)InfectionB)Congenital diseasesC)Air pollutionD)Cigarette smokingAnswer:DExplanation:A)INCORRECT. Repeated respiratory infections can sometimes lead to COPD, butthis is not common.B)INCORRECT. Congenital diseases will not commonly lead to COPD.C)INCORRECT. Although extended exposure to air pollution can cause COPD, it isnot the primary cause.D)CORRECT. Cigarette smoking causes the overwhelming majority of COPD cases.32)You are on the scene of a 3-year-old patient who is in respiratory distress. The mother states thatthe patient has been making a barking cough for the past 24 hours. The child is very scared andupset. He is crying inconsolably. The patient has tachypnea, but his vital signs are normalotherwise. He is leaning forward in the tripod position and is drooling profusely. What conditiondo you suspect?32)A)Strep throatB)CroupC)EpiglottitisD)Child abuseAnswer:CExplanation:A)INCORRECT. Strep throat usually presents as a sore throat and rarely presentswith a high-pitched stridorous cough or with profound drooling.B)INCORRECT. Although croup is known for a high-pitched stridorous cough,profound drooling is not commonly present.C)CORRECT. Profound drooling is the hallmark of epiglottitis.D)INCORRECT. The patient is febrile, which indicates an infection. This, along withno clinical signs of abuse, indicates that child abuse is highly unlikely.11

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33)When the lung collapses without injury or any other cause, it is called which of the following?33)A)Spontaneous pertussisB)Spontaneous pulmonary embolismC)Spontaneous pneumothoraxD)COPDAnswer:CExplanation:A)INCORRECT. Pertussis, or whooping cough, is unrelated to a spontaneous lungcollapse.B)INCORRECT. When something that is not blood becomes lodged in a pulmonaryblood vessel, it is called a pulmonary embolism; lung collapse is unrelated.C)CORRECT. When a lung collapses without injury or any other obvious cause, it iscalled a spontaneous pneumothorax.D)INCORRECT. Chronic obstructive pulmonary disease (COPD) does not refer alung collapse.34)You are on the scene of a 5-year-old patient who is in respiratory distress. The mother states thatthe patient has been making a "seal bark"-sounding cough for the past 24 hours. The child is veryscared. The patient has stable vital signs. He is leaning forward in the tripod position and isdrooling profusely. After performing your primary assessment, what is your best treatment option?34)A)Provide oxygen by BVM.B)Use a tongue depressor to examine the patient's mouth to determine whether the patient hasstrep throat or croup.C)Provide high-concentration oxygen and have the parent hold it to the patient's face.D)Calm the child as much as possible and provide oxygen by blow-by.Answer:DExplanation:A)INCORRECT. Positive pressure ventilations are not indicated in this situation, andattempting it could cause additional swelling.B)INCORRECT. Any use of a tongue depressor is contraindicated as it could increaseswelling to the point the airway occludes completely.C)INCORRECT. Holding an oxygen mask to a child's face can greatly upset a childand make the swelling worse.D)CORRECT. A patient with epiglottitis should be kept as calm as possible to preventadditional swelling of the epiglottis; provide supplemental oxygen by blow-by ifpossible.35)When ventilating a child with inadequate respirations, which of the following is the maximum rateat which artificial respirations should be delivered?35)A)12 per minuteB)24 per minuteC)20 per minuteD)15 per minuteAnswer:CExplanation:A)INCORRECT. 12 ventilations per minute is not the maximum rate for a pediatricpatient.B)INCORRECT. A ventilation rate of 24 per minute is actually higher than themaximum rate for a child.C)CORRECT. The adequate rate for artificial ventilation is 12 breaths per minute foradults and 20 per minute for infants and children. Never hyperventilate a patientwithout specific medical direction.D)INCORRECT. Ventilations can be delivered to a child at a faster rate than 15 perminute.12

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36)You are on the scene of a person down. You arrive at a college dormitory and find a 21-year-oldpatient lying supine on the floor, unresponsive. The patient is "guppy" breathing at 5 times aminute, has a strong radial pulse at 110 beats per minute, and has vomited on himself. Friends statethey went out to dinner and a party. They returned to change clothes for another party and henever came out of his room. Your partner suctions the patient, inserts an oropharyngeal airway,and ventilates the patient with a bag-valve mask with high-concentration oxygen. You listen tolung sounds and there are coarse rhonchi bilaterally. What condition do you suspect?36)A)Severe meningitisB)Status asthmaticusC)AspirationD)OverdoseAnswer:CExplanation:A)INCORRECT. Rhonchi would not be auscultated in a patient with meningitis.B)INCORRECT. Status asthmaticus does not present with rhonchi.C)CORRECT. Unresponsive supine patients often aspirate emesis because they canno longer protect their airway. Aspirated emesis presents as rhonchi uponauscultation.D)INCORRECT. Overdose is a possibility, but there is no information in the questionto confirm or deny the diagnosis.37)Which of the following respiratory rates is considered an abnormal respiratory rate for an adult?37)A)12 breaths/minB)8 breaths/minC)16 breaths/minD)20 breaths/minAnswer:BExplanation:A)INCORRECT. A respiratory rate of 12 would be considered normal for most adults.B)CORRECT. An adult patient breathing 8 times per minute is most likely notbreathing adequately.C)INCORRECT. 16 breaths per minute would not be abnormal for an average adult.D)INCORRECT. 20 breaths per minute is at the higher end of what rate is considerednormal for an adult patient.38)When you hear wheezes while auscultating your patient's breath sounds, which of the following ismost likely the cause?38)A)There is mucus in the air passages.B)The lower air passages in the lungs are narrowed.C)There is an upper airway obstruction.D)There is fluid in the lungs.Answer:BExplanation:A)INCORRECT. Mucus in the air passages will cause rhonchi or cracklesrather thanwheezing.B)CORRECT. Wheezes are high-pitched sounds created by air moving throughnarrowed air passages in the lungs.C)INCORRECT. An upper airway obstruction will not commonly result in wheezeswhen auscultating lung sounds.D)INCORRECT. The EMT will auscultate either bubbling or low snoring soundswhen fluid is in the lungs.13

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