Final Exam Practice Quiz

Chapters 1-12, 14-39, and 41

CHAPTER 1: EMS SYSTEMS

1. Which of the following descriptions MOST accurately portrays emergency medical services (EMS)?
A. a vast network of advanced life support (ALS) providers who provide definitive emergency care in the
prehospital setting
B. a team of health care professionals who are responsible for providing emergency care and transportation to
the sick and injured
C. a system composed exclusively of emergency medical responders (EMRs) and emergency medical
technicians (EMTs) who are responsible for providing care to sick and injured patients
D. a team of paramedics and emergency physicians who are responsible for providing emergency care to
critically injured patients

2. The standards for prehospital emergency care and the individuals who provide it are typically regulated by
the:
A. state office of EMS.
B. regional trauma center.
C. American Heart Association.
D. National Registry of EMTs.

3. An EMS provider who has extensive training in various aspects of advanced life support (ALS) is called
a(n):
A. EMT.
B. paramedic.
C. advanced EMT (AEMT).
D. EMR.

4. EMT training in nearly every state meets or exceeds the guidelines recommended by the:
A. National Registry of EMTs.
B. individual state’s EMS protocols.
C. National Association of EMTs.
D. National Highway Traffic Safety Administration (NHTSA).

5. According to the National EMS Scope of Practice Model, an EMT should be able to:
A. assist a patient with certain prescribed medications.
B. insert a peripheral intravenous (IV) line and infuse fluids.
C. administer epinephrine via the subcutaneous route.
D. interpret a basic electrocardiogram (ECG) rhythm and treat accordingly.

6. Cardiac monitoring, pharmacological interventions, and other advanced treatment skills are functions of the:
A. EMT.
B. paramedic.
C. AEMT.
D. EMR.

7. The criteria to be licensed and employed as an EMT include:

A. demonstration of the ability to lift and carry at least 200 pounds.
B. proof of immunization against certain communicable diseases.
C. a minimum of 60 college credit hours that focus on health care.
D. successful completion of a recognized bystander cardiopulmonary resuscitation (CPR) course.
8. If an EMT candidate has been convicted of a felony or misdemeanor, he or she should:
A. wait at least 24 months before taking another state-approved EMT class.
B. send an official request to the National Registry of EMT (NREMT) to seek approval to take the EMT exam.
C. recognize that any such conviction will disqualify him or her from EMT licensure.
D. contact the state EMS office and provide them with the required documentation.

9. Which of the following statements regarding the Americans With Disabilities Act (ADA) of 1990 is
correct?
A. The ADA only applies to individuals with a diagnosed and well-documented physical disability.
B. The requirements to successfully complete an EMT program are different for those who are disabled.
C. The ADA prohibits employers from failing to provide full and equal employment to the disabled.
D. According to the ADA, EMT candidates with a documented disability are exempt from taking the NREMT
exam.

10. As an EMT, you may be authorized to administer aspirin to a patient with chest pain based on:
A. the patient’s condition.
B. your local EMS protocols.
C. an order from a paramedic.
D. the transport time to the hospital.

11. According to the National EMS Scope of Practice Model, an EMT would require special permission from
the medical director and the state EMS office in order to:
A. perform blood glucose monitoring.
B. apply and interpret a pulse oximeter.
C. use an automatic transport ventilator.
D. give aspirin to a patient with chest pain.

12. Which of the following statements regarding the NREMT is correct?

A. The NREMT is a governmental agency that certifies EMTs.
B. EMS training standards are regulated by the NREMT.
C. The NREMT is the exclusive certifying body for EMTs.
D. The NREMT provides a national standard for EMS testing.

13. Which of the following scenarios does NOT involve the administration of ALS?
A. a 48-year-old patient whose airway is secured with a multilumen device
B. a 53-year-old patient who is given glucagon for significant hypoglycemia
C. a 61-year-old trauma patient whose chest is decompressed with a needle
D. a 64-year-old cardiac arrest patient who is defibrillated with an automated external defibrillator (AED)

14. Laypeople are often trained to perform all of the following skills, EXCEPT:
A. one- or two-rescuer CPR.
B. splinting of a possible fracture.
C. insertion of an oropharyngeal airway.
D. control of life-threatening bleeding.

15. Which of the following skills or interventions is included at every level of prehospital emergency training?
A. oral glucose for hypoglycemia
B. AED
C. intranasal medication administration
D. use of a manually triggered ventilator
16. EMRs such as fire fighters, law enforcement officers, and park rangers, are an integral part of the EMS
system because:
A. they are usually trained to assist paramedics with certain procedures.
B. the presence of a person trained to initiate basic life support (BLS) care cannot be ensured.
C. the average response time for the EMT crew is approximately 15 minutes.
D. they can initiate certain ALS procedures before EMS arrival.

17. Which of the following is a unique function of the emergency medical dispatcher (EMD)?
A. relaying relevant information to the EMTs
B. directing the ambulance to the correct address
C. obtaining patient information from the caller
D. providing callers with life-saving instructions

18. The ____________ deals with the well-being of the EMT, career progression, and EMT compensation.
A. human resources department
B. office of the medical director
C. EMS administrator or chief
D. local public health department

19. The person who is responsible for authorizing EMTs to perform emergency medical care in the field is the:
A. shift supervisor.
B. medical director.
C. EMS administrator.
D. field training officer.

20. Which of the following statements regarding the EMS medical director and an EMT’s scope of practice is
correct?
A. The EMS medical director can expand the EMT’s scope of practice but cannot limit it without state
approval.
B. The EMS medical director can expand or limit an individual EMT’s scope of practice without state
approval.
C. An EMT’s scope of practice is exclusively regulated by the state EMS office, not the EMS medical director.
D. An EMT’s scope of practice may be expanded by the medical director after proper training and state
approval.

21. What type of medical direction do standing orders and protocols describe?
A. radio
B. online
C. off-line
D. direct

22. The continuous quality improvement (CQI) process is designed to:

A. provide punitive action to EMTs who do not follow local protocols.
B. identify areas of improvement and provide remedial training if needed.
C. ensure that all EMTs maintain licensure through the state EMS office.
D. focus specifically on the quality of emergency care provided to the patient.

23. Which of the following errors is an example of a knowledge-based failure?

A. An EMT gives the correct drug to a patient, although his protocols clearly state that he is not authorized to
do so.
B. Due to an improperly applied cervical collar, a patient’s spinal injury is aggravated and he is permanently
disabled.
C. A patient is given nitroglycerin by an EMT who did not obtain proper authorization from medical control
first.
D. An EMT administers the wrong drug to a patient because she did not know the pertinent information about
the drug.

24. Continuing education in EMS serves to:

A. prove research and statistical findings in prehospital care.
B. maintain, update, and expand your knowledge and skills.
C. enforce mandatory attendance to agency-specific training.
D. provide an ongoing review and audit of the EMS system.

25. Obtaining continuing medical education is the responsibility of the:

A. individual EMT.
B. State Bureau of EMS.
C. EMS training officer.
D. EMS medical director.

26. Which of the following is an example of a primary prevention strategy?

A. community awareness programs that emphasize the dangers of drinking and driving
B. the construction of a guardrail on a dangerous curve following a fatal motor vehicle crash
C. protecting a patient’s spine from further injury after a fall from a significant height
D. teaching a group of new parents how to perform one- and two-rescuer infant CPR

27. The determination that prompt surgical care in the hospital is more important than performing time-
consuming procedures in the field on a major trauma patient is based MOSTLY on:
A. EMS research.
B. local protocols.
C. the lead EMT’s decision.
D. regional trauma guidelines.

28. Why are prehospital emergency care guidelines updated on a regular basis?
A. Statistical data indicate that an increasing number of people are being diagnosed with a particular illness.
B. EMS providers should be encouraged to actively participate in research and become familiar with data
analysis.
C. Additional information and evidence indicate that the effectiveness of certain interventions has changed.
D. The federal government requires that changes be made to existing emergency care protocols at least every 5
years.

29. If a defibrillator manufacturer claims that its device terminates ventricular fibrillation on the first shock 95%
of the time, you should:
A. avoid purchasing the device because this claim is unrealistic.
B. recognize that this does not mean it will save more lives.
C. purchase the device based solely on the manufacturer’s claim.
D. determine which device the American Heart Association suggests.

30. An appropriate demonstration of professionalism when your patient is frightened, demanding, or unpleasant
is to:
A. continue to be nonjudgmental, compassionate, and respectful.
B. demand the patient to be quiet and cooperative during transport.
C. ignore the patient’s feelings and focus on his or her medical complaint.
D. reassure him or her that everything will be all right, even if it will not be.

CHAPTER 2: WORKFORCE SAFETY AND WELLNESS

1. While providing care to a patient, blood got onto the ambulance stretcher. Because the stretcher was not
properly cleaned afterward, a virus was transmitted to another emergency medical technician (EMT) several
days later. What route of transmission does this scenario describe?
A. direct contact
B. indirect contact
C. airborne transmission
D. vector-borne transmission

2. Vector-borne transmission of an infectious organism occurs via:

A. animals or insects.
B. smoke or dust.
C. direct contact.
D. inanimate objects.

3. The simplest yet most effective method of preventing the spread of an infectious disease is to:
A. undergo an annual physical examination.
B. ensure that your immunizations are up-to-date.
C. wash your hands in between patient contacts.
D. undergo human immunodeficiency virus (HIV) testing at least twice a year.

4. If you use a waterless handwashing substitute in the field, it is important to:

A. wash your hands with soap and water at the hospital.
B. immediately dry your hands with a paper towel.
C. wait at least 5 minutes before touching another patient.
D. avoid donning another pair of gloves for at least 10 minutes.

5. Gloves, a mask, eye protection, and a face shield should be used:

A. any time you touch non-intact skin.
B. during routine cleaning of the ambulance.
C. while handling needles or other sharps.
D. when performing endotracheal intubation.

6. If a mask cannot be placed on a coughing patient, the Centers for Disease Control and Prevention (CDC)
recommend that you maintain a distance of at least ________ feet if possible.
A. 2
B. 3
C. 4
D. 5

7. Prescription glasses do not provide adequate eye protection because they:

A. have large rounded lenses.
B. are not secured with a strap.
C. offer little or no side protection.
D. do not have shatterproof lenses.
8. You are transporting a 40-year-old male with respiratory distress. The patient tells you that he recently had a
positive tuberculosis (TB) skin test and is currently being evaluated for possible TB. You should:
A. apply a nonrebreathing mask on the patient and a high-efficiency particulate air (HEPA) respirator on
yourself.
B. remain at least 3 feet away from the patient and apply a surgical mask on him.
C. apply a sterile surgical mask on yourself and a HEPA respirator on the patient.
D. apply a nasal cannula on the patient and a sterile surgical mask on yourself.

9. While assisting an advanced life support (ALS) ambulance crew, you are accidentally stuck with an IV
needle. You should:
A. immerse your wound in an alcohol-based solution.
B. report the incident to your supervisor after the call.
C. get immunized against hepatitis as soon as possible.
D. discontinue patient care and seek medical attention.

10. The spread of HIV and hepatitis in the health care setting can usually be traced to:
A. careless handling of sharps.
B. a lack of proper immunizations.
C. excessive blood splashing or splattering.
D. a noncompliance with standard precautions.

11. According to Occupational Safety and Health Administration (OSHA) regulations, an employer must:
A. guarantee a 100% risk-free environment prior to employment.
B. offer a workplace environment that reduces the risk for exposure.
C. provide gloves and other personal protective equipment (PPE) to full-time paid employees only.
D. screen all prospective employees for bloodborne pathogens.

12. Determination of exposure is an important component of an infection control plan because it:
A. determines the time of day that most exposures are likely to occur.
B. determines which type of communicable disease might be present in the workplace.
C. defines who is most likely to transmit communicable diseases in the workplace.
D. defines who is at risk for contact with blood and body fluids and which tasks pose a risk of exposure.

13. The hepatitis B vaccine program, a component of the infection control plan, addresses all of the following
issues, EXCEPT:
A. family history of hepatitis.
B. postvaccine antibody titers.
C. vaccine safety and efficacy.
D. record keeping and tracking.

14. The compliance monitoring component of an infection control plan should:

A. ensure that employees understand what they should do and why it is important.
B. identify who to notify after an exposure and where treatment should be provided.
C. consist of a list of tasks that pose a risk for contact with blood or other body fluids.
D. address issues such as medical waste collection, storage, and ambulance disinfection.

15. If it is not possible to adequately clean your ambulance at the hospital following a call, you should:
A. quickly wipe down all high contact surfaces with an antibacterial solution.
B. clean the ambulance at your station in a designated area that is well ventilated.
C. wait until the end of your shift and then disinfect the entire patient compartment.
D. thoroughly wash the back of the ambulance at a local car wash or similar facility.
16. When decontaminating the back of your ambulance after a call, you should:
A. allow surfaces to air dry unless otherwise indicated in the product directions.
B. use a bleach and water solution at a 1:2 dilution ratio to thoroughly wipe all surfaces.
C. clean all surfaces and patient contact areas with a mixture of alcohol and water.
D. spray the contaminated areas and then immediately wipe them dry with a towel.

17. Which of the following is the MOST significant factor in determining if a person will become ill from
certain germs?
A. age
B. race
C. gender
D. immunity

18. Which of the following statements regarding the hepatitis B vaccine is correct?
A. Vaccination against hepatitis B provides partial immunity for life.
B. OSHA requires that your employer offer you the vaccine free of charge.
C. The hepatitis B vaccine provides protection against the disease for 2 years.
D. Vaccination with the hepatitis B vaccine confers immunity against hepatitis A.

19. According to the CDC, recommended immunizations and tests include a:

A. smallpox vaccine every 5 years.
B. TB skin test every 6 months.
C. two-shot hepatitis A vaccination series.
D. tetanus-diphtheria booster every 10 years.

20. Vaccination against the hepatitis A virus is unnecessary if you:

A. are older than 35 years of age.
B. have a weak immune system.
C. have been infected in the past.
D. received a hepatitis B vaccination.

21. If a person is partially immune to a particular disease, he or she:

A. is not protected from a new infection if exposed to another individual.
B. must be revaccinated at least every 18 months to avoid infection.
C. may develop illness from germs that lie dormant from the initial infection.
D. will not experience future illness, even if his or her immune system is stressed.

22. Which of the following infectious diseases confers no protection from reinfection after exposure?
A. mumps
B. rubella
C. syphilis
D. chickenpox

23. Which of the following statements regarding HIV is correct?

A. It is far more contagious than hepatitis B.
B. It is easily transmittable in the EMS field.
C. HIV is transmitted exclusively via blood.
D. There is no vaccine against HIV infection.

24. A positive TB skin test indicates that:

A. you have never been exposed to TB.
B. you have been exposed to the disease.
C. you are actively infected with the disease.
D. the disease is dormant and may become active.

25. If you are exposed to a patient’s blood or other bodily fluid, your first action should be to:
A. report the incident to the infection control officer.
B. abandon patient care and seek medical attention.
C. transfer care of your patient to another EMS provider.
D. vigorously clean the area with soap and water.

26. The BEST way to reduce your risk of contracting a work-related disease following exposure is to:
A. vigorously wash the affected area with an antimicrobial solution.
B. be evaluated by a physician within 72 hours following the exposure.
C. get vaccinated against the disease you think you were exposed to.
D. activate your department’s infection control plan as soon as possible.

27. The general adaptation syndrome is characterized by which of the following phases?
A. alarm response, reaction and resistance, and recovery
B. delayed reaction, alarm response, and physical recovery
C. reaction and resistance, euphoria, and physical exhaustion
D. immediate reaction, psychological exhaustion, and recovery

28. Physiologic manifestations of stress include:

A. flushed skin, decreased muscle control, and vomiting.
B. slow heart rate, low blood pressure, and severe headaches.
C. perspiration, increased blood glucose levels, and dilated pupils.
D. increased blood pressure, decreased blood glucose levels, and chest pain.

29. What type of stress reaction occurs when an EMT is exposed to many insignificant stressors over a period of
several months or years?
A. acute stress reaction
B. cumulative stress reaction
C. posttraumatic stress reaction
D. critical incident stress reaction

30. Which of the following scenarios MOST accurately depicts a posttraumatic stress disorder (PTSD) reaction?
A. An EMT with many years of field experience becomes irritable with her coworkers and experiences
headaches and insomnia.
B. A newly certified EMT becomes extremely nauseated and diaphoretic at the scene of an incident involving
grotesque injuries.
C. An EMT is emotionally exhausted and depressed after a school bus crash involving critical injuries and the
death of several children.
D. An EMT becomes distracted at the scene of a motor vehicle crash involving the same type of car in which a
child was previously killed.

31. Critical incident stress management (CISM) can occur at an ongoing scene in all of the following
circumstances, EXCEPT:
A. when personnel are assessed during periods of rest.
B. before personnel are preparing to reenter the scene.
C. when patients are actively being assessed or treated.
D. before leaving the scene after the incident is resolved.
32. You have been working at the scene of a major building collapse for 8 hours. Many injured people are still
being removed, and everyone is becoming frustrated and losing focus. This situation is MOST effectively
managed by:
A. providing large amounts of caffeine to the rescue workers.
B. requesting a CISM team to provide on-scene peer support.
C. conducting a critical incident stress debriefing the next day.
D. allowing each worker to sleep in 15- to 30-minute increments.

33. A critical incident stress debriefing should be conducted no longer than ________ hours following the
incident.
A. 6
B. 12
C. 24
D. 72

34. As an EMT, it is important to remember that the signs and symptoms of cumulative stress:
A. may not be obvious or present all the time.
B. usually manifest suddenly and without warning.
C. cannot be identified and can cause health problems.
D. are most effectively treated with medications.

35. Which of the following signs would indicate that your partner is experiencing significant stress?
A. increased interest in daily activities
B. isolation from the rest of the crew
C. hyperactivity during an EMS call
D. acute increase in his or her appetite

36. Which of the following is the MOST effective strategy for managing stress?
A. Frequently reflect on troublesome calls.
B. Avoid friends and interests outside of EMS.
C. Request overtime to increase your income.
D. Focus on delivering high-quality patient care.

37. When considering his or her personal life, it is important for the EMT to realize that:
A. he or she should not discuss stressful issues with family members.
B. shift work is the least stressful type of an EMS-related work schedule.
C. family or friends may not understand the stress associated with EMS.
D. it is more difficult to effectively relax at home than it is while on duty.

38. Quid pro quo, a type of sexual harassment, occurs when the harasser:
A. requests sexual favors in exchange for something else.
B. touches another person without his or her consent.
C. stares at certain parts of another person’s anatomy.
D. makes rude remarks about a person’s body parts.

39. It is especially important for EMS personnel to develop nonadversarial relationships with their coworkers
because they:
A. are highly prone to stress and burnout.
B. depend on each other for their safety.
C. must work together every third day.
D. may have to bunk in the same room.
40. While on duty, your partner asks you out on a date and touches you in an inappropriate location without
your consent. You should:
A. tell your partner to quit kidding around and focus on his or her job.
B. warn your partner that you will report him or her if it happens again.
C. notify law enforcement personnel and have your partner arrested.
D. tell your partner to stop and report the incident to your supervisor.

41. The MOST serious consequence of drug or alcohol abuse among EMS personnel is:
A. punitive action and the loss of a job.
B. low morale and frequently missed shifts.
C. tension among coworkers and supervisors.
D. substandard or inappropriate patient care.

42. Your partner, a veteran EMT who you have worked with regularly for the past 4 years, seems unusually
agitated during a call involving an elderly patient. Upon arrival back at your station, you note the obvious
smell of alcohol on his breath. What should you do?
A. Remain quiet and simply request another partner.
B. Report the incident to your EMS medical director.
C. Discreetly report your suspicions to your supervisor.
D. Tell your partner that he must seek professional help.

43. You and your partner respond to the residence of a 66-year-old male with shortness of breath. As you are
assessing the patient, his wife tells you that he was recently diagnosed with lung cancer. The patient is
verbally abusive and tells you that failure of the health care system caused his disease. What stage of the
grieving process is this patient’s behavior consistent with?
A. denial
B. anger
C. bargaining
D. depression

44. Which of the following statements is MOST consistent with the bargaining phase of the grieving process?
A. “It is because of our lousy health care system that I developed this brain tumor.”
B. “I will be compliant with all my medications if I can just see my grandson graduate.”
C. “I understand that my death is inevitable and I am ready to die when the time comes.”
D. “The doctors must be wrong in their diagnosis because I have always been healthy.”

45. The final stage of death and dying is MOST commonly displayed as:
A. anger.
B. denial.
C. depression.
D. acceptance.

46. Which of the following statements regarding the different stages of the grieving process is correct?
A. The grieving process typically begins with severe depression.
B. It is rare that people will jump back and forth between stages.
C. The stages of the grieving process may occur simultaneously.
D. Bargaining is the most unpleasant stage of the grieving process.

47. Which of the following statements would NOT be appropriate to say to the family of a dying patient?
A. “Things will get better in time.”
B. “It is okay to be angry and sad.”
C. “This must be painful for you.”
D. “Tell me how you are feeling.”

48. While trying to make a family member feel better after a loved one has died, your partner uses trite
statements. The family members may view this as:
A. your partner’s attempt to diminish their grief.
B. a show of respect for the person who has died.
C. coaching them through the grieving process.
D. your partner’s caring and supportive attitude.

49. You are summoned to a convalescent center for an 88-year-old female with an altered mental status. A staff
nurse advises you that the patient has terminal cancer and her physician stated that she would probably die
within the next few hours; a valid do not resuscitate (DNR) order is presented to you. When caring for this
patient, you should:
A. depart the scene and allow her to die with dignity.
B. start cardiopulmonary resuscitation (CPR) if she experiences cardiopulmonary arrest.
C. provide no interventions and transport to the hospital.
D. make her comfortable and provide emotional support.

50. Common questions asked by patients with a serious illness or injury include all of the following, EXCEPT:
A. “Am I going to die?”
B. “What hospital am I going to?”
C. “What are you doing to me?”
D. “Will I be permanently disabled?”

51. You are transporting an elderly woman who has possibly experienced a stroke. She is obviously scared but
is unable to talk and cannot move the entire right side of her body. In addition to providing the medical care
that she needs, you should:
A. reassure her that after proper treatment in the hospital, she will regain her speech in time.
B. acknowledge that she is scared and tell her that you are going to take good care of her.
C. maintain eye contact at all times and tell her that there is no need for her to be scared.
D. tell her that you understand why she is scared and that everything will likely be okay.

52. A 75-year-old male with a terminal illness has died at home. As you and your partner enter the residence, a
family member becomes verbally abusive, pushes you, and states that you took too long to get there. You
should:
A. retreat and notify law enforcement personnel.
B. tell the family member that it is not your fault.
C. subdue the family member until the police arrive.
D. ignore the family member and assess the patient.

53. Patients who become dependent upon EMS personnel or other health care providers often feel:
A. relieved.
B. superior.
C. hopeful.
D. shamed.

54. When a patient is dying, he or she may experience regression. This is MOST accurately defined as:
A. anger projected toward the EMT or other providers.
B. fear of being completely dependent upon other people.
C. behavior consistent with an earlier developmental stage.
D. a decreased ability to exercise age-appropriate judgment.
55. You are assessing a middle-aged man with chest pain that you suspect is caused by a cardiac problem. The
patient tells you that he does not want to go to the hospital and insists that you leave him alone. You should:
A. reassure him that he will not receive a bill for the EMS call if he cannot pay.
B. tell him that he is having a heart attack and that he needs to go to the hospital.
C. explain the seriousness of the situation to him, but avoid causing undue alarm.
D. proceed to treat him because the stress of the situation has impaired his thinking.

56. A 15-year-old boy was killed when he was struck by a car while riding his bicycle. He has numerous
disfiguring injuries and has been placed in the back of the ambulance to shield him from curious bystanders.
When the child’s parents arrive at the scene, they demand to see him. You should:
A. advise them that their son had severely disfiguring injuries and ask them if there is anyone they would like
you to contact first.
B. discreetly escort them to the back of the ambulance and allow them to see their child by themselves while
you wait outside.
C. let them know that because of the circumstances of their child’s death, they will not be permitted to see him
at this time.
D. express your sincere condolences over their loss and have them escorted away from the scene by a law
enforcement officer.

57. When caring for the parents of a child who has died of leukemia, the EMT should:
A. immediately refer them to a counselor.
B. tell them that their feelings are understood.
C. refrain from using words such as “died” or “dead.”
D. acknowledge the death of their child in private.

58. Common factors that influence how a patient reacts to the stress of an illness or injury include all of the
following, EXCEPT:
A. distrust of the EMT.
B. mental disorders.
C. history of chronic disease.
D. fear of medical personnel.

59. You are caring for a 35-year-old female with pregnancy-related complications. She is clearly experiencing
significant stress and is crying uncontrollably. Your MOST appropriate action would be to:
A. demonstrate courtesy and speak with a professional tone of voice.
B. discourage her from expressing fears until a counselor is available.
C. explain to her that “everything will be all right” in order to calm her down.
D. restrain her if she is extremely emotional and will not calm down.

60. You are caring for a 40-year-old female who was involved in a motor vehicle crash. Her husband, who was
driving the vehicle, was killed. When the patient asks you if her husband is all right, you should:
A. tell her that he is being resuscitated by other EMTs.
B. immediately tell her of his death so that she may grieve.
C. let clergy or hospital staff relay the bad news if possible.
D. avoid answering her questions and focus on her injuries.

61. What should you do before attempting to access a patient trapped in a vehicle?
A. Check for other patients.
B. Ensure the vehicle is stable.
C. Request another ambulance.
D. Contact medical control.
62. The MOST important consideration at the scene of a hazardous material incident is:
A. identifying the material.
B. calling the hazardous materials team.
C. evacuating the bystanders.
D. ensuring your personal safety.

63. You are dispatched to the scene of a crash involving a large tanker truck. While you are en route, dispatch
advises you that there are multiple patients and that the fire department is en route as well. As you approach
the scene, you should:
A. maintain a safe distance and try to read the placard with binoculars.
B. cordon off the area and quickly remove all of the injured patients.
C. immediately begin evacuating residents that live near the crash site.
D. don PPE and quickly triage all patients.

64. At the scene of an automobile crash, a utility pole has been broken, and power lines are lying across the car.
The patients inside the car are conscious. You should:
A. proceed with normal extrication procedures.
B. remove the lines with a nonconductive object.
C. advise the patients to carefully get out of the car.
D. mark off a danger zone around the downed lines.

65. You are assessing a woman who was thrown from her horse. She is located in a large field and you can see
that a thunderstorm is rapidly approaching. Suddenly, you feel your skin begin to tingle and the hair on your
arms stands on end. The ambulance is located about 30 yards away. You should:
A. crouch down in a position so that only your feet are touching the ground.
B. sit down, bend your knees, and hold your crossed arms close to your body.
C. quickly cover the patient with a blanket and then lie down flat on the ground.
D. immediately lie down on your side and draw your knees into your abdomen.

66. Hazards that are associated with a structural fire include all of the following, EXCEPT:
A. smoke and toxic gases.
B. carbon dioxide deficiency.
C. high ambient temperatures.
D. the risk of building collapse.

67. Carbon monoxide blocks the ability of the blood to oxygenate the body because it:
A. binds with the hemoglobin in the red blood cells.
B. fills the lungs with secretions.
C. causes the body to expel too much carbon dioxide.
D. destroys the number of circulating red blood cells.

68. You and your partner are EMTs and have been dispatched to standby at the scene of a residential fire. While
standing next to the ambulance observing the fire fighters, you see a woman frantically moving around in
her burning house. You should:
A. request permission from the fire chief to enter the structure.
B. don a self-contained breathing apparatus (SCBA) and rescue the woman.
C. stay where you are until fire fighters remove her from the house.
D. immediately notify the incident commander or safety officer.

69. Upon arriving at the scene of a motor vehicle crash, you note that two small cars collided head-on; the
occupants are still in their vehicles. The fire department is in the process of stabilizing the vehicles and law
 enforcement personnel are directing traffic. After parking the ambulance at a safe distance, you and your
partner should:
A. quickly begin the triage process.
B. assist with vehicle stabilization.
C. report to the incident commander.
D. put on high-visibility safety vests.

70. The MOST effective way to preserve your own body heat when functioning in cold, wet weather is to:
A. wear a heavy, thick jacket or coat.
B. avoid outer clothing with zippers.
C. wear at least three layers of clothing.
D. wear socks made of heavy-duty cotton.

71. When treating a patient who is trapped in a vehicle and covered with broken glass, it is BEST to wear:
A. latex gloves with thick leather gloves underneath.
B. puncture-proof leather gloves over your latex gloves.
C. fire fighter gloves only, to preserve manual dexterity.
D. thick fire fighter gloves over two pairs of latex gloves.

72. You arrive at the scene of a domestic violence situation. As you approach the doorway of the apartment, you
hear screaming and the statement “He has a gun!” Your MOST appropriate action should be to:
A. continue into the apartment using extreme caution.
B. proceed into the apartment and apprehend the gunman.
C. get in your ambulance and leave the scene immediately.
D. seek a safe place and request law enforcement assistance.

73. Which of the following statements regarding a patient with a behavioral crisis is correct?
A. Depression accounts for a very small percentage of violent attacks.
B. A quiet patient is not as likely to attack you as one who is screaming.
C. A past history of violence is an unreliable indicator of future violence.
D. People who say that they are “hearing voices” are usually bluffing you.

74. Which of the following factors is NOT taken into consideration when assessing a person’s potential for
violence?
A. poor impulse control
B. tattoos, such as those with gang identification
C. substance abuse
D. large physical size

CHAPTER 3: MEDICAL, LEGAL, AND ETHICAL ISSUES

1. To minimize the risk of litigation, the EMT should always:

A. transport patients to the hospital of their choice.
B. provide competent care that meets current standards.
C. use universal precautions with every patient encounter.
D. utilize at least four personnel when moving a patient.

2. Which of the following general statements regarding consent is MOST correct?

A. A patient can consent to transport but can legally refuse to be treated.
B. Patients who are intoxicated are generally allowed to refuse treatment.
C. Expressed consent is valid only if given in writing by a family member.
D. All patients older than 18 years can legally refuse treatment or transport.
3. What type of consent is involved when a 39-year-old mentally competent female with a severe headache
asks you to take her to the hospital?
A. formal
B. implied
C. informed
D. expressed

4. Which of the following scenarios MOST accurately depicts informed consent?

A. A patient advises an EMT of why he or she is refusing care.
B. An EMT advises a patient of the risks of receiving treatment.
C. An EMT initiates immediate care for an unconscious adult.
D. A patient is advised by an EMT of the risks of refusing care.

5. Which of the following types of consent allows treatment of a patient who is unconscious or mentally
incapacitated?
A. actual
B. implied
C. informed
D. expressed

6. You are dispatched to an office building for a 49-year-old male with chest pain. When you arrive at the
scene, you find the patient to be conscious and alert, but in obvious pain. He tells you that he did not call 9-
1-1; a coworker did. He further states that he does not want to be treated or transported to the hospital. You
should:
A. ensure that he is aware of the risks of refusing medical care.
B. err in the best interest of the patient and transport him at once.
C. have him sign a refusal of care form and then return to service.
D. tell him that he is having a heart attack and needs medical care.

7. You suspect that a pregnant 16-year-old girl has a broken leg after she was hit by a car. You explain that
you plan to splint her leg, and she agrees to treatment. What type of consent is her agreement considered?
A. implied
B. informed
C. expressed
D. minor’s

8. In many states, a minor may be treated as an adult for the purpose of consenting to or refusing medical
treatment if the minor:
A. possesses a valid driver’s license.
B. is mentally competent and able to refuse.
C. has a poor relationship with his or her parents.
D. is self-supporting and lives by him- or herself.

9. You arrive at the scene of a motor vehicle versus pedestrian accident. The patient, a 13-year-old male, is
unconscious and has multiple injuries. As you are treating the child, a law enforcement officer advises you
that the child’s parents will be at the scene in approximately 15 minutes. What should you do?
A. Transport the child immediately and have the parents meet you at the hospital.
B. Treat the child at the scene and wait for the parents to arrive and give consent.
C. Begin transport at once and have the parents meet you en route to the hospital.
D. Withhold treatment until the parents arrive and give you consent for treatment.
10. You are dispatched to a middle school for a 16-year-old female experiencing an asthma attack. She is
conscious and alert, but in severe respiratory distress. The school nurse informs you that she has tried
several times to contact the patient’s parents but has not been successful. You should:
A. provide treatment up to your level of training and transport the child at once.
B. recognize that you cannot begin treatment without expressed parental consent.
C. transport the child to the closest hospital and let them provide any treatment.
D. administer oxygen only until you receive parental consent for further treatment.

11. You are treating a man with a closed head injury following an assault by a burglar. The patient, who has
slurred speech, becomes verbally abusive and tells you to leave him alone. You should:
A. ask a police officer to transport the patient to the hospital.
B. allow him to refuse treatment since the injury was not his fault.
C. proceed with treatment and utilize law enforcement if necessary.
D. have the police arrest him so that you can legally begin treatment.

12. A patient regains consciousness en route from his office to the emergency department. The patient tells you
that he feels fine and does not want to go to the hospital. Under these circumstances, you should:
A. document the patient’s request but continue to transport him.
B. have the patient sign a refusal form and return him to his office.
C. request that the police place the patient under protective custody.
D. assess whether or not the patient’s mental condition is impaired.

13. Shortly after loading your patient, a 50-year-old man with abdominal pain, into the ambulance, he tells you
that he changed his mind and does not want to go to the hospital. He is conscious and alert and has no signs
of mental incapacitation. You are suspicious that the man has a significant underlying condition and feel
strongly that he should go to the hospital. Which of the following statements regarding this situation is
correct?
A. A mentally competent adult can withdraw his or her consent to treat at any time.
B. Any patient who refuses EMS treatment must legally sign a patient refusal form.
C. Because of your suspicions, the best approach is to transport him to the hospital.
D. Once a patient is in the ambulance, he or she cannot legally refuse EMS treatment.

14. You suspect that a 6-year-old girl has broken her leg after falling from a swing at a playground. Shortly after
you arrive, the child’s mother appears and refuses to allow you to continue treatment. You should:
A. use your authority under the implied consent law.
B. try to persuade the mother that treatment is needed.
C. ask the mother to sign a refusal form and then leave.
D. tell the mother that her refusal is a form of child abuse.

15. In which of the following circumstances can the EMT legally release confidential patient information?
A. a police officer requests a copy to place on file
B. the family requests a copy for insurance purposes
C. a media representative inquires about the patient
D. the patient is competent and signs a release form

16. Your BEST protection against legal liability when a competent patient refuses EMS care and transport is to:
A. advise medical control of the situation.
B. err on the side of caution and transport.
C. ensure that the family is aware of the risks.
D. thoroughly document the entire event.
17. What section of the Health Insurance Portability and Accountability Act (HIPAA) MOST affects EMS
personnel?
A. controlling insurance cost
B. protecting patient privacy
C. preventing insurance fraud
D. ensuring access to insurance

18. Which of the following is NOT considered to be protected health information (PHI)?
A. patient history
B. treatment rendered
C. location of the call
D. assessment findings

19. During your monthly internal quality improvement (QI) meeting, you review several patient care reports
(PCRs) with the staff of your EMS system. You identify the patient’s name, age, and sex, and then discuss
the treatment that was provided by the EMTs in the field. By taking this approach to the QI process, you:
A. acted appropriately but must have each EMT sign a waiver stating that he or she will not discuss the cases
with others.
B. adequately safeguarded the patient’s PHI because the cases were discussed internally.
C. are in violation of HIPAA because you did not remove the PHI from the PCR beforehand.
D. violated the patient’s privacy because you should have only discussed the information with the EMTs who
provided it.

20. In order for a do not resuscitate (DNR) order to be valid, it must:

A. be dated within the previous 24 months.
B. clearly state the patient’s medical problem.
C. be updated a minimum of every 6 months.
D. be signed by the local justice of the peace.

21. When faced with a situation in which a patient is in cardiac arrest, and a valid living will or DNR order
cannot be located, you should:
A. begin resuscitation at once.
B. contact medical control first.
C. determine the patient’s illness.
D. notify the coroner immediately.

22. You respond to the home of a 59-year-old man who is unconscious, has slow, shallow breathing, and has a
weak pulse. The family states that the patient has terminal brain cancer and does not wish to be resuscitated.
They further state that there is a DNR order for this patient; however, they are unable to locate it. You
should:
A. begin treatment and contact medical control as needed.
B. honor the patient’s wishes and withhold all treatment.
C. transport the patient without providing any treatment.
D. decide on further action once the DNR order is produced.

23. You and your partner arrive at the scene of a major motor vehicle crash. The driver, a young male, is
severely entrapped in his car. He has an open head injury and massive facial trauma. He is unresponsive, is
not breathing, and does not have a palpable carotid pulse. You should:
A. stop any active bleeding and advise dispatch to send a paramedic crew.
B. ventilate the patient for 5 minutes and then stop if there is no response.
C. request the fire department to extricate the patient so you can begin cardiopulmonary resuscitation (CPR).
D. have your partner check for a pulse to confirm that the patient is deceased.
24. You arrive at the scene of an apparent death. When evaluating the patient, which of the following is a
definitive sign of death?
A. absence of a pulse
B. profound cyanosis
C. dependent lividity
D. absent breath sounds

25. Putrefaction is defined as:

A. decomposition of the body’s tissues.
B. profound cyanosis to the trunk and face.
C. blood settling to the lowest point of the body.
D. separation of the torso from the rest of the body.

26. Where would you MOST likely find information regarding a patient’s wishes to be an organ donor?
A. driver’s license
B. insurance card
C. Social Security card
D. voter registration card

27. At the scene of a mass-casualty incident, you identify a patient as an organ donor. When triaging the other
patients, you:
A. should transport the donor patient before critical patients.
B. may have to assign the donor patient a lower triage priority.
C. should use a separate ambulance to transport the donor patient.
D. must assign the donor the highest priority regardless of injuries.

28. The EMT’s scope of practice within his or her local response area is defined by the:
A. medical director.
B. state EMS office.
C. EMS supervisor.
D. local health district.

29. The manner in which the EMT must act or behave when caring for a patient is called the:
A. EMT oath.
B. code of ethics.
C. standard of care.
D. scope of practice.

30. As an EMT, the performance of your duties will be compared to that of:
A. another EMT.
B. the general public.
C. the medical director.
D. a paramedic supervisor.

31. You have been tasked by your medical director to assist in the development of your EMS agency’s
institutional standards. When developing these standards, it is important to:
A. require personnel to transport all patients to the closest hospital.
B. be reasonable and realistic to avoid overburdening your personnel.
C. demand that all personnel consistently exceed the standard of care.
D. expect personnel to function beyond their scope of practice if needed.
32. When performing his or her duties, the EMT is generally expected to:
A. consistently exceed the standard of care.
B. contact medical control on every EMS call.
C. function above his or her scope of practice.
D. exercise reasonable care and act prudently.

33. In which of the following situations does the EMT NOT have a legal duty to act?
A. a response to the residence of a patient who fell
B. a response to a motor vehicle crash while off duty
C. a response to an injured patient while off duty
D. Local policy requires you to assist in any emergency.

34. Which of the following MOST accurately defines negligence?

A. transport of a mentally incompetent patient against his or her will
B. deviation from the standard of care that may result in further injury
C. transferring patient care to a provider with a lower level of training
D. providing care that is consistent with care provided by other EMTs

35. Which of the following components are needed to prove negligence?

A. abandonment, breach of duty, damages, and causation
B. duty to act, abandonment, breach of duty, and causation
C. duty to act, breach of duty, injury/damages, and causation
D. breach of duty, injury/damages, abandonment, and causation

36. When caring for a 65-year-old male with respiratory distress, you place him in a comfortable position but do
not apply oxygen. The patient’s condition continues to deteriorate and he develops cardiac arrest and dies at
the hospital. This scenario is an example of:
A. assault.
B. battery.
C. negligence.
D. abandonment.

37. Which of the following scenarios MOST accurately depicts abandonment?

A. A paramedic transfers patient care to an EMT.
B. An AEMT transfers patient care to a paramedic.
C. A physician assumes patient care from an EMT.
D. An EMT gives a verbal report to an emergency room nurse.

38. While transporting a stable patient with chest pain to the hospital, you come across a major motor vehicle
crash involving several critically injured patients. Your MOST appropriate action should be to:
A. ask a bystander to remain with your patient as you treat the crash victims.
B. remain at the scene until law enforcement and another ambulance arrive.
C. stop and triage the patients while your partner remains in the ambulance.
D. continue transporting your patient and notify the dispatcher of the crash.

39. An EMT would MOST likely be held liable for abandonment if he or she:
A. refused to care for a violent patient who is armed with a knife.
B. remained at the hospital for 30 minutes to give a patient report.
C. did not make provisions for continued care of an injured patient.
D. terminated care of a competent adult patient at his or her request.
40. Acting in such a way as to make another person fear immediate bodily harm is called:
A. libel.
B. assault.
C. battery.
D. negligence.

41. Which of the following statements regarding the Good Samaritan law is correct?
A. It provides the EMT immunity from a lawsuit.
B. It guarantees that the EMT will not be held liable if he or she is sued.
C. The law does not protect EMTs who are off duty.
D. It will not protect the EMT in cases of gross negligence.

42. If an action or procedure that was performed on a patient is not recorded on the written report:
A. it was not performed in the eyes of the law.
B. it can be qualified by the EMT in charge.
C. it cannot be used in establishing negligence.
D. it was performed haphazardly by the EMT.

43. In the eyes of the court, an incomplete or untidy patient care form indicates:
A. that inadequate patient care was administered.
B. potential falsification of the patient care form.
C. that thorough documentation was not required.
D. that the EMT was too busy providing patient care.

44. Which of the following situations requires you to notify the appropriate authorities?
A. cardiac arrest
B. drug overdose
C. attempted suicide
D. accidental knife wound

45. You and your partner are the first to arrive at a potential crime scene with a critically injured patient
involved. The scene is safe. Your first priority is to:
A. notify medical control for advice.
B. provide immediate patient care.
C. wait for law enforcement to arrive.
D. determine why the patient was injured.

46. Maintaining the chain of evidence at the scene of a crime should include:
A. quickly moving any weapons out of the patient’s sight.
B. placing the patient in a private area until the police arrive.
C. making brief notes at the scene and then completing them later.
D. not cutting through holes in clothing that were caused by weapons.

47. You are dispatched to an apartment complex for a shooting. Law enforcement personnel are present and
have the suspect in custody. You find the patient lying in a narrow space between the couch and coffee table
of his small apartment. He is semiconscious and has a large gunshot wound to his chest. You should:
A. obtain permission from law enforcement before moving anything.
B. quickly move the coffee table so you can access and treat the patient.
C. treat the patient where he is so that you do not destroy any evidence.
D. drag the patient into a larger area so that you can begin treatment.
48. Two EMTs witnessed a call in which a coworker gave adequate medical care but ignored the patient’s
emotional needs. The coworker was deliberately rude solely because the patient was thought to be infected
with the human immunodeficiency virus (HIV). The EMTs ignored the coworker’s treatment of this patient
and took no steps to prevent this behavior from happening again. This lack of action on the part of the two
EMTs is considered:
A. legal and ethical.
B. legal but unethical.
C. illegal but ethical.
D. illegal and unethical.

49. While transporting a woman with diabetes, you inadvertently give her oral glucose even though her blood
glucose level was high. You reassess the patient and note that her condition did not change; she remained
stable. You should:
A. document the error and report it to your supervisor.
B. notify law enforcement so they can file an incident report.
C. contact medical control and notify him or her of the error.
D. exclude this from the PCR since it did not harm the patient.

50. When you and your partner arrive at the residence of a man in cardiac arrest, you immediately recognize the
patient as the drunk driver who killed your brother several years earlier. A backup ambulance is en route to
the scene. You should:
A. advise your partner that you cannot provide care to this patient.
B. wait for the backup ambulance while your partner performs CPR.
C. obtain permission from medical control to not attempt resuscitation.
D. begin two-rescuer CPR and apply the automated external defibrillator (AED) as soon as possible.

CHAPTER 4: COMMUNICATIONS AND DOCUMENTATION

1. Ethnocentrism is defined as:

A. understanding that people from different cultural backgrounds respond to pain and stress differently.
B. suspecting that a person has an ulterior motive based on the tone of his or her voice when answering a
question.
C. subconsciously forcing your cultural values onto a patient because you feel that yours are more acceptable.
D. considering your own cultural values as more important when interacting with people of a different culture.

2. You are dispatched to the residence of an Asian family for a child with a high fever. When you assess the
child, you note that he has numerous red marks on his back. The child’s parents explain that these marks
represent coining—a traditional Asian healing practice in which hot coins are rubbed on the back. You
should:
A. advise the child’s parents that this is a harmful practice and is considered a form of child abuse in the United
States.
B. acknowledge and respect this practice as a cultural belief, but advise the child’s parents that it has no
healing power.
C. document this on your patient care report and advise the emergency department staff of what the child’s
parents told you.
D. advise the emergency department physician that you feel as though the child was intentionally abused by his
parents.
3. You are assessing a 75-year-old woman with mild shortness of breath. As you are asking her questions
regarding her chief complaint and medical history, you progressively move closer and closer to her. In doing
this, it is important to remember that:
A. placing yourself in the patient’s personal space is relaying to her that you can be trusted.
B. as you physically get closer to the patient, a greater and greater sense of trust must be established.
C. it is necessary to enter an older person’s intimate space because the elderly are typically hearing impaired.
D. a patient’s personal space should not be violated, regardless of any barriers that may hamper
communication.

4. A 60-year-old man complains of chest pain. He is conscious and alert and denies shortness of breath. Which
of the following questions would be the MOST appropriate to ask him?
A. “Were you exerting yourself when the chest pain began?”
B. “Does the pain in your chest move to either of your arms?”
C. “Does the pain in your chest feel like a stabbing sensation?”
D. “Do you have any heart problems or take any medications?”

5. You are interviewing a 52-year-old man who complains of chest discomfort. The patient is a retired
paramedic and is very anxious because he thinks he is having a heart attack. Which of the following
statements would be appropriate to say?
A. “It is possible that you are experiencing a heart attack. I am going to give you four baby aspirin to chew and
swallow.”
B. “I notice that you are a retired paramedic, so I’m sure you will understand all of the things that we will be
doing to you.”
C. “This is nothing to worry about. Please try to stay calm. The physician at the hospital will probably not find
any signs of a heart problem.”
D. “We need to take you to the ED stat. We will give you ASA and NTG en route and then reassess your vitals.
Do you have any questions?”

6. Calming and reassuring an anxious patient can be facilitated by:

A. maintaining eye contact with the patient whenever possible.
B. using medical terminology to ensure the patient understands.
C. positioning yourself at a level that is higher than the patient.
D. withholding unpleasant information until arrival at the hospital.

7. During your assessment of a 20-year-old man with a severe headache and nausea, you ask him when his
headache began, but he does not answer your question immediately. You should:
A. repeat your question because he probably did not hear you.
B. allow him time to think about the question and respond to it.
C. ask him if he frequently experiences severe headaches and nausea.
D. tell him that you cannot help him unless he answers your questions.

8. In what manner should you act and speak with a patient?

A. passive
B. authoritative
C. loud and official
D. calm and confident

9. When communicating with an older patient, it is important to remember that:

A. your questions should focus exclusively on the patient’s obvious problem.
B. most older people think clearly and are capable of answering questions.
C. hostility and confusion should be presumed to be due to the patient’s age.
D. speaking loudly and distinctly will ensure that the patient can hear you.

10. A 4-year-old boy had an apparent seizure. He is conscious and calm and is sitting on his mother’s lap. His
father is sitting in a nearby chair. The child’s mother suddenly begins crying uncontrollably, which causes
the child to start crying. You should:
A. consider asking the father to hold the child so you can assess him while your partner tries to calm the
mother.
B. give the child a favorite toy or blanket to hold onto and perform your assessment to the best of your ability.
C. reassure the child’s mother that seizures in children are very common and that there is nothing to worry
about.
D. attempt to calm the child’s mother, but avoid separating her from her child because this will increase her
anxiety.

11. Which of the following statements regarding communication with a child is MOST correct?
A. Most children are intrigued by strangers wearing uniforms.
B. Give the child minimal information to avoid scaring him or her.
C. Standing over a child often increases his or her level of anxiety.
D. Unlike adults, children cannot see through lies or deceptions.

12. Communicating with hearing-impaired patients can be facilitated by doing all of the following, EXCEPT:
A. shining a light on your face when you are in a darkened environment.
B. elevating the tone of your voice and exaggerating word pronunciation.
C. placing yourself in a position to ensure that the patient can see your lips.
D. providing pen and paper if the patient prefers to write his or her response.

13. When communicating with a visually impaired patient, you should:

A. determine the degree of the patient’s impairment.
B. expect him or her to have difficulty understanding.
C. recall that most visually impaired patients are blind.
D. possess an in-depth knowledge of sign language.

14. You and your partner are dispatched to a residence for an “ill person.” When you arrive, you find that the
patient, a 44-year-old man, does not speak English. There are no relatives or bystanders present who can act
as an interpreter. You should:
A. give the patient oxygen, assess his vital signs, and transport him to the hospital in a position of comfort.
B. speak to the patient with a moderately louder voice to facilitate his ability to understand what you are
saying.
C. use short, simple questions and point to specific parts of your body to try to determine the source of the
patient’s complaint.
D. refrain from performing any assessment or treatment until you can contact someone who can function as an
interpreter.

15. As you are wheeling your patient through the emergency department doors, you receive another call for a
major motor vehicle crash. You should:
A. place the patient in a high-visibility area and then respond to the call.
B. inform the admissions clerk of the situation and then respond at once.
C. leave a copy of the run form with a nurse and then respond to the call.
D. respond only after giving a verbal patient report to a nurse or physician.

16. The official transfer of patient care does not occur until the EMT:
A. gives a radio report to the receiving medical facility.
B. notifies the admitting clerk of their arrival at the hospital.
C. informs dispatch of their arrival at the emergency department.
D. gives an oral report to the emergency room physician or nurse.

17. When you begin an oral report, you should state the patient’s age, sex, and:
A. chief complaint.
B. any known allergies.
C. past medical history.
D. the emergency care given.

18. Typical components of an oral patient report include all of the following, EXCEPT:
A. the chief complaint or mechanism of injury.
B. important medical history not previously given.
C. the set of baseline vital signs taken at the scene.
D. the patient’s response to treatment you provided.

19. The patient care report (PCR) ensures:

A. research data.
B. legal protection.
C. quality assurance.
D. continuity of care.

20. Your EMS system uses a computerized PCR in which you fill in the information electronically and then
send it to the emergency department via a secure Internet server. The PCR has a comprehensive series of
drop-down boxes, which are used to identify your assessment findings and specify the treatment that you
provided; it also has a section for your narrative. When completing your PCR after a call, you should:
A. defer the narrative only if the information in the drop-down boxes accurately reflects the assessment and
treatment that you performed.
B. complete a thorough and accurate narrative because drop-down boxes cannot provide all of the information
that needs to be documented.
C. enter all of the pertinent information of the electronic PCR, but then print it out and provide a copy to the
emergency department staff.
D. avoid documenting personally identifiable information, such as the patient’s name, because the PCR could
be intercepted during transmission.

21. Which of the following statements is NOT appropriate to document in the narrative section of a PCR?
A. “General impression revealed that the patient was intoxicated.”
B. “Significant damage was noted to the front end of the vehicle.”
C. “The patient admits to smoking marijuana earlier in the day.”
D. “After oxygen was administered, the patient’s breathing improved.”

22. All information recorded on the PCR must be:

A. typewritten or printed.
B. considered confidential.
C. a matter of public record.
D. reflective of your opinion.

23. After delivering your patient to the hospital, you sit down to complete the PCR. When documenting the
patient’s last blood pressure reading, you inadvertently write 120/60 instead of 130/70. To correct this
mistake, you should:
A. draw a single horizontal line through the error, initial it, and write the correct data next to it.
B. attempt to erase the error, initial it, and then write the correct data on a separate addendum.
C. cover the error with correction fluid and simply write the patient’s actual blood pressure over it.
D. leave the error on your PCR but inform the staff of the patient’s actual blood pressure.

24. A patient’s refusal for EMS treatment and/or transport must be:
A. an informed refusal.
B. authorized by a judge.
C. reported to the police.
D. witnessed by a notary.

25. Which of the following statements regarding a patient refusal is MOST correct?
A. A patient who consumed a few beers will likely be able to refuse EMS treatment.
B. Advice given to a patient who refuses EMS treatment should not be documented.
C. A mentally competent adult has the legal right to refuse EMS care and transport.
D. Documentation of proposed care is unnecessary if the patient refuses treatment.

26. Despite numerous, sincere efforts to convince a 40-year-old man to consent to EMS treatment and transport,
he refuses. After explaining the potential consequences of his refusal and determining that he has decision-
making capacity, you ask him to sign an EMS refusal form, but he refuses to do that as well. You should:
A. sign the refusal form, include the date and time, and have your partner witness it with his or her signature.
B. document the patient’s refusal, but leave the refusal form blank because only the patient can legally sign it.
C. advise the patient that unless he signs the refusal form, he cannot legally refuse EMS treatment or transport.
D. ask a family member, law enforcement officer, or bystander to sign the form verifying that the patient
refused to sign.

27. Which of the following incidents does NOT require a report to be filed with local authorities?
A. spousal abuse
B. animal bites
C. cardiac arrest
D. gunshot wounds

28. Any radio hardware containing a transmitter and receiver that is located in a fixed location is called a:
A. repeater.
B. multiplex.
C. mobile radio.
D. base station.

29. Which of the following statements regarding a “dedicated line” is MOST correct?
A. It is an exclusive frequency that is used by EMTs to communicate with each other in the field.
B. It is a constantly open line of communication that cannot be accessed by outside users.
C. It is a designated frequency on a portable radio that provides direct access to medical control.
D. It is a constantly open line of communication that is under exclusive control of a single user.

30. While at the scene of a motor vehicle crash, you determine that there are two critically injured patients and
that another ambulance is needed. You attempt to contact the dispatcher with your portable radio but are
unsuccessful. You should:
A. reattempt to contact dispatch from an area of higher terrain.
B. place both patients in the ambulance and transport at once.
C. ask a police officer to call dispatch with his portable radio.
D. use the mobile radio in the ambulance to contact dispatch.

31. Which of the following has the weakest transmission signal and, as a result, is LEAST likely to be heard by
the party being called?
A. multiplex base station
B. land-base repeater station
C. mobile repeater station
D. hand-held portable radio

32. A ___________ receives messages and signals on one frequency and then automatically retransmits them on
a second frequency.
A. duplex
B. scanner
C. repeater
D. decoder

33. What type of communications equipment functions as a radio receiver and searches across several
frequencies?
A. scanner
B. duplex station
C. simplex station
D. mobile repeater

34. Two-way communication that requires the EMT to “push to talk” and “release to listen” describes what
mode of communication?
A. duplex
B. simplex
C. multiplex
D. mediplex

35. Which of the following is NOT a function of the Federal Communications Commission (FCC)?
A. monitoring all radio traffic and conducting field spot checks
B. maintaining communications equipment on the ambulance
C. licensing base stations and assigning appropriate radio call signs
D. allocating specific radio frequencies for use by EMS providers

36. During the alert and dispatch phase of EMS communications, the dispatcher’s responsibilities include all of
the following, EXCEPT:
A. discouraging the caller from providing care until the EMS unit arrives.
B. selecting and notifying the correct EMS response units and personnel.
C. screening and assigning a priority to each call based on local protocols.
D. coordinating responding EMS units with other public safety personnel.

37. After being dispatched on an emergency call, you should expect the dispatcher to provide you with all of the
following information, EXCEPT:
A. the time at which your unit was dispatched.
B. the number of patients involved in the incident.
C. other agencies that are responding to the scene.
D. the general geographic location of the incident.

38. Immediately after being dispatched to a residence for an elderly patient with diabetic complications, you
should:
A. confirm with dispatch that you received the call information.
B. ask the dispatcher to obtain a medical history from the caller.
C. ask the dispatcher if the patient is conscious or unconscious.
D. request that law enforcement secure the scene before you arrive.
39. When relaying patient information via radio, communications should be:
A. brief and easily understood.
B. coded and scripted.
C. spoken in a loud voice.
D. lengthy and complete.

40. You are transporting a 54-year-old male in cardiac arrest. An EMR is driving the ambulance as you and
your partner attempt to resuscitate the patient. What is the MOST logical way of notifying the hospital?
A. Call the receiving hospital with your cellular phone as you attempt resuscitation.
B. Have the driver contact dispatch and relay the patient information to the hospital.
C. Request that a police officer respond to the hospital to apprise them of your arrival.
D. Wait until you arrive at the hospital and then quickly apprise them of the situation.

41. General guidelines for effective radio communications include all of the following, EXCEPT:
A. speaking in a clear, calm, monotone voice.
B. acknowledging a transmission as soon as possible.
C. using 10 codes to ensure radio traffic confidentiality.
D. holding the microphone about 2" to 3" from your mouth.

42. When communicating information over the radio, you should:

A. respond professionally by saying “please” and “thank you.”
B. use the words “affirmative” and “negative” instead of “yes” or “no.”
C. limit any single transmission to 60 seconds or less and use 10 codes.
D. use the patient’s name only when communicating with the hospital.

43. When providing a patient report via radio, you should protect the patient’s privacy by:
A. using coded medical language.
B. not disclosing his or her name.
C. withholding medical history data.
D. refraining from objective statements.

44. Information included in a radio report to the receiving hospital should include all of the following,
EXCEPT:
A. your perception of the severity of the problem.
B. a preliminary diagnosis of the patient’s problem.
C. a brief history of the patient’s current problem.
D. a brief summary of the care you provided.

45. You could be sued for ___________ if your radio report to the hospital describes the patient in a manner
that injures his or her reputation.
A. libel
B. assault
C. slander
D. negligence

46. When obtaining patient care orders from a physician via a two-way radio, it is MOST important to
remember that:
A. his or her instructions are based on the information you provide.
B. the use of 10 codes is an effective method of communication.
C. all orders should be carried out immediately and without question.
D. the physician may or may not be located within your service area.
47. After receiving online orders from medical control to perform a patient care intervention, you should:
A. perform the intervention as ordered.
B. confirm the order in your own words.
C. ask the physician to repeat the order.
D. repeat the order to medical control word for word.

48. Medical control gives you an order that seems inappropriate for the patient’s condition. After confirming
that you heard the physician correctly, you should:
A. carry out the order and then carefully document it on the run form.
B. advise the physician that the order is unclear and ask for clarification.
C. state that you will not carry out the order because it is inappropriate.
D. obtain consent from the patient and then carry out the order as usual.

49. Which of the following statements regarding standing orders is MOST correct?
A. Standing orders have less legal authority than orders given via radio.
B. Standing orders require you to contact medical control first.
C. Standing orders only highlight the care that you may provide.
D. Standing orders should be followed when physician contact is not possible.

50. You and your partner are attempting to resuscitate a middle-aged female in cardiac arrest. Because of the
remote location you are in, you are unable to contact medical control. What should you do?
A. Perform CPR only and initiate immediate transport.
B. Make continuous attempts to contact medical control.
C. Ask the husband if he wants to continue resuscitation.
D. Follow locally established protocols or standing orders.

CHAPTER 5: MEDICAL TERMINOLOGY

_____

CHAPTER 6: THE HUMAN BODY

1. The nose, chin, umbilicus (navel), and spine are examples of ___________ anatomic structures.
A. midline
B. proximal
C. superior
D. midaxillary

2. The ___________ plane separates the body into left and right halves.
A. sagittal
B. coronal
C. transverse
D. midsagittal

3. A 5-year-old boy has fallen and has a severe deformity of the forearm near the wrist. He has possibly
sustained a fracture of the:
A. proximal forearm.
B. superior forearm.
C. dorsal forearm.
D. distal forearm.

4. A fracture of the humerus just above the elbow would be described as a:

A. distal humerus fracture.
B. proximal elbow fracture.
C. distal forearm fracture.
D. proximal humerus fracture.

5. The topographic term used to describe the location of body parts that are closer toward the midline or center
of the body is:
A. lateral.
B. medial.
C. midaxillary.
D. midclavicular.

6. The topographic term used to describe the part of the body that is nearer to the feet is:
A. dorsal.
B. inferior.
C. internal.
D. superior.

7. In relation to the wrist, the elbow is:

A. distal.
B. medial.
C. lateral.
D. proximal.

8. In relation to the chest, the back is:

A. ventral.
B. inferior.
C. anterior.
D. posterior.

9. Which of the following anatomic terms is synonymous with the word “dorsal”?
A. medial
B. posterior
C. palmar
D. anterior

10. A young male jumped from a tree and landed feet first. What aspect of his body has sustained the initial
injury?
A. palmar
B. plantar
C. dorsal
D. ventral

11. The ___________ of the heart is the inferior portion of the left ventricles.
A. apex
B. base
C. dorsum
D. septum

12. Movement or motion away from the body’s midline is called:

A. flexion.
B. extension.
C. adduction.
D. abduction.

13. A patient has fractured both femurs. Anatomically, these injuries would be described as being:
A. medial.
B. proximal.
C. bilateral.
D. unilateral.

14. Relative to the kidneys, the liver is:

A. medial.
B. dorsal.
C. unilateral.
D. posterior.

15. An intoxicated 40-year-old male is found lying face down. How would you document his body’s position?
A. dorsal
B. supine
C. prone
D. recumbent

16. A patient in a semireclined position with the head elevated to facilitate breathing is in the ___________
position:
A. prone
B. supine
C. Fowler’s
D. recovery

17. Trendelenburg’s position is MOST accurately defined as a:

A. recumbent position with the head lower than the legs.
B. supine position with the legs elevated approximately 6" to 12".
C. recumbent position with the head elevated at a 25° to 45° angle.
D. supine position with the legs elevated 6" to 12" higher than the head.

18. The axial skeleton is composed of the:

A. arms, legs, and pelvis.
B. lower part of the torso and the legs.
C. skull, face, thorax, and vertebral column.
D. bones that comprise the pelvic girdle.

19. The brain connects to the spinal cord through a large opening at the base of the skull called the:
A. foramen ovale.
B. vertebral foramen.
C. spinous foramen.
D. foramen magnum.

20. Which of the following is NOT a facial bone?

A. mastoid
B. maxilla
C. mandible
D. zygoma

21. The ___________ is made up of the maxilla and zygoma, as well as the frontal bone of the cranium.
A. orbit
B. occiput
C. mastoid
D. sphenoid

22. The atlas is the:

A. point where the ribs attach to the sternum.
B. seventh cervical vertebra, which is easily palpable.
C. first cervical vertebra, which articulates with the skull.
D. attachment between the first and second cervical vertebrae.

23. The cervical spine is composed of ___________ vertebrae.

A. four
B. five
C. six
D. seven

24. Twelve pairs of ribs attach to what section of the spinal column?
A. sacral
B. lumbar
C. thoracic
D. coccyx

25. The ___________ portion of the spinal column is joined to the iliac bones of the pelvis.
A. sacrum
B. coccyx
C. lumbar
D. thoracic

26. The most distal four spinal vertebrae, which are fused together, form the:
A. ilium.
B. coccyx.
C. sacrum.
D. ischium.

27. Select the areas of the spinal column in descending order.

A. cervical, thoracic, sacral, lumbar, coccyx
B. cervical, thoracic, lumbar, sacral, coccyx
C. cervical, thoracic, coccyx, lumbar, sacral
D. cervical, lumbar, thoracic, sacral, coccyx

28. The most superior portion of the sternum is called the:

A. manubrium.
B. costal arch.
C. angle of Louis.
D. xiphoid process.

29. The inferior cartilaginous tip of the sternum is called the:

A. sternal notch.
B. xiphoid process.
C. angle of Louis.
D. jugular notch.
30. What three bones make up the shoulder girdle?
A. clavicle, scapula, humerus
B. acromion, clavicle, scapula
C. acromion, scapula, humerus
D. acromion, humerus, clavicle

31. The ____________ is a muscular dome that forms the inferior boundary of the thorax, separating the thorax
from the abdomen.
A. costal arch
B. diaphragm
C. mediastinum
D. costovertebral angle

32. The large, flat, triangular bone that overlies the posterior thoracic wall is called the:
A. glenoid.
B. clavicle.
C. scapula.
D. acromion.

33. The bones of the forearm are called the:

A. radius and ulna.
B. tibia and radius.
C. humerus and ulna.
D. radius and humerus.

34. The supporting bone of the arm is the:

A. ulna.
B. humerus.
C. radius.
D. clavicle.

35. The carpal bones form the:

A. foot.
B. ankle.
C. hand.
D. wrist.

36. Each pelvic bone is formed by the fusion of the:

A. sacrum and ischium.
B. ilium, ischium, and pubis.
C. pubis and acetabulum.
D. ilium, pubis, and sacrum.

37. The femoral head forms a ball-and-socket joint with the:

A. ilium.
B. ischium.
C. acetabulum.
D. femoral condyle.

38. The bony prominence on the lateral/superior aspect of the thigh is called the:
A. iliac crest.
B. sacroiliac joint.
C. sacral symphysis.
D. greater trochanter.

39. The bones that comprise the fingers and toes are called:
A. carpals.
B. metacarpals.
C. phalanges.
D. metatarsals

40. Anterior to the knee is a specialized bone called the:

A. tibia.
B. patella.
C. femur.
D. calcaneus.

41. The distal aspect of the tibia forms the:

A. lateral condyle.
B. medial malleolus.
C. Achilles tendon.
D. lateral malleolus.

42. The elbow is an example of a ____________ joint.

A. hinge
B. saddle
C. gliding
D. ball-and-socket

43. A person’s bones would become brittle if he or she was deficient in:
A. sodium.
B. calcium.
C. potassium.
D. magnesium.

44. Which of the following statements regarding smooth muscle is correct?

A. A person has no voluntary control over smooth muscle.
B. Smooth muscle is found exclusively within blood vessels.
C. The biceps and quadriceps are examples of smooth muscle.
D. Smooth muscle is under control of the voluntary nervous system.

45. Which of the following structures does NOT contain smooth muscle?
A. blood vessels
B. urinary system
C. skeletal system
D. gastrointestinal tract

46. Skeletal muscle is also called:

A. smooth muscle.
B. autonomic muscle.
C. voluntary muscle.
D. involuntary muscle.
47. A by-product of involuntary muscle contraction and relaxation is:
A. heat.
B. oxygen.
C. nitrogen.
D. lactic acid.

48. Which of the following is a function of the upper airway?

A. relaxes bronchiole smooth muscle
B. exchanges oxygen and carbon dioxide
C. creates sound from vocal cord vibration
D. warms and humidifies inhaled air

49. The vocal cords are located in the:

A. larynx.
B. pharynx.
C. oropharynx.
D. nasopharynx

50. The leaf-shaped flap of tissue that prevents food and liquid from entering the trachea during swallowing is
called the:
A. uvula.
B. epiglottis.
C. vallecula.
D. pharynx.

51. The firm cartilaginous ring that forms the inferior portion of the larynx is called the:
A. costal cartilage.
B. cricoid cartilage.
C. thyroid cartilage.
D. laryngo cartilage.

52. Together, the right and left lungs contain how many lobes?
A. three
B. four
C. five
D. six

53. As the bronchus divides into smaller bronchioles, the terminal ends of these smaller passages form the:
A. pleura.
B. alveoli.
C. bronchi.
D. capillaries.

54. The diaphragm is a unique muscle because it:

A. is the exclusive muscle of breathing.
B. does not receive impulses from the brain.
C. is both a voluntary and involuntary muscle.
D. does not have striations like skeletal muscle.

55. The diaphragm and intercostal muscles contract during:

A. inhalation.
B. exhalation.
C. respiration.
D. ventilation.

56. Negative pressure breathing involves:

A. relaxing the respiratory muscles.
B. a drop in pressure within the chest cavity.
C. pushing or forcing air into the lungs.
D. increasing airway resistance during breathing.

57. How does respiration differ from ventilation?

A. Ventilation occurs when air is forced into the lungs, whereas respiration occurs when air is drawn or sucked
into the lungs.
B. Respiration occurs when the diaphragm and intercostal muscles contract, whereas ventilation occurs when
those same muscles relax.
C. Respiration occurs when oxygen is delivered to the cells of the body, whereas ventilation occurs when
carbon dioxide is removed.
D. Respiration is the process of gas exchange, whereas ventilation is the simple movement of air between the
lungs and the environment.

58. Oxygen and carbon dioxide pass across the alveolar membrane in the lungs through a process called:
A. osmosis.
B. breathing.
C. diffusion.
D. ventilation.

59. Breathing occurs as the result of a(n):

A. decrease in oxygen, which increases the pH of the cerebrospinal fluid (CSF).
B. increase in oxygen, which decreases the pH of the CSF.
C. decrease in carbon dioxide, which increases the pH of the CSF.
D. increase in carbon dioxide, which decreases the pH of the CSF.

60. Which of the following statements regarding the medulla oblongata is correct?
A. The medulla reduces the rate and depth of breathing if it detects an increase in carbon dioxide levels.
B. The medulla is sensitive to pH changes and sends messages via the phrenic nerve to contract the diaphragm.
C. The medulla’s primary role is to increase your level of oxygen, not to decrease your level of carbon dioxide.
D. The medulla is a portion of the cerebrum and primarily responds to an increase in the pH of CSF.

61. Relative to the adult’s airway, the child’s:

A. tongue takes up less space in the pharynx.
B. pharynx is smaller and less deeply curved.
C. trachea is smaller, softer, and less flexible.
D. mouth and nose are proportionately larger.

62. The backup system of respiratory control, which is based on low concentrations of oxygen in the blood, is
called the:
A. hypoxic drive.
B. pneumotaxic drive.
C. hypocarbic drive.
D. oxyhemoglobin drive.
63. The dorsal respiratory group (DRG) is a part of the brain stem and is responsible for:
A. initiating inspiration.
B. inhibiting deep inspiration.
C. controlling expiration.
D. decreasing respiratory depth.

64. Which of the following signs of respiratory distress is typically unique to infants and children?
A. seesaw respirations
B. unequal breath sounds
C. unequal chest expansion
D. irregular breathing pattern

65. What function does the pneumotaxic center serve?

A. stimulates the DRG, resulting in prolonged inspiration
B. inhibits the DRG, but only affects the respiratory rate
C. inhibits the DRG, resulting in shorter, faster respirations
D. stimulates the DRG, resulting in longer, slower respirations

66. Both areas of the pons are used to:

A. provide forced inspiration or expiration as needed.
B. augment respirations during emotional or physical stress.
C. ensure that the lungs do not overinflate during breathing.
D. set the base rate and depth of breathing in a healthy person.

67. The Hering-Breuer reflex is stimulated when:

A. excess carbon dioxide needs to be eliminated from the body.
B. stretch receptors in the chest wall detect that the lungs are too full.
C. the DRG stops and the process of expiration begins.
D. the brain stem senses that there is a low amount of oxygen in the blood.

68. The amount of air that remains in the lungs simply to keep them open is called:
A. tidal volume.
B. residual volume.
C. inspiratory reserve volume.
D. expiratory reserve volume.

69. Dead space is the portion of the respiratory system that:

A. includes the alveoli and capillaries surrounding the alveoli.
B. must be filled with air before gas exchange can take place.
C. receives oxygen but is unable to release carbon dioxide.
D. contains no alveoli and does not participate in gas exchange.

70. If an average-sized patient’s chest barely moves during inhalation, even if his or her respiratory rate is
normal, you should suspect that:
A. minute volume is decreased.
B. inspiratory reserve is increased.
C. overall tidal volume is increased.
D. expiratory reserve volume is decreased.

71. What is the minute volume of a patient with a tidal volume of 500 mL, a dead space volume of 150 mL, and
a respiratory rate of 16 breaths/min?
A. 5,600 mL
B. 6,000 mL
C. 7,200 mL
D. 8,000 mL

72. Signs of adequate breathing in the adult include all of the following, EXCEPT:
A. a reduction in tidal volume.
B. respirations of 20 breaths/min.
C. bilaterally clear breath sounds.
D. rhythmic inhalation and exhalation.

73. Which of the following is MOST characteristic of adequate breathing in an adult?

A. use of the accessory muscles in the neck and cyanosis
B. respirations of 30 breaths/min and reduced tidal volume
C. cool, clammy skin and retractions above the clavicles
D. respirations of 20 breaths/min and bilateral chest movement

74. Which of the following statements regarding agonal respirations is correct?

A. Agonal respirations result in excessive tidal volume.
B. Agonal respirations typically occur before the heart stops.
C. Agonal respirations are ineffective and need to be assisted.
D. Agonal respirations are characterized by fast irregular breaths.

75. The heart muscle is called the:

A. epicardium.
B. myocardium.
C. pericardium.
D. endocardium.

76. Which of the following statements regarding the heart is correct?

A. It is under control of the autonomic nervous system.
B. It can tolerate an interruption of oxygen for 5 minutes.
C. It receives its blood supply from the pulmonary arteries.
D. It relies on an external electrical source to correctly function.

77. The primary function of the right atrium is to:

A. receive blood from the vena cava.
B. pump blood to the pulmonary artery.
C. receive blood from the pulmonary veins.
D. pump blood to the lungs for reoxygenation.

78. Contraction of the right ventricle causes:

A. closure of the mitral and aortic valves.
B. a return of blood from the pulmonary veins.
C. blood to flow into the pulmonary circulation.
D. ejection of blood into the systemic circulation.

79. The left side of the heart receives oxygenated blood from the lungs through the:
A. pulmonary veins.
B. pulmonary arteries.
C. inferior venae cavae.
D. superior venae cavae.
80. At rest, the normal adult heart rate should not exceed:
A. 70 beats/min.
B. 80 beats/min.
C. 90 beats/min.
D. 100 beats/min.

81. During each heartbeat, ___________ of blood is ejected from the adult heart. This is called stroke volume
(SV).
A. 40 to 50 mL
B. 70 to 80 mL
C. 90 to 100 mL
D. 100 to 120 mL

82. Cardiac output (CO) is affected by:

A. heart rate only.
B. stroke volume only.
C. stroke volume and heart rate.
D. the patient’s blood pressure.

83. The electrical impulse of the heart normally begins at the:

A. sinoatrial node.
B. bundle of His.
C. Purkinje fibers.
D. atrioventricular node.

84. What happens when blood volume is lost from the body?
A. Arterial blood is diverted to the skin and muscles.
B. The veins dilate to increase systemic perfusion.
C. Widespread vasodilation causes blood pressure to decrease.
D. The arteries contract to increase the blood pressure.

85. The major artery that supplies all other arteries with blood is the:
A. aorta.
B. carotid.
C. brachial.
D. femoral.

86. Which of the following are central pulses?

A. femoral and carotid
B. brachial and radial
C. temporal and pedal
D. popliteal and ulnar

87. Which of the following arteries does NOT carry highly oxygenated blood?
A. aorta
B. renal
C. femoral
D. pulmonary

88. The artery that can be palpated on the anterior surface of the foot is the:
A. ventral pedis.
B. dorsalis pedis.
C. anterior tibial.
D. posterior tibial.

89. The exchange of oxygen and nutrients for waste products of metabolism occurs at the cellular level in the:
A. venules.
B. arteries.
C. arterioles.
D. capillaries.

90. The descending aorta branches into the:

A. deep femoral arteries.
B. internal carotid arteries.
C. common iliac arteries.
D. external carotid arteries.

91. Capillary sphincter closure during internal or external bleeding is detrimental because:
A. waste products are not removed and nutrients are not delivered to the cells.
B. available blood is shunted off to another venule while still carrying oxygen.
C. high levels of oxygen remain in the cell and can cause significant damage.
D. carbon dioxide and other waste can enter the cell, but oxygen cannot enter.

92. Deoxygenated blood from the abdomen, pelvis, and lower extremities is returned to the right atrium via the:
A. common iliac vein.
B. coronary sinus vein.
C. inferior vena cava.
D. superior vena cava.

93. Worn out blood cells, foreign substances, and bacteria are filtered from the blood by the:
A. liver.
B. spleen.
C. kidney.
D. pancreas.

94. Which of the following statements regarding plasma is correct?

A. Plasma transports the blood cells and nutrients.
B. Approximately 45% of the blood is composed of plasma.
C. Plasma has no role in the body’s blood-clotting mechanism.
D. Most of the body’s plasma is contained within the large veins.

95. Hemoglobin is a molecule that attaches to ___________ and carries oxygen.

A. monocytes
B. erythrocytes
C. leukocytes
D. thrombocytes

96. White blood cells are also called leukocytes and function by:
A. producing the body’s erythrocytes.
B. producing blood-clotting factors.
C. protecting the body from infection.
D. carrying oxygen and other nutrients.
97. What is the function of platelets?
A. initial formation of a blood clot
B. transport of oxygen and nutrients
C. defense against invading organisms
D. transport of cellular waste materials

98. The phase of the cardiac cycle in which the ventricles fill with blood is called:
A. systole.
B. diastole.
C. cardiac output.
D. stroke volume.

99. A patient has a blood pressure of 130/70 mm Hg. The “130” represents:
A. atrial contraction.
B. ventricular filling.
C. ventricular contraction.
D. ventricular relaxation.

100. The average adult has approximately ___________ of blood in his or her body.
A. 3 L
B. 4 L
C. 5 L
D. 6 L

101. The circulation of blood within an organ or tissue in adequate amounts to meet the cells’ current needs is
called:
A. respiration.
B. perfusion.
C. metabolism.
D. cardiac output.

102. ___________ pressure is the pressure exerted by a liquid and occurs when blood is moved through the
artery at relatively high pressures.
A. Hydrostatic
B. Osmotic
C. Oncotic
D. Diffusion

103. Key hormones of the sympathetic nervous system include:

A. acetylcholine and insulin.
B. epinephrine and norepinephrine.
C. glucagon and noradrenaline.
D. norepinephrine and acetylcholine.

104. Stimulation of alpha-adrenergic receptors results in:

A. increased heart rate.
B. dilation of the blood vessels.
C. increased cardiac contractility.
D. constriction of the blood vessels.
105. An increase in heart rate and contractility occurs due to stimulation of:
A. beta-1 receptors.
B. beta-2 receptors.
C. alpha-1 receptors.
D. alpha-2 receptors.

106. Stimulation of the parasympathetic nervous system would result in:

A. tachycardia.
B. a strong pulse.
C. vasoconstriction.
D. a slow heart rate.

107. Which of the following statements regarding nervous system control of the cardiovascular system is
correct?
A. When stimulated, the parasympathetic nervous system is responsible for increasing the heart rate.
B. Alpha-adrenergic receptors are located exclusively in the heart and are stimulated by epinephrine.
C. Baroreceptors located throughout the body provide information to the brain regarding the blood pressure.
D. The sympathetic and parasympathetic nervous systems work together to perform the same function.

108. Activities such as walking, talking, and writing are regulated exclusively by the:
A. central nervous system.
B. somatic nervous system.
C. autonomic nervous system.
D. involuntary nervous system.

109. The central nervous system is composed of the:

A. brain and spinal cord.
B. brain and sensory nerves.
C. motor and sensory nerves.
D. spinal cord and sensory nerves.

110. The autonomic nervous system controls all of the following functions, EXCEPT:
A. digestion.
B. breathing.
C. breath holding.
D. vessel dilation.

111. The largest portion of the brain, which is commonly referred to as the “gray matter,” is called the:
A. cerebrum.
B. cerebellum.
C. brain stem.
D. diencephalon.

112. The part of the brain that controls the left side of the body is the:
A. right side cerebrum.
B. left side cerebrum.
C. left parietal lobe.
D. right temporal lobe.

113. Trauma to the __________ lobe of the brain would likely result in visual disturbances.
A. frontal
B. parietal
C. temporal
D. occipital

114. Which part of the central nervous system is responsible for coordinating bodily movements such as writing
or sewing?
A. cerebrum
B. cerebellum
C. brain stem
D. hypothalamus

115. All necessary life functions are coordinated in what part of the brain?
A. cerebrum
B. gray matter
C. cerebellum
D. brain stem

116. Your ability to remain awake is a function of the:

A. cerebellum.
B. limbic system.
C. pons and medulla.
D. reticular activating system.

117. The connecting nerve, a nerve of the peripheral nervous system, functions by:
A. connecting the sensory and motor nerves and bypassing the brain.
B. connecting motor nerves directly to the walls of the blood vessels.
C. connecting sensory nerves directly to the posterior cerebral cortex.
D. connecting the spinal cord directly to the target muscle or organ.

118. What set of nerves is responsible for carrying information from the body to the central nervous system?
A. motor
B. cranial
C. vertebral
D. sensory

119. Which of the following skin layers contains sweat and oil glands, hair follicles, blood vessels, and nerve
endings?
A. dermis
B. epidermis
C. sebaceous
D. subcutaneous

120. What layer of the skin is composed of fatty tissue and serves as an insulator for the body?
A. epidermis
B. subcutaneous
C. dermal
D. sebaceous

121. Which of the following is NOT a function of the skin?

A. sensory reception
B. temperature regulation
C. metabolic coordination
D. pressure and pain perception
122. Which of the following organs is NOT part of the digestive system?
A. kidney
B. pancreas
C. stomach
D. gallbladder

123. The __________ fills the entire anteroposterior depth of the right upper quadrant (RUQ) of the abdomen.
A. liver
B. spleen
C. pancreas
D. stomach

124. Which organ lies in the lateral and posterior portion of the left upper quadrant (LUQ) of the abdomen?
A. liver
B. stomach
C. cecum
D. spleen

125. Which of the following organs or structures lies within the retroperitoneal space?
A. spleen
B. kidneys
C. gallbladder
D. abdominal aorta

126. The kidneys and pancreas are called retroperitoneal organs because they:
A. are protected by the anterior rib cage.
B. are located behind the abdominal cavity.
C. sit in front of the liver, spleen, and stomach.
D. lie just anterior to the costovertebral angle.

127. The exocrine gland of the pancreas secretes:

A. bile.
B. insulin.
C. pancreatic juice.
D. glucose.

128. Bile is produced by the liver and concentrated and stored in the:
A. kidneys.
B. pancreas.
C. stomach.
D. gallbladder.

129. The primary organ responsible for absorption of products of digestion is the:
A. pancreas.
B. gallbladder.
C. small intestine.
D. large intestine.

130. Which of the following systems is responsible for releasing hormones that regulate body activities?
A. skeletal
B. nervous
C. endocrine
D. reproductive

131. Abnormalities in metabolism are MOST likely caused by dysfunction of the:

A. pancreas.
B. thyroid gland.
C. adrenal gland.
D. parathyroid gland.

132. Which of the following glands regulates the function of all other endocrine glands in the body?
A. thyroid
B. pituitary
C. adrenal
D. parathyroid

133. Which of the following statements regarding the kidneys is correct?

A. The kidneys eliminate toxic waste products from the body and control its balance of water and salt.
B. Both kidneys are located in the anterior abdominal cavity and lie in between the liver and the spleen.
C. Since the kidneys require little oxygen, only 5% of your blood volume passes through them each minute.
D. A series of small blood vessels attach the kidneys directly to the superior vena cava and renal arteries.

134. Urine is transported from the kidneys to the urinary bladder via the:
A. prostate.
B. ureters.
C. urethra.
D. renal duct.

135. What is the function of the fallopian tubes?

A. connect both ovaries together
B. supply blood to the uterine lining
C. produce progesterone and estrogen
D. transport a mature egg to the uterus

136. Large amounts of adenosine triphosphate (ATP) is generated when:

A. the cells function without oxygen.
B. circulating blood glucose levels fall.
C. the cells function with adequate oxygen.
D. carbon dioxide levels in the blood are high.

137. The waste products of aerobic metabolism include:

A. ATP and glucose.
B. glucose and lactic acid.
C. uric acid and nitrogen.
D. carbon dioxide and water.

138. Which of the following statements regarding anaerobic metabolism is correct?

A. Anaerobic metabolism can be supported in most of the body’s cells for up to 10 minutes.
B. Anaerobic metabolism produces lactic acid and occurs when cellular oxygen is limited.
C. The body functions optimally and produces maximum ATP during anaerobic metabolism.
D. Without anaerobic metabolism, perfusion to the body would suffer and cellular death would occur.
139. Pathophysiology is the study of the functional changes that occur when the body reacts to a particular:
A. medication.
B. assessment.
C. disease.
D. protocol.

140. The air you breathe is _______ oxygen, and the air you exhale is _______ oxygen.
A. 16%, 25%
B. 21%, 16%
C. 25%, 32%
D. 21%, 35%

CHAPTER 7: LIFE SPAN DEVELOPMENT

1. Which of the following statements regarding an infant’s vital signs is correct?

A. An infant’s heart rate generally ranges between 70 and 110 beats/min.
B. An infant’s normal body temperature is typically higher than a preschooler’s.
C. By 6 months of age, an infant’s normal tidal volume is 2 to 4 mL/kg.
D. An infant’s normal heart rate increases by 10 beats/min each month.

2. An infant’s blood pressure typically increases with age because:

A. the infant’s total blood volume decreases with age.
B. his or her normal heart rate usually increases with age.
C. as the infant gets older, his or her blood vessels dilate.
D. blood pressure directly corresponds to body weight.

3. You are dispatched to a call for a 4-month-old infant with respiratory distress. While you prepare to take
care of this child, you must remember that:
A. small infants are nose breathers and require clear nasal passages at all times.
B. assisted ventilations in infants often need to be forceful to inflate their lungs.
C. the infant’s proportionately small tongue often causes an airway obstruction.
D. an infant’s head should be placed in a flexed position to prevent obstruction.

4. Infants are often referred to as “belly breathers” because:

A. their rib cage is less rigid and the ribs sit horizontally.
B. an infant’s ribs are brittle and are less able to expand.
C. their intercostal muscles are not functional.
D. their diaphragm does not receive impulses from the brain.

5. Which of the following is an anatomic difference between children and adults?

A. The ribcage of an infant is less flexible than an adult’s.
B. An infant’s tongue is proportionately larger than an adult’s.
C. The trachea of an infant is proportionately longer than an adult’s.
D. An infant’s head accounts for less body weight than an adult’s.

6. An infant or small child’s airway can be occluded if it is overextended or overflexed because:

A. the back of the head is flat, which prevents a neutral position.
B. he or she has a long neck, which makes the trachea prone to collapse.
C. the occiput is proportionately large and the trachea is flexible.
D. the tongue is proportionately small and can fall back into the throat.

7. Which of the following describes the Moro reflex?

A. When something touches a neonate’s cheek, he or she instinctively turns his or her head toward the touch.
B. The neonate opens his or her arms wide, spreads his or her fingers, and seems to grasp at something after
being startled.
C. An infant’s heart rate decreases secondary to hypoxia because he or she depends heavily on the heart rate to
perfuse the body.
D. When the sole of the foot is stroked with a blunt object, the big toe lifts upward and the other toes fan
outward.

8. The anterior fontanelle fuses together between the ages of:

A. 3 and 4 months.
B. 6 and 8 months.
C. 7 and 14 months.
D. 9 and 18 months.

9. You are assessing a 13-month-old female who is running a fever and has been vomiting. While you are
performing your physical examination on this child, you will MOST likely find that she:
A. is unable to track your movements with her eyes.
B. responds to her name but is fearful of your presence.
C. will readily allow you to separate her from her mother.
D. has bulging fontanelles secondary to severe dehydration.

10. Which of the following are noticeable characteristics of a 9-month-old infant?

A. places objects in the mouth, pulls himself or herself up
B. knows his or her name, can walk without any assistance
C. responds to his or her name, crawls around efficiently
D. walks without help, becomes frustrated with restrictions

11. In contrast to secure attachment, anxious-avoidant attachment occurs when a child:

A. becomes acutely anxious at the presence of strangers or in unfamiliar surroundings.
B. clings to a parent or caregiver because he or she knows that the person can be trusted.
C. shows little emotional response to a parent or caregiver following repeated rejection.
D. reaches out and explores because he or she knows that the parents are there as a safety net.

12. At what age does separation anxiety typically peak in infants and small children?
A. 6 to 8 months
B. 10 to 18 months
C. 18 to 24 months
D. 24 to 36 months

13. An infant or small toddler would MOST likely gain trust in an individual who:
A. provides an organized, routine environment.
B. maintains eye contact, even if the person is a stranger.
C. frequently changes the infant or toddler’s regular routine.
D. does not tower over him or her and avoids painful procedures.

14. Which of the following statements regarding toddlers and preschoolers is correct?
A. The normal respiratory rate in toddlers and preschoolers is between 12 and 20 breaths/min.
B. Toddlers and preschoolers have well-developed lung musculature, even though they have less lung tissue.
C. Muscle mass and bone density decrease in toddlers and preschoolers because of increased physical activity.
D. Toddlers and preschoolers commonly experience upper respiratory infections because of a loss of passive
immunity.
15. The pulse rate of a child from ages 6 to 12 years is approximately:
A. 60 to 100 beats/min.
B. 70 to 120 beats/min.
C. 90 to 140 beats/min.
D. 100 to 150 beats/min.

16. In preconventional reasoning, children:

A. make decisions based on their conscience.
B. look for approval from their peers and society.
C. act almost purely to avoid punishment and to get what they want.
D. blame their actions on what they have observed in older children.

17. Which of the following is a physical change that typically occurs in the adolescent age group?
A. Secondary sexual development begins.
B. Muscle and bone growth both decrease.
C. The normal pulse rate steadily increases.
D. The systolic blood pressure decreases.

18. A 16-year-old female complains of vaginal bleeding and abdominal cramping that began several hours ago.
During your assessment interview, you should:
A. obtain the majority of your information from one of her parents.
B. inquire about the possibility of pregnancy in private, if possible.
C. avoid asking questions that she will feel uncomfortable answering.
D. recall that patients in this age group prefer not to be treated as adults.

19. Which of the following statements regarding psychosocial development in the adolescent age group is
correct?
A. Antisocial behavior and peer pressure peak around 14 to 16 years of age.
B. Family conflict decreases as the adolescent gains control of his or her life.
C. Adolescents are less fixated on their public image than younger children.
D. Because they think rationally, adolescents are at the lowest risk for suicide.

20. The human body should be functioning at its optimal level between the ages of:
A. 18 and 22 years.
B. 19 and 25 years.
C. 21 and 30 years.
D. 25 and 35 years.

21. The low normal systolic blood pressure for a 30-year-old is:
A. 60 mm Hg.
B. 70 mm Hg.
C. 80 mm Hg.
D. 90 mm Hg.

22. Physical changes that typically occur in early adults include an:
A. increase in muscle strength and reflexes.
B. increase in height because of spinal disc expansion.
C. increase in fatty tissue, which leads to weight gain.
D. increase in respiratory rate due to increased metabolism.
23. The average pulse rate of individuals between 19 and 60 years of age is typically:
A. 60 beats/min.
B. 70 beats/min.
C. 80 beats/min.
D. 90 beats/min.

24. Which of the following statements regarding middle adults is correct?

A. Cardiovascular health becomes an issue in this age group, as does the greater incidence of cancer.
B. Women in the middle adult age group typically experience menopause in their late 50s or early 60s.
C. Significant impairments in hearing and vision begin to occur in persons between the ages of 41 and 44
years.
D. Increased cholesterol levels in the middle adult age group often do not respond to exercise and diet.

25. Why do middle adults commonly experience financial concerns?

A. They are typically receiving social security and must budget with a fixed income.
B. Most people in the middle adult age group have chronic illnesses and cannot work.
C. They are preparing for retirement but must still manage everyday financial demands.
D. The majority of middle adults still have small children that live at home with them.

26. At present, the average life expectancy is ________ years, while the maximum life expectancy is estimated
at ________ years.
A. 68, 100
B. 70, 102
C. 72, 110
D. 78, 120

27. Which of the following is NOT a common factor that would affect a 75-year-old patient’s vital signs?
A. medications
B. overall health
C. increased weight
D. medical conditions

28. The decline in cardiac function that commonly occurs in late adulthood is MOST often related to:
A. hypotension.
B. medication use.
C. kidney failure.
D. atherosclerosis.

29. You suspect that a 75-year-old man has internal injuries after he fell and struck his ribs and abdomen on the
corner of a table. When assessing and treating an injured patient of this age, you must recall that:
A. his ability to physiologically compensate for his injury may be impaired due to an inability to increase
cardiac output.
B. it is not uncommon to observe heart rates in excess of 150 beats/min in elderly patients with internal
injuries.
C. blood pressure is usually adequately maintained because the blood vessels of older people can contract
easily.
D. functional blood volume in patients of this age steadily increases due to increased production of red blood
cells.

30. With increasing age, the heart must work harder to move the blood effectively because:
A. the blood vessels become stiff.
B. the arteries dilate significantly.
C. diastolic blood pressure decreases.
D. the blood thickens as a person ages.

31. When assessing an 80-year-old patient in shock, it is important to remember that:

A. it is common to see a more significant increase in heart rate than what would be expected in younger adults.
B. age-related changes in the cardiovascular system may make the patient less able to compensate for
decreased perfusion.
C. the patient’s cardiac output is able to increase by nearly 200% in response to the decrease in perfusion.
D. in older adults, it is especially common to observe a significant decrease in heart rate in response to shock.

32. Breathing is often more labor intensive in older adults because the:
A. elasticity of the lungs decreases.
B. surface area of the alveoli increases.
C. overall size of the airway decreases.
D. diaphragm and intercostal muscles enlarge.

33. Factors that contribute to a decline in the vital capacity of an elderly patient include all of the following,
EXCEPT:
A. a loss of respiratory muscle mass.
B. increased stiffness of the thoracic cage.
C. decreased residual volume.
D. increased surface area available for air exchange.

34. In late adults, the amount of air left in the lungs after expiration of the maximum amount of air:
A. remains unchanged because the lungs have become accustomed to years of breathing pollution.
B. decreases, resulting in widespread collapsing of the alveoli and impaired diffusion of gases.
C. increases, which hampers diffusion of gases because of stagnant air that remains in the alveoli.
D. decreases, which increases diffusion in the lungs and causes an accumulation of carbon dioxide.

35. Why does the incidence of diabetes mellitus increase with age?
A. decreased food intake, decreased weight gain, and decreased blood sugar levels
B. decreased physical activity, increased weight gain, and decreased insulin production
C. increased physical activity, increased food intake, and increased insulin production
D. decreased physical activity, increased weight gain, and decreased blood sugar levels

36. Age-related changes in the renal system result in:

A. a significant increase in filtration, which causes the excretion of large amounts of water from the body.
B. a decreased ability to clear wastes from the body and a decreased ability to conserve fluids when needed.
C. the formation of large amounts of urine secondary to an increase in kidney mass of up to 20%.
D. dilation of the blood vessels that supply the nephrons, which allows the kidneys to maintain their function.

37. Which of the following statements regarding age-related changes in the nervous system is correct?
A. Interconnections between brain cells often prevent a loss of knowledge or skill, despite a loss of neurons.
B. The metabolic rate in the brain increases with age, but the consumption of oxygen decreases significantly.
C. Generally speaking, the brain increases in size by 10% to 20% by the time a person reaches 80 years of age.
D. Because of a decrease in the number of brain cells, a person’s level of intelligence decreases with age.

38. The risk of bleeding in the skull, which increases with age, is MOST directly related to:
A. blood vessel dilation.
B. a decrease in neurons.
C. meningeal deterioration.
D. shrinkage of the brain.
39. When communicating with an older patient, it is important to remember that:
A. deafness and blindness are a normal part of the process of aging.
B. most older patients are confused due to a decrease in brain cells.
C. age-related changes diminish the effectiveness of the eyes and ears.
D. the majority of older patients experience a loss of low-frequency hearing.

40. According to the terminal drop hypothesis:

A. a person’s physical health begins to decline after the age of 75 years.
B. most late-stage adults retain high brain function until 1 month before death.
C. most elderly patients experience depression after the death of a loved one.
D. mental function is presumed to decline in the 5 years preceding death.

CHAPTER 8: LIFTING AND MOVING PATIENTS

1. The _________ is both the mechanical weight-bearing base of the spinal column and the fused central
posterior section of the pelvic girdle.
A. coccyx
B. sacrum
C. thorax
D. ischium

2. When a person is standing upright, the weight of anything being lifted and carried in the hands is FIRST
reflected onto the:
A. pelvic girdle.
B. spinal column.
C. thigh muscles.
D. shoulder girdle.

3. When the shoulder girdle is aligned over the pelvis during lifting:
A. the weight is exerted straight down the vertebrae.
B. the hands can be held further apart from the body.
C. the muscles of the back experience increased strain.
D. the risk of back injuries is significantly increased.

4. An EMT may injure his or her back, even if it is straight, if the:

A. back is bent forward at the hips.
B. hands are held close to the legs.
C. shoulder is aligned over the pelvis.
D. force is exerted straight down the spine.

5. The FIRST rule of safe lifting is to:

A. always lift with your palms facing down.
B. spread your legs approximately 20″ apart.
C. keep your back in a slightly curved position.
D. keep your back in a straight, vertical position.

6. Which of the following statements regarding the power lift is correct?

A. It involves using your lower back instead of your legs to lift.
B. The leg muscles should remain relaxed during the power lift.
C. It is the safest and most powerful method of lifting a patient.
D. It is not recommended for people with weak knees or thighs.

7. The proper technique for using the power grip is to:

A. lift with your palms up.
B. rotate your palms down.
C. hold the handle with your fingers.
D. position your hands about 6″ apart.

8. Which of the following statements regarding patient weight distribution is correct?

A. The majority of a horizontal patient’s weight is in the torso.
B. Most of the patient’s weight rests on the foot end of the stretcher.
C. A semi-sitting patient’s weight is equally distributed on both ends.
D. The EMT at the patient’s head will bear the least amount of weight.

9. General guidelines for carrying a patient on a stretcher include:

A. maintaining slight flexion of your back.
B. leaning back from your waist when lifting.
C. slightly twisting your body when carrying.
D. constant communication with your partners.

10. To minimize the risk of injuring yourself when lifting or moving a patient, you should:
A. flex at the waist instead of the hips.
B. avoid the use of log rolls or body drags.
C. use a direct carry whenever possible.
D. keep the weight as close to your body as possible.

11. Which of the following MOST accurately describes the correct position of the EMTs who are executing the
diamond carry technique?
A. two at the head, two at the feet, and a fifth EMT balancing the torso
B. one at the head, two at the feet, and a fourth EMT balancing the torso
C. one at the head, one at the feet, and one on each side of the patient’s torso
D. two at the head, one at the feet, and one on the left side of the patient’s torso

12. When carrying a patient on a backboard up or down stairs:

A. keep your palms facing down.
B. keep the head end elevated.
C. carry the patient headfirst.
D. keep the foot end elevated.

13. When carrying a patient up or down stairs, you should avoid:

A. flexing your body at the knees.
B. the use of more than two EMTs.
C. using a wheeled stretcher whenever possible.
D. the use of a long backboard or scoop stretcher.

14. Which of the following is the MOST appropriate device to use when immobilizing a patient with a
suspected spinal injury?
A. long backboard
B. scoop stretcher
C. portable stretcher
D. wheeled stretcher
15. In order to facilitate a safe and coordinated move, the team leader should:
A. be positioned at the feet so the team can hear.
B. use preparatory commands to initiate any moves.
C. speak softly but clearly to avoid startling the patient.
D. never become involved in the move, just direct the move.

16. With proper technique, you and your partner should be able to safely lift a patient who weighs up to ______
lb.
A. 150
B. 175
C. 190
D. 220

17. You should not attempt to lift a patient who weighs more than 250 lb with fewer than _______ rescuers,
regardless of individual strength.
A. three
B. four
C. five
D. six

18. You and your partner respond to the scene of a 49-year-old male with acute abdominal pain. As you enter
his residence, you find him lying on the floor in severe pain. He is conscious and alert. The patient appears
to weigh in excess of 350 lb. Your FIRST action should be to:
A. request the fire department if one attempt to move him fails.
B. encourage the patient to walk himself to the awaiting ambulance.
C. assess him and then move him to the stretcher with a direct carry.
D. request additional personnel before making any attempts to lift him.

19. As you and your partner are carrying a stable patient down a flight of stairs in a stair chair, you feel a
sudden, sharp pain in your lower back. You should:
A. reposition your hands and continue to move the patient.
B. stop the move and request additional lifting assistance.
C. guide your partner while moving the chair backwards.
D. stop the move and have the patient walk down the stairs.

20. When pulling a patient, you should extend your arms no more than ________ in front of your torso.
A. 5″ to 10″
B. 10″ to 15″
C. 15″ to 20″
D. 20″ to 30″

21. When using a body drag to pull a patient who is on the ground, you should:
A. kneel to minimize the distance that you will have to lean over.
B. extend your elbows as far beyond your anterior torso as possible.
C. bend your back laterally to maximize your amount of pulling power.
D. avoid situations involving strenuous effort lasting more than 5 minutes.

22. To avoid injury when pushing a patient or other object, you should:
A. push the patient from an overhead position if possible.
B. avoid pushing the patient with your elbows fully extended.
C. push from the area of your body between the knees and hips.
D. kneel if you are pushing an object that is above waist level.

23. Which of the following statements regarding an emergency patient move is correct?
A. The spine must be fully immobilized prior to performing an emergency move.
B. An emergency move is performed before the primary assessment and treatment.
C. The patient is dragged against the body’s long axis during an emergency move.
D. It is not possible to perform an emergency move without injuring the patient.

24. In which of the following situations is an emergency patient move indicated?

A. A patient has an altered mental status or is in shock.
B. The EMT is unable to protect the patient from scene hazards.
C. The EMT has to gain access to lesser-injured patients in a vehicle.
D. A significant mechanism of injury is involved.

25. Which of the following steps is NOT proper procedure when performing an emergency move?
A. using a long-axis body drag during the move
B. pulling the patient on a blanket or similar object
C. pulling the patient’s clothing in the shoulder area
D. lifting the patient by the belt to move him or her

26. You and your partner enter the residence of an elderly couple, both of whom are found unconscious in their
bed. There is no evidence of trauma. As you begin your assessment, you and your partner notice the smell of
natural gas in the residence. Which of the following should be your MOST appropriate action?
A. Perform a rapid assessment and then move the patients from their residence.
B. Request another ambulance to assist with lifting and moving the patients.
C. Quickly exit the residence and request the fire department to move the patients.
D. Rapidly remove the patients from their residence using a blanket or clothes drag.

27. Which of the following situations would require an urgent patient move?
A. conscious patient with abrasions and a possibly fractured humerus
B. imminent risk of a fire or explosion in or near the patient’s vehicle
C. semiconscious patient with shallow respirations and signs of shock
D. stable patient who is blocking access to a critically injured patient

28. A critical aspect of the rapid extrication technique is to:

A. maintain stabilization of the spine at all times.
B. move the patient as quickly as you possibly can.
C. extricate the patient with one coordinated move.
D. apply a vest-style device before moving the patient.

29. Upon arriving at the scene of a motor vehicle crash, you find a single patient still seated in his car. There are
no scene hazards. As you approach the vehicle, you note that the patient is semiconscious and has a large
laceration to his forehead. You should:
A. direct your partner to apply manual in-line support of the patient’s head.
B. apply a cervical collar and quickly remove the patient with a clothes drag.
C. apply a vest-style extrication device before attempting to move the patient.
D. slide a long backboard under his buttocks and lay him sideways on the board.

30. Situations in which you should use the rapid extrication technique include all of the following, EXCEPT:
A. a patient who can be properly assessed while still in the vehicle.
B. a patient who blocks access to another seriously injured patient.
C. a patient who needs immediate care that requires a supine position.
D. a patient whose condition requires immediate transport to the hospital.

31. When performing the rapid extrication technique to remove a patient from his or her vehicle, you should:
A. apply a vest-style extrication device prior to moving the patient.
B. apply a cervical collar and immobilize the patient on a short backboard.
C. grasp the patient by the clothing and drag him or her from the car.
D. apply a cervical collar and remove the patient on a long backboard.

32. The MOST serious consequence of a poorly planned or rushed patient move is:
A. unnecessarily wasting time.
B. injury to you or your patient.
C. causing patient anxiety or fear.
D. confusion among team members.

33. A 56-year-old female is found supine in a narrow hallway of her mobile home. She complains of severe
weakness and dizziness, and states that she is unable to walk. There is no evidence of trauma and the patient
states that she did not fall. How should you and your partner move this patient to a more spacious area?
A. direct carry
B. extremity lift
C. scoop stretcher
D. emergency move

34. In which of the following situations would a direct ground lift be the MOST appropriate method of moving
a patient?
A. a conscious patient complaining of abdominal pain
B. a patient who complains of hip pain following a fall
C. a pedestrian with back pain after being struck by a car
D. an unconscious patient with a possible ischemic stroke

35. The extremity lift would NOT be appropriate to use on a patient:

A. without a spinal injury.
B. with a deformed humerus.
C. who complains of nausea.
D. with forearm lacerations.

36. The direct carry is used to transfer a patient:

A. with multiple long bone injuries.
B. with a possible cervical spine injury.
C. from a bed to the ambulance stretcher.
D. who cannot be placed on a backboard.

37. What is the MOST appropriate method to use when moving a patient from his or her bed to the wheeled
stretcher?
A. log roll
B. direct carry
C. extremity carry
D. draw sheet method

38. Which of the following conditions or situations presents the MOST unique challenge to the EMT when
immobilizing an elderly patient on a long backboard?
A. joint flexibility
B. patient disorientation
C. naturally deformed bones
D. abnormal spinal curvature

39. An 81-year-old female fell and struck her head. You find the patient lying on her left side. She is conscious
and complains of neck and upper back pain. As you are assessing her, you note that she has a severely
kyphotic spine. What is the MOST appropriate method of immobilizing this patient?
A. Apply a cervical collar and place her in a sitting position on the wheeled stretcher.
B. Immobilize her in a supine position on a long backboard and secure her with straps.
C. Leave her on her side and use blanket rolls to immobilize her to the long backboard.
D. Move her to a supine position and immobilize her with a scoop stretcher and padding.

40. In most instances, you should move a patient on a wheeled ambulance stretcher by:
A. pushing the foot of the stretcher while your partner guides the head.
B. pushing the head of the stretcher while your partner guides the foot.
C. slightly lifting the stretcher to prevent unnecessary patient movement.
D. retracting the undercarriage and carrying the stretcher to the ambulance.

41. In contrast to typical wheeled ambulance stretchers, features of a bariatric stretcher include:
A. a collapsible undercarriage.
B. a weight capacity of up to 650 lb.
C. increased stability due to a wider wheelbase.
D. two safety rails on both sides of the stretcher.

42. A folding or portable stretcher is MOST beneficial when:

A. a second patient must be transported on the squad bench of the ambulance.
B. an injured patient cannot be placed on a long board due to severe back pain.
C. a conscious, alert patient must be carried down several flights of steep stairs.
D. a patient requires full spinal immobilization when spinal injury is suspected.

43. You have two patients who were involved in a motor vehicle crash when their SUV struck a tree—one with
neck and back pain, and the other with a deformed left femur. The patient with the deformed femur states
that he does not want to be placed on a hard board, nor does he want a collar around his neck. What is the
MOST appropriate and practical method of securing these patients and placing them into the ambulance?
A. Immobilize both patients with a cervical collar and long backboard based on the mechanism of injury; place
one on the wheeled stretcher and the other on the squad bench.
B. Immobilize the patient with neck and back pain on a long backboard and place him on the wheeled
stretcher; place the patient with the deformed femur on a folding stretcher secured to the squad bench.
C. Immobilize the patient with neck and back pain on a long backboard and place him on the squad bench;
allow the patient with the deformed femur to sit on the wheeled stretcher.
D. Apply a traction splint to the patient with the deformed femur and place him on the wheeled stretcher; place
the patient with neck and back pain on the squad bench immobilized with a cervical collar and scoop
stretcher.

44. An unrestrained patient is sitting in his car after an automobile crash. He is conscious and alert, has no
visible trauma, and is complaining of neck and back pain. Before removing him from his car, you should:
A. slide a scoop stretcher under his buttocks and rotate him laterally.
B. apply a cervical collar and immobilize him with a vest-style device.
C. perform a detailed head-to-toe assessment and apply a cervical collar.
D. maintain manual stabilization of his head and grasp him by the clothes.

45. The MOST appropriate carrying device to use when moving a patient across rough or uneven terrain is the:
A. stair chair.
B. wheeled stretcher.
C. scoop stretcher.
D. basket stretcher.

46. Which of the following statements regarding the scoop stretcher is NOT correct?
A. The construction of the scoop stretcher prohibits x-rays while the patient is on it.
B. You must fully secure the patient to the scoop stretcher before moving him or her.
C. A scoop stretcher will provide adequate immobilization of a patient’s spinal column.
D. Both sides of the patient must be accessible in order for a scoop stretcher to be used.

47. When moving a conscious, weak patient down a flight of stairs, you should:
A. secure the patient to a scoop stretcher and carry him or her headfirst down the stairs to the awaiting
stretcher.
B. place the wheeled stretcher at the bottom of the stairs and carry the patient down the stairs with a stair chair.
C. collapse the undercarriage of the wheeled stretcher and carefully carry the patient down the stairs on the
stretcher.
D. assist the patient in walking down the stairs and place him or her on the wheeled stretcher at the bottom of
the stairs.

48. Which of the following statements regarding the neonatal isolette is correct?
A. The isolette serves to keep the neonate warm and protects from excess handling.
B. A freestanding isolette should be used, not one that is secured to the stretcher.
C. The safest type of isolette is one that takes the place of the ambulance stretcher.
D. If an isolette is not available, the neonate can safely be transported on the stretcher.

49. It is essential that you ____________ your equipment to prevent the spread of disease.
A. throw out
B. decontaminate
C. burn
D. store

50. Prior to applying medical restraints to a combative patient, you should:

A. have at least three rescuers present, one for the upper extremities, one for the lower extremities, and one for
the head.
B. place the patient in a prone position to avoid airway and breathing compromise once restrained and placed
onto the stretcher.
C. advise the patient that medical restraint is necessary, but can be removed if he or she cooperates with you
during transport.
D. evaluate the patient for potentially correctible cause of combativeness, such as head injury, hypoxia, or
hypoglycemia.

CHAPTER 9: PATIENT ASSESSMENT

1. Which of the following is an example of a symptom?

A. cyanosis
B. headache
C. tachycardia
D. hypertension
2. Which of the following scenarios does NOT involve the presence of any symptoms?
A. a 44-year-old male with abdominal pain and severe dizziness
B. a 49-year-old female with blurred vision and ringing in the ears
C. a 55-year-old male with a severe headache and 2 days of nausea
D. a 61-year-old female who is unconscious with facial cyanosis

3. Which of the following actions would NOT be performed during the scene size-up?
A. asking a neighbor to secure the patient’s dog
B. rapidly assessing a patient’s respiratory status
C. notifying the dispatcher to send fire personnel
D. noting the position of a crashed motor vehicle

4. While en route to the scene of a shooting, the dispatcher advises you that the caller states that the perpetrator
has fled the scene. You should:
A. ask the dispatcher if he or she knows the location of the perpetrator.
B. confirm this information with law enforcement personnel at the scene.
C. request law enforcement personnel if the scene is unsafe upon arrival.
D. proceed to the scene as usual but exercise extreme caution upon arrival.

5. Upon arriving at a potentially unsafe scene, you should:

A. remove all bystanders.
B. request another ambulance.
C. move the patient to safety.
D. ensure that you are safe.

6. You are assessing a 72-year-old man with abdominal pain. The patient is sitting in a chair; he is conscious,
alert, and calm. As you are talking to the patient, your partner discreetly directs your attention to a handgun,
which is located on a nearby table. You should:
A. immediately cease all patient care, carefully back out of the residence, and request law enforcement
assistance.
B. direct your partner to move the gun to a safe area and then advise the patient that his weapon has been
secured.
C. document the presence of the weapon, including its specific location, and continue your assessment of the
patient.
D. position yourself in between the patient and the gun and ask your partner to request law enforcement
assistance.

7. Which of the following statements regarding the mechanism of injury (MOI) is correct?
A. A nonsignificant MOI rules out the possibility of serious trauma.
B. The MOI may allow you to predict the severity of a patient’s injuries.
C. The exact location of a patient’s injuries can be determined by the MOI.
D. A significant MOI always results in patient death or permanent disability.

8. The MOST effective way to determine whether your patient’s problem is medical or traumatic in origin is
to:
A. perform a careful and thorough assessment.
B. establish the patient’s medical history early.
C. take note of the patient’s general appearance.
D. ask if bystanders are familiar with the patient.

9. During an EMS call, you should take standard precautions:

A. any time before you load the patient into the ambulance.
B. after it has been determined that the patient is bleeding.
C. immediately after completion of your primary assessment.
D. upon exiting the ambulance, but before actual patient contact.
10. Treatment and transport priorities at the scene of a mass-casualty incident should be determined after:
A. a physician arrives at the scene.
B. the number of patients is known.
C. all the patients have been triaged.
D. area hospitals have been notified.

11. When is it MOST appropriate to consider requesting additional ambulances at an accident scene?
A. after you have triaged all the critical patients
B. when you determine there are multiple patients
C. after noncritical patients have been identified
D. when all the deceased patients are accounted for

12. The goal of the primary assessment is to:

A. determine if the patient’s problem is medical or trauma.
B. identify patients that require transport to a trauma center.
C. determine the need to perform a head-to-toe assessment.
D. identify and rapidly treat all life-threatening conditions.

13. Observations made when forming a general impression of a patient would include all of the following,
EXCEPT:
A. appearance.
B. pulse strength.
C. race and gender.
D. level of distress.

14. When approaching a 32-year-old male who is complaining of traumatic neck pain, you should:
A. ensure that the patient can see you approaching him.
B. approach him from behind and ask him not to move.
C. stand behind him and immediately stabilize his head.
D. assess his mental status by having him move his head.

15. Which of the following conditions would be LEAST likely to cause an altered level of consciousness?
A. drug overdose
B. inadequate perfusion
C. acute anxiety
D. poisoning

16. Which of the following patients does NOT have an altered mental status?
A. a patient with an acute allergic reaction and dizziness
B. a diabetic who opens his eyes when you ask questions
C. a patient with a head injury who is slow to answer questions
D. a patient who overdosed and moans when he is touched

17. A patient who does not respond to your questions but moves or cries out when his or her trapezius muscle is
pinched, is said to be:
A. conscious and alert.
B. completely unresponsive.
C. responsive to verbal stimuli.
D. responsive to painful stimuli.

18. An elderly patient has fallen and hit her head. You assess her level of consciousness as unresponsive using
the AVPU scale. Your initial care should focus on:
A. obtaining baseline vital signs.
B. gathering medical history data.
C. providing immediate transport.
D. airway, breathing, and circulation.

19. A patient’s short-term memory is MOST likely intact if he or she correctly answers questions regarding:
A. time and place.
B. date and event.
C. event and person.
D. person and place.

20. A 29-year-old male with a head injury opens his eyes when you speak to him, is confused as to the time and
date, and is able to move all of his extremities on command. His Glasgow Coma Scale (GCS) score is:
A. 10.
B. 12.
C. 13.
D. 14.

21. An injured patient is assigned a total score of 9 on the GCS. He is assigned a score of 2 for eye opening, a
score of 3 for verbal response, and a score of 4 for motor response. Which of the following clinical findings
is consistent with his GCS score?
A. opens eyes in response to voice, makes incomprehensible sounds, localizes pain
B. opens eyes in response to pain, uses inappropriate words, withdraws from pain
C. opens eyes spontaneously, is confused when spoken to, exhibits abnormal flexion
D. eyes remain closed, makes incomprehensible sounds, exhibits abnormal extension

22. When you inspect a patient’s pupils with a penlight, the pupils should normally react to the light by:
A. constricting.
B. enlarging.
C. dilating.
D. fluttering.

23. When you shine a light into one pupil, the normal reaction of the other pupil should be to:
A. dilate.
B. not react.
C. become larger.
D. become smaller.

24. Which of the following pupillary changes would indicate depressed brain function?
A. Both pupils dilate when a bright light is removed.
B. Both pupils constrict when a bright light is introduced.
C. Both pupils react briskly to light instead of sluggishly.
D. Both pupils dilate with introduction of a bright light.

25. Which of the following conditions would MOST likely cause the pupils to remain significantly constricted?
A. severe cerebral hypoxia
B. intracranial hemorrhaging
C. overdose of an opiate drug
D. oculomotor nerve pressure

26. What maneuver should be used to open the airway of an unresponsive patient with suspected trauma?
A. tongue-jaw lift
B. jaw-thrust maneuver
C. head tilt–chin lift
D. head tilt–neck lift

27. Which of the following statements regarding stridor is MOST correct?

A. It is a whistling sound heard in the lower airway.
B. It is caused by incorrect airway positioning.
C. It is a high-pitched, crowing upper airway sound.
D. It suggests the presence of fluid in the lungs.

28. Which of the following findings indicates that your patient has a patent airway?
A. audible breathing
B. forceful coughing
C. inspiratory stridor
D. unresponsiveness

29. You respond to a call for a female pedestrian who has been struck by a car. As your partner maintains
manual stabilization of her head, you perform a primary assessment. She is unconscious, has ineffective
breathing, and has bloody secretions in her mouth. You should:
A. assist her breathing with a bag-mask device.
B. quickly insert an oropharyngeal airway.
C. assess the rate and quality of her pulse.
D. immediately suction her oropharynx.

30. A 40-year-old male crashed his motorcycle into a tree. He is semiconscious, has snoring respirations, and
has a laceration to the forearm with minimal bleeding. You should:
A. apply a cervical collar and suction his airway.
B. open his airway with the jaw-thrust maneuver.
C. apply a pressure dressing to the patient’s arm.
D. tilt the patient’s head back and lift up on his chin.

31. After performing a head tilt–chin lift maneuver to open the airway of an unresponsive patient who has a
pulse, you should:
A. place him or her in the recovery position.
B. provide positive-pressure ventilatory assistance.
C. assess respiratory rate, depth, and regularity.
D. suction as needed and insert an airway adjunct.

32. A patient with spontaneous respirations is breathing:

A. at a normal rate.
B. with shallow depth.
C. without difficulty.
D. without assistance.

33. Typical methods of assessing a patient’s breathing include all of the following, EXCEPT:
A. listening to breath sounds with a stethoscope.
B. observing for nasal flaring during inhalation.
C. observing the chest for adequate rise and fall.
D. quickly scanning the chest for obvious movement.

34. Supplemental oxygen via nonrebreathing mask should be administered to patients:

A. who are semiconscious with shallow respirations.
B. with rapid respirations and a reduced tidal volume.
C. who have accessory muscle use and slow breathing.
D. with difficulty breathing and adequate tidal volume.

35. You are dispatched to the county jail for an inmate who is “sick.” When you arrive, you find the patient, a
33-year-old male, unresponsive. His airway is patent and his respirations are rapid and shallow. Your initial
action should be to:
A. apply a pulse oximeter.
B. request a paramedic unit.
C. provide assisted ventilation.
D. assess his blood pressure.

36. If a patient develops difficulty breathing after your primary assessment, you should immediately:
A. determine his or her respiratory rate.
B. begin assisting his or her breathing.
C. reevaluate his or her airway status.
D. auscultate his or her breath sounds.

37. The normal respiratory rate for an adult should range from:
A. 10 to 15 breaths per minute.
B. 12 to 20 breaths per minute.
C. 18 to 24 breaths per minute.
D. 24 to 28 breaths per minute.

38. Normal respiratory rates should not exceed _______ breaths per minute in children and _______ breaths per
minute in infants.
A. 18, 28
B. 20, 30
C. 24, 45
D. 30, 50

39. Which of the following is the MOST effective method of assessing the quality of air movement in the
lungs?
A. evaluating the patient’s chest for cyanosis
B. applying a pulse oximeter and monitoring the SpO2
C. auscultating breath sounds with a stethoscope
D. looking for the presence of accessory muscle use

40. Which of the following abnormal breath sounds indicates obstruction of the upper airway?
A. rales
B. stridor
C. crackles
D. rhonchi

41. Clinical signs of labored breathing include all of the following, EXCEPT:
A. shallow chest movement.
B. use of accessory muscles.
C. supraclavicular retractions.
D. gasping attempts to breathe.

42. When a patient’s respirations are shallow:

A. chest rise will be easily noticeable.
B. tidal volume is markedly reduced.
C. oxygenation occurs more efficiently.
D. carbon dioxide elimination is increased.

43. Which of the following signs of respiratory distress is seen MOST commonly in pediatric patients?
A. seesaw breathing
B. rapid respirations
C. pursed-lip breathing
D. accessory muscle use

44. An adult patient who is NOT experiencing difficulty breathing will:

A. be able to speak in complete sentences without unusual pauses.
B. assume a position that will facilitate effective and easy breathing.
C. exhibit an indentation above the clavicles and in between the ribs.
D. have a respiratory rate that is between 20 and 24 breaths/min.

45. You should suspect that a patient is experiencing respiratory failure if he or she:
A. is restless and is working hard to breathe.
B. has an increased heart rate and retractions.
C. has bradycardia and diminished muscle tone.
D. is anxious, tachycardic, and leaning forward.

46. During the primary assessment, circulation is evaluated by assessing:

A. skin quality, blood pressure, and capillary refill.
B. pulse quality, external bleeding, and skin condition.
C. blood pressure, pulse rate, and external bleeding.
D. external bleeding, skin condition, and capillary refill.

47. A palpable pulse is created by:

A. the pressure of circulating blood against the walls of the arteries.
B. the pressure that is caused when venous blood returns to the heart.
C. pressure waves through the arteries caused by cardiac contraction.
D. electrical conduction in the heart producing ventricular contraction.

48. Which of the following is the MOST accurate guide to palpating a pulse?
A. Avoid compressing the artery against a bone or solid structure.
B. Place the tips of your index and long fingers over the pulse point.
C. Use your thumb to increase the surface area that you are palpating.
D. Apply firm pressure to the artery with your ring and little fingers.

49. In responsive patients that are older than 1 year of age, you should palpate the pulse at the ________ artery.
A. radial
B. carotid
C. brachial
D. femoral

50. Palpating the carotid pulse is not recommended in infants because:

A. the pulse rate is usually too fast to count.
B. a decrease in cerebral perfusion may occur.
C. the carotid artery is more anterior in infants.
D. you may inadvertently compress the trachea.
51. When palpating the carotid pulse of a responsive older patient, you should:
A. avoid compressing both carotid arteries simultaneously.
B. ensure that his or her head is in a hyperextended position.
C. avoid gentle pressure so that weak pulses can be detected.
D. firmly compress the artery because the pulse is often weak.

52. You receive a call to a local daycare center for an unresponsive 8-month-old infant. Upon arrival, you
perform an assessment and determine that the infant is not breathing. Your next action should be to:
A. open the airway and give 2 rescue breaths.
B. begin chest compressions and request backup.
C. immediately transport the child to the hospital.
D. assess for a brachial pulse for 5 to 10 seconds.

53. If you cannot palpate a pulse in an unresponsive patient, you should:

A. attach an automated external defibrillator (AED) at once.
B. immediately begin cardiopulmonary resuscitation (CPR).
C. palpate at another pulse site.
D. assess for adequate breathing.

54. You respond to the residence of a 62-year-old male who is unresponsive. Your primary assessment reveals
that he is apneic and pulseless. You should:
A. start CPR and attach the AED as soon as possible.
B. ask the family if the patient has a terminal disease.
C. perform CPR and transport the patient immediately.
D. notify dispatch and request a paramedic ambulance.

55. Which of the following factors would MOST likely cause a patient’s pulse rate to be slower than normal?
A. anxiety or severe stress
B. beta-blocker medications
C. internal bleeding from trauma
D. lack of a regular exercise routine

56. When palpating a patient’s pulse, you note that it is grossly irregular. You should:
A. count the pulse rate for at least 30 seconds to ensure accuracy.
B. count the number of pulsations in 15 seconds and multiply by four.
C. count the number of pulsations in 30 seconds and multiply by two.
D. count the pulse rate for a full minute to obtain an accurate reading.

57. For an adult, the normal resting pulse should be between:

A. 50 and 60 beats/min.
B. 50 and 70 beats/min.
C. 60 and 100 beats/min.
D. 70 and 110 beats/min.

58. In the adult, bradycardia is defined as a pulse rate less than _______ beats/min, and tachycardia is defined as
a heart rate greater than _______ beats/min.
A. 60, 100
B. 50, 110
C. 40, 120
D. 30, 130

59. A pulse with a consistent pattern is considered to be:

A. weak.
B. strong.
C. regular.
D. irregular.

60. When palpating a patient’s pulse, you note that there is a short interval between pulsations. This indicates
that the pulse is:
A. slow.
B. rapid.
C. irregular.
D. thready.

61. When assessing a 62-year-old female with crushing chest pain, you note that her pulse is rapid and irregular.
In addition to administering oxygen, you should:
A. apply a cardiac monitor and observe her cardiac rhythm.
B. transport at once and consider requesting a paramedic unit.
C. document your findings and perform a detailed assessment.
D. conclude that the irregular pulse is normal based on her age.

62. In patients with deeply pigmented skin, changes in color may be apparent only in certain areas, such as the:
A. back of the neck.
B. forehead and face.
C. dorsum of the hand.
D. lips or oral mucosa.

63. In infants and small children, skin color should be assessed on the:
A. forehead.
B. palms and soles.
C. chest and abdomen.
D. underside of the arms.

64. Poor peripheral circulation will cause the skin to appear:

A. pink.
B. ashen.
C. flushed.
D. cyanotic.

65. When assessing the skin of an unconscious patient, you note that it has a bluish tint to it. This finding is
called:
A. pallor.
B. flushing.
C. cyanosis.
D. mottling.

66. Cyanosis of the skin is caused by:

A. increased blood oxygen.
B. peripheral vasodilation.
C. venous vasoconstriction.
D. decreased blood oxygen.

67. Normal skin color, temperature, and condition should be:

A. pink, warm, and dry.
B. pale, cool, and moist.
C. pink, warm, and moist.
D. flushed, cool, and dry.

68. A patient with high blood pressure would be expected to have skin that is:
A. flushed and red.
B. mottled and cool.
C. pale and moist.
D. cyanotic and dry.

69. A 40-year-old male presents with pain to the right upper quadrant of his abdomen. He is conscious and alert
with stable vital signs. During your assessment, you note that his skin and sclera are jaundiced. You should
suspect:
A. acute pancreatitis.
B. liver dysfunction.
C. gallbladder disease.
D. renal insufficiency.

70. A patient with profuse sweating is referred to as being:

A. flushed.
B. plethoric.
C. diaphoretic.
D. edematous.

71. When you assess capillary refill time (CRT) in an infant, normal color to the tested area should return
within:
A. 1 second.
B. 2 seconds.
C. 3 seconds.
D. 4 seconds.

72. During your assessment of a 6-month-old male with vomiting and diarrhea, you note that his capillary refill
time is approximately 4 seconds. From this information, you should conclude that his:
A. respiratory status is adequate.
B. systolic blood pressure is normal.
C. peripheral circulation is decreased.
D. skin temperature is abnormally cold.

73. With regard to the assessment of a patient’s cardiovascular status, capillary refill time is MOST reliable in:
A. children who are younger than 6 years of age.
B. patients who are significantly hypotensive.
C. children who are older than 6 years of age.
D. patients with decreased peripheral perfusion.

74. External bleeding from an extremity can usually be controlled by a combination of:
A. direct pressure and elevation.
B. direct pressure and a tourniquet.
C. elevation and chemical ice packs.
D. elevation and pressure point control.
75. A 39-year-old male sustained a stab wound to the groin during an altercation at a bar. As you approach the
patient, you note that he is conscious, is screaming in pain, and is attempting to control the bleeding, which
is bright red and spurting from his groin area. You should:
A. ensure that his airway is patent.
B. apply direct pressure to the wound.
C. elevate his legs and keep him warm.
D. administer 100% supplemental oxygen.

76. The full-body scan of a patient that occurs following the primary assessment should take no longer than:
A. 30 seconds.
B. 60 to 90 seconds.
C. 90 to 120 seconds.
D. 120 to 180 seconds.

77. After performing a primary assessment, a rapid scan of the body should be performed in order to:
A. determine the need for spinal motion restriction precautions.
B. identify less obvious injuries that require immediate treatment.
C. look specifically for signs and symptoms of inadequate perfusion.
D. find and treat injuries or conditions that do not pose a threat to life.

78. You should gently palpate a patient’s pelvis only if:

A. you note gross deformity to the pelvic area.
B. the patient does not complain of pelvic pain.
C. the MOI suggests pelvic trauma.
D. the possibility of a pelvic fracture has been ruled out.

79. A 71-year-old female slipped on a rug and fell. She is conscious and alert and complains of severe pelvic
pain. Her respirations are 22 breaths/min with adequate depth and her heart rate is 120 beats/min. Which of
the following would NOT be appropriate for this patient?
A. performing a full-body scan
B. 100% supplemental oxygen
C. treating her for possible shock
D. gentle palpation of the pelvis

80. When assessing a patient’s abdomen, you will typically evaluate for all of the following, EXCEPT:
A. subcutaneous emphysema.
B. open wounds or eviscerations.
C. gross bleeding and tenderness.
D. rigidity and obvious bleeding.

81. Which of the following situations or conditions warrants immediate transport?

A. mild pain in the lower abdomen
B. severe chest pain and cool, pale skin
C. decreased ability to move an extremity
D. responsiveness and ability to follow commands

82. When performing a full-body scan on a supine patient, what part of the body is typically assessed last?
A. abdomen
B. posterior
C. extremities
D. anterior chest
83. As you assess the head of a patient with a suspected spinal injury, your partner should:
A. maintain stabilization of the head.
B. look in the ears for gross bleeding.
C. prepare the immobilization equipment.
D. assess the rest of the body for bleeding.

84. A 50-year-old male presents with an altered mental status. His wife tells you that he had a “small stroke” 3
years ago but has otherwise been in good health. The patient is responsive but unable to follow commands.
After administering oxygen, you should:
A. repeat the primary assessment.
B. inquire about his family history.
C. prepare for immediate transport.
D. perform a head-to-toe assessment.

85. The “Golden Period” begins when an injury occurs and ends when:
A. the patient receives definitive care.
B. the patient is admitted to the ICU.
C. you depart the scene for the hospital.
D. you arrive at the emergency department.

86. After the first 60 minutes of experiencing a significant injury:

A. the patient’s blood pressure elevates significantly.
B. the patient’s injuries will most likely be irreparable.
C. most patients will die secondary to internal bleeding.
D. the body’s ability to compensate for shock decreases.

87. An unstable patient should be reassessed at least every:

A. 5 minutes.
B. 10 minutes.
C. 15 minutes.
D. 20 minutes.

88. During a 30-minute transport of a stable patient, you should reassess him or her at least ________ times.
A. 2
B. 3
C. 4
D. 6

89. What part of the patient assessment process focuses on obtaining additional information about the patient’s
chief complaint and any medical problems he or she may have?
A. history taking
B. general impression
C. primary assessment
D. secondary assessment

90. The chief complaint is MOST accurately defined as the:

A. most life-threatening condition that you discover.
B. condition that exacerbates an underlying problem.
C. most serious thing the patient is concerned about.
D. gross physical signs that you detect on assessment.
91. Upon arriving at the scene of a patient with difficulty breathing, you determine that the scene is safe. You
enter the residence and find the patient sitting in a chair in obvious distress. Your first action should be to:
A. ask the patient what’s wrong.
B. obtain a set of baseline vital signs.
C. assess the patient’s airway status.
D. introduce yourself to the patient.

92. Which of the following questions is used to determine a patient’s chief complaint?
A. “What seems to be the matter?”
B. “When did the chest pain begin?”
C. “Are you having trouble breathing?”
D. “Do you have a history of diabetes?”

93. When interviewing a patient, you can show him or her that you understand the situation by:
A. repeating statements back to him or her.
B. using medical terminology whenever possible.
C. maintaining constant eye contact with him or her.
D. interrupting him or her as needed for clarification.

94. A 50-year-old male is found unconscious in his car. There were no witnesses to the event. When gathering
medical history information for this patient, the EMT should:
A. wait for family members to arrive before asking any questions.
B. defer SAMPLE history questions until you arrive at the hospital.
C. determine if the patient has a medical alert bracelet or wallet card.
D. ask law enforcement officials if they are familiar with the patient.

95. Which of the following medical history questions would be of LEAST pertinence in an acute situation?
A. “Does the pain stay in your chest?”
B. “Does your mother have diabetes?”
C. “Has this ever happened to you before?”
D. “Are there medications that you cannot take?”

96. Which of the following questions would you ask a patient to ascertain the “M” in the SAMPLE history?
A. “Have you ever had any major surgeries?”
B. “How long have you had your chest pain?”
C. “How much Tylenol do you take each day?”
D. “When was the last time you ate a meal?”

97. Which of the following patient responses would establish the “E” in the SAMPLE history?
A. “I was in the hospital a week ago.”
B. “I am not having any difficulty breathing.”
C. “The chest pain started about 45 minutes ago.”
D. “I was mowing the lawn when the pain began.”

98. Palliating factors regarding a patient’s pain involve those that:

A. worsen the pain.
B. alleviate the pain.
C. initiate the pain.
D. change the pain.

99. Pain that moves from its point of origin to another body location is said to be:
A. radiating.
B. referred.
C. palliating.
D. provoking.

100. In which of the following situations is a pertinent negative identified?

A. A 50-year-old woman states that nothing makes her chest pain better or worse.
B. A 53-year-old man with dizziness also tells you that he has vomited three times.
C. A 56-year-old woman states that her chest hurts every time she takes a deep breath.
D. A 59-year-old man complains of crushing chest pain but denies shortness of breath.

101. When evaluating a patient with multiple complaints, the EMT’s responsibility is to:
A. direct his or her attention to the most obvious signs and symptoms.
B. determine which complaint poses the greatest threat to the patient’s life.
C. definitively rule out serious causes of each of the patient’s complaints.
D. assess each complaint based on the patient’s perception of its seriousness.

102. Which of the following statements regarding the secondary assessment is correct?
A. The secondary assessment should focus on a certain area or region of the body as determined by the chief
complaint.
B. The secondary assessment should be performed en route to the hospital, regardless of the severity of the
patient’s condition.
C. A secondary assessment should be performed, even if you must continually manage life threats that were
identified in the primary assessment.
D. During the secondary assessment, the EMT’s primary focus should be on taking the patient’s vital signs and
obtaining a SAMPLE history.

103. Which of the following statements regarding the secondary assessment is correct?
A. If your general impression of a patient does not reveal any obvious life threats, you should proceed directly
to the secondary assessment.
B. The purpose of the secondary assessment is to systematically examine every patient from head to toe,
regardless of the severity of his or her injury.
C. You may not have time to perform a secondary assessment if you must continually manage life threats that
were identified during the primary assessment.
D. A focused secondary assessment would be the most appropriate approach for a patient who experienced
significant trauma to multiple body systems.

104. The pulse oximeter is an assessment tool used to evaluate the:

A. percentage of red blood cells.
B. effectiveness of oxygenation.
C. saturation level of venous blood.
D. amount of exhaled carbon dioxide.

105. When using the pulse oximeter as part of your assessment of a patient, it is important to remember that:
A. pulse oximetry is especially useful in patients who have cold extremities because vasoconstriction forces
blood to the capillary beds.
B. carbon monoxide has no effect on pulse oximetry readings because the pulse oximeter presumes that oxygen
is saturating the hemoglobin.
C. as long as the patient’s oxygen saturation is greater than 95%, oxygen is usually not necessary, even if the
patient has respiratory distress.
D. any situation that causes vasoconstriction or loss of red blood cells, such as anemia or bleeding, may result
in an inaccurate or misleading value.

106. End-tidal carbon dioxide (ETCO2) is defined as the:

A. maximal concentration of CO2 at the end of an exhaled breath.
B. maximum amount of CO2 that remains in the lungs at all times.
C. total amount of CO2 that remains in the lungs between breaths.
D. amount of CO2 that a person breathes in during a single inhalation.

107. A low ETCO2 reading, as measured by capnography, would MOST likely be observed if:
A. a patient in cardiac arrest is receiving high-quality CPR.
B. an endotracheal (ET) tube is correctly placed in the trachea.
C. there is an absence or decrease in the level of CO2 in the lungs.
D. the cells produce large amounts of CO2 and return it to the lungs.

108. Which of the following would the EMT most likely NOT perform on a responsive patient with a headache
and no apparent life-threatening conditions?
A. focused secondary assessment
B. assessment of oxygen saturation
C. systemic head-to-toe examination
D. noninvasive blood pressure monitoring

109. The goal of the full-body scan that is performed during the secondary assessment is to:
A. detect and treat all non–life-threatening injuries.
B. assess only the parts of the body that are injured.
C. definitively rule out significant internal injuries.
D. locate injuries not found in the primary assessment.

110. A full-body scan should be performed on:

A. stable patients who are able to tell you exactly what happened.
B. all patients with traumatic injuries who will require EMS transport.
C. responsive medical patients and patients without a significant MOI.
D. patients with a significant MOI and unresponsive medical patients.

111. You respond to the scene of a motor vehicle collision. Upon arrival, you find the driver, a young female,
sitting on the curb. She is confused, is in obvious respiratory distress, and has pale, moist skin. As your
partner manually stabilizes her head, you perform a primary assessment. After performing any immediate
livesaving treatment, you should:
A. perform a rapid scan of her entire body and prepare for immediate transport.
B. assess her vital signs, secure her to a backboard, and transport her immediately.
C. fully immobilize her spine, load her into the ambulance, and assess her vital signs.
D. identify the specific areas of her injuries and focus your assessment on those areas.

112. When performing a full-body scan on a trauma patient, you note the presence of Battle’s sign. This is
defined as:
A. unequal pupils.
B. bruising behind the ear.
C. swelling to the orbital area.
D. fluid drainage from the nose.

113. A decrease in the blood pressure may indicate:

A. a loss of vascular tone.
B. arterial constriction.
C. increased blood volume.
D. forceful cardiac contraction.
114. The pressure exerted against the walls of the artery when the left ventricle contracts is called the:
A. blood pressure.
B. systolic pressure.
C. diastolic pressure.
D. pulse pressure.

115. The diastolic pressure represents the:

A. average pressure against the arterial walls during a cardiac cycle.
B. minimum amount of pressure that is always present in the arteries.
C. increased arterial pressure that occurs during ventricular contraction.
D. difference in pressure between ventricular contraction and relaxation.

116. While evaluating a patient with chest pain, your partner tells you that the patient’s blood pressure is 140/94
mm Hg. The lower number represents the pressure from the:
A. atria relaxing.
B. atria contracting.
C. ventricles relaxing.
D. ventricles contracting.

117. A blood pressure cuff that is too small for a patient’s arm will give a:
A. falsely low systolic and diastolic reading.
B. falsely high systolic but low diastolic reading.
C. falsely high systolic and diastolic reading.
D. falsely low systolic but high diastolic reading.

118. A properly sized blood pressure cuff should cover:

A. two thirds the length from the armpit to the crease in the elbow.
B. one half the length between the armpit to the crease in the elbow.
C. one third the length from the armpit to the crease at the elbow.
D. the entire upper arm between the armpit and the crease at the elbow.

119. Which of the following statements regarding the blood pressure is correct?
A. The systolic pressure represents ventricular relaxation.
B. Blood pressure falls early in patients with hypoperfusion.
C. Blood pressure is the most reliable indicator of perfusion.
D. Blood pressure is usually not measured in children younger than 3 years of age.

120. When auscultating the blood pressure in a patient’s upper extremity, you should place the diaphragm
(head) of the stethoscope over the _________ artery.
A. radial
B. apical
C. femoral
D. brachial

121. When you use the palpation method to obtain a blood pressure, the measurement you obtain is the:
A. pulse pressure.
B. systolic blood pressure.
C. diastolic blood pressure.
D. cardiac output pressure.

122. When assessing motor function in a conscious patient’s lower extremities, you should expect the patient to:
A. wiggle his or her toes on command.
B. feel you touching the extremity.
C. note any changes in temperature.
D. identify different types of stimuli.

123. A crackling sound produced by air bubbles under the skin is called:
A. crepitus
B. rhonchi.
C. Korotkoff sounds.
D. subcutaneous emphysema.

124. Jugular venous distention suggests a problem with blood returning to the heart if the patient is:
A. in a supine position.
B. in a prone position.
C. in a recumbent position.
D. sitting up at a 45° angle.

125. Which of the following MOST accurately describes paradoxical movement of the chest wall?
A. multiple rib fractures that cause a marked deformity of the chest wall
B. a marked decrease in chest wall movement due to abdominal breathing
C. only one section of the chest rises on inspiration while another area falls
D. one side of the chest wall moves opposite the direction of the other

126. Reassessment is performed to determine all of the following, EXCEPT:

A. the reason why the patient called EMS.
B. the patient’s response to your treatment.
C. whether or not the patient is deteriorating.
D. the nature of any newly identified problems.

127. When performing a reassessment of your patient, you should first:

A. obtain updated vital signs.
B. reassess your interventions.
C. repeat the primary assessment.
D. confirm medical history findings.

CHAPTER 10: AIRWAY MANAGEMENT

1. Which of the following statements regarding normal gas exchange in the lungs is correct?
A. The oxygen content in the alveoli is highest during the exhalation phase.
B. Oxygen and carbon dioxide diffuse across the alveolar walls and capillaries.
C. The actual exchange of oxygen and carbon dioxide occurs in the capillaries.
D. Blood that returns to the lungs from the body has a low carbon dioxide content.

2. Which of the following structures is NOT found in the upper airway?

A. larynx
B. pharynx
C. bronchus
D. oropharynx

3. The leaf-shaped structure located superior to the larynx is called the:

A. epiglottis.
B. vallecula.
C. cricoid ring.
D. thyroid cartilage.
4. The __________ cartilage is a firm ring that forms the inferior part of the larynx.
A. cricoid
B. thyroid
C. laryngeal
D. pyriform

5. Structures of the lower airway include all of the following, EXCEPT the:
A. alveoli.
B. trachea.
C. epiglottis.
D. bronchioles.

6. The actual exchange of oxygen and carbon dioxide occurs in the:

A. bronchioles.
B. alveolar sacs.
C. apex of the lung.
D. pulmonary capillaries.

7. Which of the following structures is contained within the mediastinum?

A. lungs
B. larynx
C. bronchioles
D. esophagus

8. The physical act of moving air into and out of the lungs is called:
A. diffusion.
B. ventilation.
C. respiration.
D. oxygenation.

9. Inhalation occurs when the:

A. diaphragm and intercostal muscles relax and cause an increase in intrathoracic pressure.
B. diaphragm and intercostal muscles ascend and cause an increase in intrathoracic pressure.
C. diaphragm and intercostal muscles contract and cause a decrease in intrathoracic pressure.
D. diaphragm ascends and the intercostal muscles contract, causing a decrease in intrathoracic pressure.

10. The diaphragm functions as an involuntary muscle when a person:

A. sleeps.
B. coughs.
C. takes a deep breath.
D. holds his or her breath.

11. The partial pressure of oxygen in the alveoli is _______ mm Hg, while the partial pressure of carbon
dioxide in the alveoli is _______ mm Hg.
A. 70, 28
B. 88, 30
C. 90, 50
D. 104, 40

12. Tidal volume is defined as the volume of air that:

A. is moved through the lungs in a single minute.
B. moves into or out of the lungs in a single breath.
C. remains in the lungs following a complete exhalation.
D. is forced into the lungs as a result of positive pressure.

13. What is the minute volume of a patient with a tidal volume of 500 mL, a dead space volume of 150 mL, and
a respiratory rate of 16 breaths/min?
A. 5,600 mL
B. 6,000 mL
C. 7,400 mL
D. 8,000 mL

14. Which of the following factors will cause a decreased minute volume in an adult?
A. shallow breathing
B. increased tidal volume
C. respirations of 20 breaths/min
D. slight decrease in respiratory rate

15. In contrast to inhalation, exhalation:

A. requires muscular effort to effectively expel air from the lungs.
B. is a passive process caused by increased intrathoracic pressure.
C. occurs when the diaphragm lowers and expels air from the lungs.
D. is an active process caused by decreased intrathoracic pressure.

16. Hypoxia is MOST accurately defined as:

A. low venous oxygen levels.
B. a decrease in arterial oxygen levels.
C. an increase in carbon dioxide in the blood.
D. inadequate oxygen to the tissues and cells.

17. The hypoxic drive—the primary stimulus to breathe for patients with certain chronic respiratory diseases—
is influenced by:
A. high blood oxygen levels.
B. low blood oxygen levels.
C. low blood carbon dioxide levels.
D. high blood carbon dioxide levels.

18. Which of the following is a late sign of hypoxia?

A. anxiety
B. cyanosis
C. tachycardia
D. restlessness

19. Which of the following statements regarding oxygenation and ventilation is correct?
A. In carbon monoxide (CO) poisoning, ventilation is impaired because CO binds to oxygen very quickly.
B. Oxygenation is the movement of air into and out of the lungs, whereas ventilation is the exchange of gases.
C. In mines or confined places, where oxygen levels are low, ventilation may continue despite adequate
oxygenation.
D. Oxygenation without adequate ventilation can occur in climbers who quickly ascend to an altitude of lower
atmospheric pressure.

20. Each cell of the body combines nutrients and oxygen and produces energy and waste products through a
process called:
A. respiration.
B. ventilation.
C. metabolism.
D. oxygenation.

21. The process of exchanging oxygen and carbon dioxide between the alveoli and the blood of the capillaries is
called:
A. external respiration.
B. cellular metabolism.
C. pulmonary ventilation.
D. alveolar ventilation.

22. Gas exchange in the lungs is facilitated by:

A. adequate amounts of surfactant.
B. water or blood within the alveoli.
C. surfactant-destroying organisms.
D. pulmonary capillary constriction.

23. In the presence of oxygen, the mitochondria of the cells convert glucose into energy through a process
called:
A. perfusion.
B. respiration.
C. aerobic metabolism.
D. anaerobic metabolism.

24. Without adequate oxygen, the body’s cells:

A. rely solely on glucose, which is completely converted into adenosine triphosphate (ATP).
B. cease metabolism altogether, resulting in carbon dioxide accumulation in the blood.
C. begin to metabolize fat, resulting in the production and accumulation of ketoacids.
D. incompletely convert glucose into energy, and lactic acid accumulates in the blood.

25. The primary waste product of aerobic metabolism is:

A. lactic acid.
B. pyruvic acid.
C. carbon dioxide.
D. adenosine triphosphate.

26. Central chemoreceptors located in the medulla provide feedback to increase the rate and depth of breathing
when they sense:
A. slight elevations in carbon dioxide or a decrease in the pH of the cerebrospinal fluid.
B. slight decreases in carbon dioxide and an increase in the pH of the cerebrospinal fluid.
C. decreased levels of oxygen in the blood and an increase in the pH of the cerebrospinal fluid.
D. increased levels of oxygen in the blood and a decrease in the pH of the cerebrospinal fluid.

27. A ventilation/perfusion (V/Q ratio) mismatch occurs when:

A. ventilation is inadequate due to a traumatic injury or medical condition, which results in an impairment in
pulmonary gas exchange.
B. a disruption in blood flow inhibits the exchange of oxygen and carbon dioxide in the lungs, even though the
alveoli are filled with fresh oxygen.
C. ventilation is compromised, resulting in the accumulation of carbon dioxide in the bloodstream, alveoli, and
the tissues and cells of the body.
D. a traumatic injury or medical condition impairs the body’s ability to effectively bring oxygen into the lungs
and remove carbon dioxide from the body.

28. If ventilation is impaired, carbon dioxide levels in the bloodstream will increase. This condition is called:
A. acidosis.
B. hypoxia.
C. hypoxemia.
D. hypercarbia.

29. Intrapulmonary shunting occurs when:

A. the presence of pulmonary surfactant causes a decrease in alveolar surface tension, thus impairing the
exchange of gases in the lungs.
B. a decrease in respiratory rate and depth causes carbon dioxide accumulation in the alveoli and an overall
decrease in blood oxygen levels.
C. blood coming from the right side of the heart bypasses nonfunctional alveoli and returns to the left side of
the heart in an unoxygenated state.
D. any impairment in circulatory function causes a reduced ability for oxygen and carbon dioxide to diffuse
across the alveolar–capillary membrane.

30. An adult at rest should have a respiratory rate that ranges between:
A. 8 and 15 breaths/min.
B. 10 and 18 breaths/min.
C. 12 and 20 breaths/min.
D. 16 and 24 breaths/min.

31. Which of the following patients is breathing adequately?

A. a conscious male with respirations of 19 breaths/min and pink skin
B. a conscious female with facial cyanosis and rapid, shallow respirations
C. a conscious male with respirations of 18 breaths/min and reduced tidal volume
D. an unconscious 52-year-old female with snoring respirations and cool, pale skin

32. Which of the following statements regarding breathing adequacy is correct?

A. Patients with a grossly irregular breathing pattern usually do not require assisted ventilation.
B. The single most reliable sign of breathing adequacy in the adult is his or her respiratory rate.
C. Patients breathing shallowly may require assisted ventilation despite a normal respiratory rate.
D. A patient with slow respirations and adequate depth will experience an increase in minute volume.

33. Which of the following would NOT cause a decrease in tidal volume?
A. shallow breathing
B. deep respirations
C. irregular breathing
D. agonal respirations

34. Irregular respirations characterized by an increasing rate and depth of breathing followed by periods of
apnea are called:
A. ataxic respirations.
B. agonal respirations.
C. eupneic respirations.
D. Cheyne-Stokes respirations.

35. An unconscious patient found in a prone position must be placed in a supine position in case he or she:
A. requires cardiopulmonary resuscitation (CPR).
B. begins to vomit.
C. regains consciousness.
D. has increased tidal volume.

36. You are dispatched to a residence where a middle-aged man was found unconscious in his front yard. There
are no witnesses who can tell you what happened. You find him in a prone position; his eyes are closed and
he is not moving. Your FIRST action should be to:
A. palpate for the presence of a carotid pulse.
B. log roll him as a unit to a supine position.
C. assess the rate and quality of his breathing.
D. open his airway with a jaw-thrust maneuver.

37. What is the MOST common cause of airway obstruction in an unconscious patient?
A. vomitus
B. the tongue
C. blood clots
D. aspirated fluid

38. In which of the following patients would the head tilt–chin lift maneuver be the MOST appropriate method
of opening the airway?
A. a 24-year-old male who is found unconscious at the base of a tree
B. a 37-year-old female who is found unconscious in her bed
C. a 45-year-old male who is semiconscious after falling 20 feet
D. a 50-year-old male who is unconscious following head trauma

39. The jaw-thrust maneuver is used to open the airway of patients with suspected:
A. mandibular fractures.
B. upper airway swelling.
C. cervical spine injuries.
D. copious oral secretions.

40. Which of the following patients would MOST likely require insertion of an oropharyngeal airway?
A. a 33-year-old semiconscious patient with reduced tidal volume
B. a 40-year-old unconscious patient with slow, shallow respirations
C. a 51-year-old confused patient with severely labored respirations
D. a 64-year-old conscious patient with rapid and deep respirations

41. A 19-year-old female is found unconscious by her roommate. Your primary assessment reveals that her
breathing is inadequate. As you insert an oropharyngeal airway, she begins to gag violently. You should:
A. continue to insert the airway as you suction her oropharynx.
B. remove the airway and be prepared to suction her oropharynx.
C. insert the airway no further but leave it in place as a bite block.
D. select a smaller oropharyngeal airway and attempt to insert it.

42. To select the proper size oropharyngeal airway, you should measure from the:
A. corner of the mouth to the earlobe.
B. center of the mouth to the posterior ear.
C. corner of the mouth to the superior ear.
D. angle of the jaw to the center of the mouth.
43. The nasopharyngeal airway is MOST beneficial because it:
A. can effectively stabilize fractured nasal bones if it is inserted properly.
B. is generally well tolerated in conscious patients with an intact gag reflex.
C. effectively maintains the airway of a patient in cardiopulmonary arrest.
D. can maintain a patent airway in a semiconscious patient with a gag reflex.

44. The MOST serious complication associated with using a nasopharyngeal airway in a patient with trauma to
the head or face is:
A. fracturing the septum.
B. damaging the turbinates.
C. penetrating the cranium.
D. causing severe bleeding.

45. A nasopharyngeal airway is inserted:

A. with the bevel facing the septum if inserted into the right nare.
B. into the larger nostril with the tip pointing away from the septum.
C. with the bevel pointing downward if inserted into the left nare.
D. into the smaller nostril with the tip following the roof of the nose.

46. A 71-year-old male is semiconscious following a sudden, severe headache. There is vomitus on his face and
his respirations are slow and shallow. The EMT must immediately:
A. insert a nasopharyngeal airway.
B. perform oropharyngeal suctioning.
C. apply oxygen via a nonrebreathing mask.
D. assist the patient’s ventilations with a bag-mask device.

47. When testing a mechanical suctioning unit, you should turn on the device, clamp the tubing, and ensure that
it generates a vacuum pressure of more than:
A. 100 mm Hg.
B. 200 mm Hg.
C. 300 mm Hg.
D. 400 mm Hg.

48. The MOST significant complication associated with oropharyngeal suctioning is:
A. oral abrasions from vigorous suctioning.
B. hypoxia due to prolonged suction attempts.
C. clogging of the catheter with thick secretions.
D. vomiting from stimulating the anterior airway.

49. Proper technique for suctioning the oropharynx of an adult patient includes:
A. continuously suctioning patients with copious oral secretions.
B. suctioning while withdrawing the catheter from the oropharynx.
C. removing large, solid objects with a tonsil-tip suction catheter.
D. suctioning for up to 1 minute if the patient is well oxygenated.

50. You have inserted an oral airway and are ventilating an apneic woman with a bag-mask device. She
suddenly begins regurgitating large amounts of vomit. You should:
A. perform a finger sweep of her mouth.
B. insert a nasal airway and then suction her mouth.
C. roll her onto her side and remove the oral airway.
D. remove the oral airway and suction her oropharynx.
51. A 23-year-old male experienced severe head trauma after his motorcycle collided with an oncoming truck.
He is unconscious, has rapid and shallow breathing, and has copious bloody secretions in his mouth. How
should you manage his airway?
A. Suction his oropharynx with a rigid catheter until all secretions are removed.
B. Insert a nasopharyngeal airway and provide suction and assisted ventilations.
C. Alternate 15 seconds of oral suctioning with 2 minutes of assisted ventilation.
D. Provide continuous ventilations with a bag-mask device to minimize hypoxia.

52. Which of the following patients should you place in the recovery position?
A. a 19-year-old conscious male with a closed head injury and normal respirations
B. a 24-year-old unconscious female who overdosed and has a reduced tidal volume
C. a 31-year-old semiconscious male with low blood sugar and adequate breathing
D. a 40-year-old conscious female with a possible neck injury and regular respirations

53. Which of the following organs or tissues can survive the longest without oxygen?
A. muscle
B. heart
C. liver
D. kidneys

54. The purpose of the pin-indexing system that has been established for compressed gas cylinders is to:
A. ensure that the correct regulator is used for the cylinder.
B. help you determine what type of oxygen regulator to use.
C. prevent destroying or stripping the threads on the cylinder.
D. reduce the cylinder pressure to a safe and more useful range.

55. The pressure of gas in a full cylinder of oxygen is approximately _______ pounds per square inch (psi).
A. 500
B. 1,000
C. 1,500
D. 2,000

56. Which of the following oxygen flowmeters is NOT affected by gravity and can be used in any position
when attached to an oxygen cylinder?
A. vertical-position flowmeter
B. Bourdon-gauge flowmeter
C. ball-and-float flowmeter
D. pressure-compensated flowmeter

57. An oxygen cylinder should be taken out of service and refilled when the pressure inside it is less than:
A. 200 psi.
B. 500 psi.
C. 1,000 psi.
D. 1,500 psi.

58. Which of the following statements regarding oxygen is correct?

A. Oxygen cylinders must always remain in an upright position.
B. Oxygen is flammable and may explode if under high pressure.
C. Oxygen supports the combustion process and may cause a fire.
D. Oxygen is most safely administered in an enclosed environment.
59. A patient who is suspected of being hypoxic and is breathing adequately should be given supplemental
oxygen with a:
A. nasal cannula.
B. nonrebreathing mask.
C. bag-mask device.
D. mouth-to-mask device.

60. With a good mask-to-face seal and an oxygen flow rate of 15 L/min, the nonrebreathing mask is capable of
delivering up to ______% inspired oxygen.
A. 70
B. 80
C. 90
D. 100
61. Prior to applying a nonrebreathing mask on a patient, you must ensure that the:
A. one-way valve is sealed.
B. flow rate is set at 6 L/min.
C. reservoir bag is fully inflated.
D. patient has reduced tidal volume.

62. At a flow rate of 6 L/min, a nasal cannula can deliver an approximate oxygen concentration of up to:
A. 24%.
B. 35%.
C. 44%.
D. 52%.

63. The nasal cannula is MOST appropriately used in the prehospital setting:
A. when the patient cannot tolerate a nonrebreathing mask.
B. if the patient’s nasopharynx is obstructed by secretions.
C. if long-term supplemental oxygen administration is required.
D. when the patient breathes primarily through his or her mouth.

64. The main advantage of the Venturi mask is:

A. the ability to adjust the percentage of inspired oxygen when caring for a critically ill or injured patient.
B. the use of its fine adjustment capabilities in the long-term management of physiologically stable patients.
C. that it does not contain an oxygen reservoir, so the same percentage of oxygen can consistently be
administered.
D. the ability to adjust the amount of oxygen administered to the patient by increasing the flow rate on the
regulator.

65. A 51-year-old female presents with a sudden onset of difficulty breathing. She is conscious and alert and
able to speak in complete sentences. Her respirations are 22 breaths/min and regular. You should:
A. administer 100% oxygen via a nonrebreathing mask.
B. insert a nasal airway in case her mental status decreases.
C. perform a secondary assessment and then begin treatment.
D. assist her breathing with a bag-mask device and 100% oxygen.

66. What occurs when a patient is breathing very rapidly and shallowly?
A. Minute volume increases because of a marked increase in both tidal volume and respiratory rate.
B. Air moves primarily in the anatomic dead space and does not participate in pulmonary gas exchange.
C. Air is forcefully drawn into the lungs due to the negative pressure created by the rapid respirations.
D. The majority of tidal volume reaches the lungs and diffuses across the alveolar-capillary membrane.
67. As the single EMT managing an apneic patient’s airway, the preferred initial method of providing
ventilations is the:
A. mouth-to-mouth technique.
B. one-person bag-mask device.
C. manually triggered ventilation device.
D. mouth-to-mask technique with a one-way valve.

68. You and your partner are treating a 66-year-old man who experienced a sudden onset of respiratory distress.
He is conscious but is unable to follow simple verbal commands. Further assessment reveals that his
breathing is severely labored and his oxygen saturation is 80%. You should:
A. attempt to insert an oropharyngeal airway.
B. assist his ventilations with a bag-mask device.
C. apply a continuous positive airway pressure (CPAP) device and monitor his breathing.
D. apply high-flow oxygen via nonrebreathing mask.

69. Which of the following statements regarding positive-pressure ventilation is correct?

A. Positive-pressure ventilation allows blood to naturally be pulled back to the heart from the body.
B. With positive-pressure ventilation, more volume is required to have the same effects as normal breathing.
C. To prevent hypotension, the EMT should increase the rate and force of positive-pressure ventilation.
D. Unlike negative-pressure ventilation, positive-pressure ventilation does not affect the esophageal opening
pressure.

70. How does positive-pressure ventilation affect cardiac output?

A. There is no effect on cardiac output because positive-pressure ventilation is the act of normal breathing.
B. It decreases intrathoracic pressure, which facilitates venous return to the heart and increases cardiac output.
C. It causes pressure in the chest to decrease, which increases stroke volume and cardiac output.
D. It increases intrathoracic pressure, which decreases venous return to the heart and causes a decrease in
cardiac output.

71. You are ventilating a 40-year-old uninjured man who is apneic but has a pulse. When your partner
reassesses his blood pressure, he notes that it has decreased significantly from previous readings. You
elevate the patient’s legs, but this action has no effect. You should:
A. reevaluate the rate and volume of your ventilations.
B. perform a head-to-toe assessment to look for bleeding.
C. increase the volume of your ventilations and reassess his blood pressure.
D. ensure that you are delivering one breath every 3 to 5 seconds.

72. You are performing mouth-to-mask ventilations with oxygen connected and set at a flow rate of 15 L/min.
What percentage of oxygen is your patient receiving?
A. 45%
B. 55%
C. 65%
D. 75%
73. You and your partner are caring for a critically injured patient. Your partner is controlling severe bleeding
from the patient’s lower extremities as you attempt ventilations with a bag-mask device. After repositioning
the mask several times, you are unable to effectively ventilate the patient. You should:
A. begin ventilations using the mouth-to-mask technique.
B. hyperextend the patient’s head and reattempt ventilations.
C. continue attempted ventilations and transport immediately.
D. suction the patient’s airway for 30 seconds and reattempt ventilations.

74. Which of the following statements regarding the one-person bag-mask device technique is correct?
A. Bag-mask ventilations should be delivered every 2 seconds when the device is being operated by one
person.
B. The C-clamp method of holding the mask to the face is not effective when ventilating a patient with a bag-
mask device.
C. Adequate tidal volume is often difficult to achieve when one EMT is operating the bag-mask device.
D. The bag-mask device delivers more tidal volume and a higher oxygen concentration than the mouth-to-mask
technique.

75. Despite your attempts to coach a conscious young female’s respirations, she continues to hyperventilate
with a marked reduction in tidal volume. You should:
A. restrain her and provide ventilatory assistance.
B. insert a nasopharyngeal airway and give oxygen.
C. explain to her that you will assist her ventilations.
D. ventilate her at the rate at which she is breathing.

76. All of the following will help minimize the risk of gastric distention when ventilating an apneic patient with
a bag-mask device, EXCEPT:
A. delivering each breath over 1 second.
B. ensuring the appropriate airway position.
C. ventilating the patient at the appropriate rate.
D. increasing the amount of delivered tidal volume.

77. Which of the following is the MOST reliable indicator of adequately performed bag-mask ventilations in an
apneic adult with a pulse?
A. 20 breaths/min being delivered to the adult
B. decreased compliance when squeezing the bag
C. an adult’s heart rate that is consistently increasing
D. adequate rise of the chest when squeezing the bag

78. On which of the following patients would it be MOST appropriate to use the flow-restricted, oxygen-
powered ventilation device?
A. an 8-year-old female with respiratory failure
B. a 21-year-old male with traumatic cardiac arrest
C. a 38-year-old apneic female with blunt chest trauma
D. a 59-year-old male with chronic obstructive pulmonary disease (COPD)

79. How does CPAP improve oxygenation and ventilation in patients with certain respiratory problems?
A. It forces the alveoli open and pushes more oxygen across the alveolar membrane.
B. It pushes thick, infected pulmonary secretions into isolated areas of the lung tissue.
C. It decreases intrathoracic pressure, which allows more room for the lungs to expand.
D. It prevents alveolar collapse by pushing air into the lungs during the inhalation phase.

80. CPAP is indicated for patients who:

A. have signs of pneumonia but are breathing adequately.
B. are unresponsive and have signs of inadequate ventilation.
C. have pulmonary edema and can follow verbal commands.
D. are hypotensive and have a marked reduction in tidal volume.
81. You are ventilating a patient with a stoma; however, air is escaping from the mouth and nose. To prevent
this, you should:
A. thrust the jaw forward.
B. seal the mouth and nose.
C. ventilate with less pressure.
D. thoroughly suction the stoma.

82. A 37-year-old male has an apparent foreign body airway obstruction. He is conscious and alert and is
coughing forcefully. His skin is pink, warm, and moist. The MOST appropriate treatment for this patient
includes:
A. a series of back blows and chest thrusts.
B. finger sweeps to remove the obstruction.
C. performing a series of abdominal thrusts.
D. encouraging him to cough and transporting.

83. While eating dinner, your partner suddenly grabs his throat and has a panicked look on his face. He has a
weak cough, faint inspiratory stridor, and cyanosis around the lips. You should:
A. encourage him to cough as forcefully as he can.
B. deliver up to five back blows and reassess him.
C. place him in a supine position and open his airway.
D. stand behind him and administer abdominal thrusts.

84. Which of the following is NOT a possible cause of airway obstruction?

A. relaxation of the tongue
B. aspirated vomitus
C. shallow breathing
D. foreign objects
85. You are ventilating an apneic woman with a bag-mask device. She has dentures, which are tight-fitting.
Adequate chest rise is present with each ventilation, and the patient’s oxygen saturation reads 96%. When
you reassess the patency of her airway, you note that her dentures are now loose, although your ventilations
are still producing adequate chest rise. You should:
A. remove her dentures, resume ventilations, and assess for adequate chest rise.
B. attempt to replace her dentures so that they fit tightly and resume ventilations.
C. leave her dentures in place, but carefully monitor her for an airway obstruction.
D. remove her dentures at once and increase the rate and volume of your ventilations.

CHAPTER 11: PRINCIPLES OF PHARMACOLOGY

1. The term “pharmacology” is MOST accurately defined as:

A. the study of drugs that are produced illegally.
B. the study of how medications affect the brain.
C. the study of drugs and their actions on the body.
D. the study of drug excretion from the human body.

2. A medication with antagonistic properties is one that:

A. stimulates receptor sites and allows other chemicals to attach to them.
B. enhances the effects of another medication when given in a higher dose.
C. blocks receptor sites and prevents other chemicals from attaching to them.
D. produces a cumulative effect when mixed with the same type of medication.

3. A drug is contraindicated for a patient when it:

A. is used to treat a multitude of conditions.
B. may cause harm or have no positive effect.
C. produces actions other than the desired ones.
D. is used to treat a specific medical condition.
4. After taking diphendydramine (Benadryl) for an allergic reaction, a person begins experiencing drowsiness
and a dry mouth. These findings are an example of a(n):
A. side effect.
B. untoward effect.
C. therapeutic effect.
D. unpredictable effect.

5. Which of the following is an example of a brand (trade) name of a drug?

A. Tylenol
B. ibuprofen
C. furosemide
D. nitroglycerin

6. Advil, Nuprin, and Motrin are brand (trade) names for the generic medication:
A. aspirin.
B. nitrostat.
C. ibuprofen.
D. acetaminophen.

7. Which of the following is an example of a drug’s generic name?

A. Bayer
B. Advil
C. Excedrin
D. aspirin

8. When gathering a patient’s medications, you find the following: Isordil, Lasix, Motrin, and Digoxin. Which
of these medications can be obtained over-the-counter (OTC)?
A. Lasix
B. Motrin
C. Isordil
D. Digoxin

9. Which of the following statements regarding parenteral medications is correct?

A. Tylenol is an example of a parenteral medication because it is taken orally.
B. Parenteral medications are absorbed more quickly than enteral medications.
C. Compared to enteral medications, parenteral medications have fewer side effects.
D. Parenteral medications are absorbed by the body through the digestive system.

10. Which of the following is the MOST rapidly acting medication administration route?
A. sublingual (SL)
B. intravenous (IV)
C. subcutaneous (SC)
D. intramuscular (IM)

11. Which of the following medication routes has the slowest rate of absorption?
A. oral
B. rectal
C. inhalation
D. sublingual
12. Which of the following medication routes would be the MOST appropriate to use in an unconscious patient
when intravenous access cannot be obtained?
A. intraosseous (IO)
B. intramuscular
C. subcutaneous
D. transcutaneous

13. Subcutaneous injections deliver the medication:

A. directly into the muscle tissue.
B. between the skin and the muscle.
C. below the first layer of muscle.
D. in the mucosa under the tongue.

14. While assisting a paramedic in the attempted resuscitation of a 55-year-old male in cardiac arrest, you
should expect the paramedic to:
A. give the patient nitroglycerin to increase his blood pressure.
B. administer drugs via the IV route to achieve the fastest effect.
C. give the patient activated charcoal to rule out a drug overdose.
D. withhold drug therapy until an intraosseous catheter is in place.

15. How is nitroglycerin usually given by the EMT?

A. orally
B. inhaled
C. injected
D. sublingually

16. Which of the following medication routes delivers a drug through the skin over an extended period of time,
such as a nitroglycerin or nicotine patch?
A. sublingual
B. intraosseous
C. subcutaneous
D. transcutaneous

17. A mucosal atomizer device (MAD) is used to deliver certain medications via the:
A. intranasal route.
B. inhalation route.
C. sublingual route.
D. transdermal route.

18. The __________ of a medication usually dictates the route by which it will be administered.
A. type
B. form
C. class
D. name

19. Medications encased in a gelatin shell taken by mouth are called:

A. pills.
B. tablets.
C. caplets.
D. capsules.

20. Activated charcoal is an example of a(n):

A. suspension.
B. solution.
C. elixir.
D. gel.

21. Which of the following statements regarding the metered-dose inhaler (MDI) is correct?
A. MDIs are contraindicated for patients with asthma or emphysema.
B. MDIs are most commonly used by patients with cardiovascular disease.
C. An MDI delivers the same amount of medication every time it is used.
D. Shaking an MDI prior to use will cause deactivation of the medication.

22. What medication form does oral glucose come in?

A. gel
B. liquid
C. suspension
D. fine powder

23. You are dispatched to a movie theater for a 39-year-old female with signs and symptoms of an allergic
reaction. As you are assessing her, she pulls an epinephrine auto-injector out of her purse and hands it to
you. After administering 100% oxygen, you should:
A. administer the drug.
B. contact medical control.
C. verify the medication name.
D. check the drug’s expiration date.

24. A 31-year-old female is experiencing an acute asthma attack. She is conscious and alert, but in obvious
respiratory distress. After assisting her with her prescribed MDI, you should:
A. check the drug’s expiration date to ensure that it is still current.
B. contact medical control and apprise him or her of what you did.
C. reassess the patient and document her response to the medication.
D. administer another treatment in 30 seconds if she is still in distress.

25. An EMT may administer aspirin to a patient if:

A. the patient is currently experiencing hypotension.
B. authorization from medical control has been obtained.
C. transport time to the hospital is greater than 30 minutes.
D. the patient is believed to be experiencing an acute stroke.

26. You are dispatched to a state park for a young female experiencing an allergic reaction. Your assessment
reveals that her breathing is severely labored and her blood pressure is very low. You carry epinephrine
auto-injectors on your ambulance and have been trained and approved by your medical director to
administer them. As your partner gives the patient high-flow oxygen, you attempt to contact medical control
but do not have a signal from your cell phone. You should:
A. notify dispatch and request that a paramedic unit respond to the scene so they can administer epinephrine to
the patient.
B. administer epinephrine to the patient, begin immediate transport, and attempt to contact medical control en
route to the hospital.
C. elevate the patient’s legs 6″ to 12″, keep her warm, begin transport to the hospital, and request a paramedic
intercept en route.
D. immediately load the patient into the ambulance, begin transport, and reattempt to contact medical control
when you receive a cell signal.

27. You are treating a middle-aged man with chest discomfort. He has a history of three previous heart attacks
and takes nitroglycerin as needed for chest pain. You have standing orders to administer aspirin to patients
 with suspected cardiac-related chest pain or discomfort. While your partner is preparing to give oxygen to
the patient, you should:
A. confirm that the patient is not allergic to aspirin, give him the appropriate dose of aspirin, and document the
time and dose given.
B. contact medical control, apprise him or her of the patient’s chief complaint and vital signs, and request
permission to give him aspirin.
C. ensure that the patient’s systolic blood pressure is at least 100 mm Hg since aspirin dilates the blood vessels
and can cause a drop in blood pressure.
D. assist the patient in taking one of his prescribed nitroglycerin, assess his vital signs, and give him aspirin if
he is still experiencing chest discomfort.

28. In ___________ administration, you are administering medication to yourself or your partner.
A. peer-assisted
B. patient-assisted
C. EMT-administered
D. paramedic-administered

29. A 74-year-old woman complains of heaviness in her chest, nausea, and sweating that suddenly began about
an hour ago. She is conscious and alert, but anxious. Her blood pressure is 144/84 mm Hg and her heart rate
is 110 beats/min. She took two of her prescribed nitroglycerin (0.4-mg tablets) before your arrival but still
feels heaviness in her chest. You should:
A. give her high-flow oxygen, avoid giving her any more nitroglycerin because it may cause a drop in her
blood pressure, and transport.
B. assist her in taking one more of her nitroglycerin tablets, reassess her blood pressure, and contact medical
control for further instructions.
C. transport her at once and wait at least 20 minutes before you consider assisting her with a third dose of her
prescribed nitroglycerin.
D. recall that geriatric patients often have slower absorption and elimination times, which may necessitate
modification of the dosing of certain drugs.

30. A 49-year-old male with an extensive cardiac history presents with 2 hours of crushing chest pain and
shortness of breath. He is pale and diaphoretic and tells you that he feels like he is going to die. His
medications include nitroglycerin, sildenafil (Viagra), and enalapril (Vasotec). His blood pressure is 140/90
mm Hg and his heart rate is 110 beats/min. In addition to administering 100% oxygen, you should:
A. obtain physician approval to give the nitroglycerin.
B. place him in a supine position and transport at once.
C. administer one nitroglycerin and call medical control.
D. ask him if he took his Viagra within the past 24 hours.

31. The process of binding or sticking to a surface is called:

A. adsorption.
B. absorption.
C. suspension.
D. digestion.

32. You arrive at a residence approximately 20 minutes after a 7-year-old boy, who weighs 22 kg, ingested a
bottle of Advil. He is conscious and alert and has stable vital signs. Medical control orders you to administer
activated charcoal and oxygen and then transport the child at once. The appropriate maximum dose of
activated charcoal for this child is:
A. 11 g.
B. 22 g.
C. 36 g.
D. 44 g.

33. Activated charcoal is frequently suspended in sorbitol, a complex sugar that:

A. significantly slows the process of digestion.
B. binds to any chemicals that are in the stomach.
C. facilitates movement through the digestive system.
D. disguises the unpleasant taste of the activated charcoal.

34. The medical term for an extremely low blood glucose level is:
A. hypoglycemia.
B. hyperglycemia.
C. hypotension.
D. hypertension.

35. Which of the following statements regarding glucose is correct?

A. Glucose is a complex sugar that rapidly absorbs into the bloodstream.
B. Glucose is a simple sugar that is readily absorbed by the bloodstream.
C. Glucose is given to patients who are suspected of being hyperglycemic.
D. Glucose is usually administered by the EMT via the intravenous route.

36. Aspirin is beneficial to patients suspected of having a heart attack because it:
A. reduces the associated chest pain.
B. dissolves the coronary artery clot.
C. causes direct coronary vasodilation.
D. prevents the aggregation of platelets.

37. When given to patients with cardiac-related chest pain, nitroglycerin:

A. relaxes the walls of the coronary arteries.
B. increases myocardial contraction force.
C. increases blood return to the right atrium.
D. constricts the veins throughout the body.

38. Shortly after assisting a 65-year-old female with her prescribed nitroglycerin, she begins complaining of
dizziness and experiences a drop of 30 mm Hg in her systolic blood pressure. The patient remains conscious
and her breathing is adequate. You should:
A. transport her in a sitting position.
B. wait 5 minutes and reassess her blood pressure.
C. place her supine and elevate her legs.
D. assist ventilations with a bag-mask device.

39. A 62-year-old male presents with crushing chest pain, which he describes as being the same kind of pain
that he had with a previous heart attack. He has prescribed nitroglycerin but states that he has not taken any.
After administering 100% oxygen and contacting medical control, you should:
A. begin immediate transport and request a rendezvous with a paramedic unit.
B. assist him with his nitroglycerin unless his systolic blood pressure is less than 100 mm Hg.
C. administer up to three doses of nitroglycerin before assessing his blood pressure.
D. administer the nitroglycerin unless he has taken Viagra within the past 72 hours.

40. You are treating a 45-year-old woman who was stung by a hornet and has a rash. She tells you that she is
allergic to hornets and has her own epinephrine auto-injector. She also tells you that she takes medication
 for hypertension. Her breath sounds do not reveal any wheezing, her breathing is unlabored, and her blood
pressure is 154/94 mm Hg. What should you do if you are not able to make contact with medical control?
A. Administer her epinephrine, reassess her condition, and transport her promptly.
B. Begin immediate transport and request an intercept with a paramedic ambulance.
C. Give her oxygen, transport her to the hospital, and monitor her condition en route.
D. Give her half the dose of her epinephrine in case her allergic reaction is delayed.

41. Which of the following is NOT a characteristic of epinephrine?

A. secreted naturally by the adrenal glands
B. dilates passages in the lungs
C. constricts blood vessels
D. decreases heart rate and blood pressure

42. Which of the following statements regarding the epinephrine auto-injector is correct?
A. The adult auto-injector delivers 0.5 to 1 mg of epinephrine.
B. The auto-injector delivers epinephrine via the subcutaneous route.
C. The epinephrine auto-injector delivers a preset amount of the drug.
D. EMTs do not need physician authorization to use the auto-injector.

43. With the flowmeter set at 6 L/min, the nasal cannula will deliver up to _______ oxygen.
A. 14%
B. 24%
C. 34%
D. 44%

44. A 37-year-old male is found unconscious in his car. His airway is patent and his respirations are rapid and
labored. As you and your partner are assessing and treating the patient, a police officer hands you a
medication named Alupent, which he found in the backseat of the patient’s car. This medication suggests
that the patient has a history of:
A. asthma.
B. heart disease.
C. hypertension.
D. allergic reactions.

45. When assessing an elderly male who complains of nausea and generalized weakness, you find that he takes
simvastatin (Vytorin) and clopidogrel (Plavix). This medication regimen suggests a history of:
A. bacterial infection.
B. cardiovascular disease.
C. reactive airway disease.
D. non–insulin-dependent diabetes.

CHAPTER 12: SHOCK

1. Shock is the result of:

A. hypoperfusion to the cells of the body.
B. the body’s maintenance of homeostasis.
C. temporary dysfunction of a major organ.
D. widespread constriction of the blood vessels.

2. Capillary sphincters are:

A. under complete control of the voluntary portion of the nervous system.
B. capable of dilating in order to increase perfusion to crucial body organs.
C. responsible for constricting to compensate for decreased cell perfusion.
D. circular muscular walls that regulate blood flow through the capillaries.

3. One of the primary waste products of normal cellular metabolism that must be removed from the body by
the lungs is:
A. lactic acid.
B. carbon dioxide.
C. pyruvic acid.
D. carbon monoxide.

4. When the body senses a state of hypoperfusion, the sympathetic nervous system releases epinephrine, the
effects of which include:
A. tachypnea.
B. tachycardia.
C. vasodilation.
D. restlessness.

5. When perfusion to the core of the body decreases:

A. blood is shunted away from the skin.
B. decreased cardiac contractility occurs.
C. blood is diverted to the gastrointestinal tract.
D. the voluntary nervous system releases hormones.

6. Pulmonary edema and impaired ventilation occur during:

A. septic shock.
B. neurogenic shock.
C. cardiogenic shock.
D. anaphylactic shock.

7. Cardiogenic shock may result from all of the following, EXCEPT:

A. heart attack.
B. increased afterload.
C. increased preload.
D. poor contractility.

8. Which of the following injuries would MOST likely cause obstructive shock?
A. liver laceration
B. cardiac tamponade
C. simple pneumothorax
D. spinal cord injury

9. Distributive shock occurs when:

A. an injury causes restriction of the heart muscle and impairs its pumping function.
B. severe bleeding causes tachycardia in order to distribute blood to the organs faster.
C. temporary but severe vasodilation causes a decrease in blood supply to the brain.
D. widespread dilation of the blood vessels causes blood to pool in the vascular beds.

10. Which of the following MOST accurately describes septic shock?

A. bacterial infection of the nervous system with widespread vasodilation
B. widespread vasoconstriction and plasma loss due to a severe viral infection
C. bacterial damage to the vessel wall, leaking blood vessels, and vasodilation
D. viral infection of the blood vessels, vascular damage, and vasoconstriction
11. Patients develop septic shock secondary to:
A. poor vessel function and severe volume loss.
B. an infection that weakens cardiac contractions.
C. failure of the blood vessels to adequately dilate.
D. weak vessel tone due to nervous system damage.

12. A 70-year-old female was recently discharged from the hospital following a total hip replacement. Today,
she presents with restlessness, tachycardia, and a blood pressure of 100/64 mm Hg. Her skin is warm and
moist. You should be MOST suspicious that she is experiencing:
A. septic shock.
B. pump failure.
C. a local infection.
D. decompensated shock.

13. Neurogenic shock occurs when:

A. failure of the nervous system causes widespread vasodilation.
B. the spinal cord is severed and causes massive hemorrhaging.
C. there is too much blood to fill a smaller vascular container.
D. massive vasoconstriction occurs distal to a spinal cord injury.

14. In an acute injury setting, neurogenic shock is commonly accompanied by:

A. hypovolemia.
B. tachycardia.
C. diaphoresis.
D. hypothermia.

15. Which of the following statements regarding anaphylactic shock is MOST correct?
A. Anaphylactic shock occurs immediately after a person is sensitized to an allergen.
B. Sensitized people will experience less severe reactions upon subsequent exposure.
C. Anaphylactic shock is the result of immune system failure due to a toxic exposure.
D. Each subsequent exposure following sensitization often produces a more severe reaction.

16. Which of the following clinical signs is unique to anaphylactic shock?

A. pallor
B. dizziness
C. wheezing
D. hypotension

17. Temporary, widespread vasodilation and syncope caused by a sudden nervous system reaction MOST
accurately describes:
A. vasovagal shock.
B. neurogenic shock.
C. psychogenic shock.
D. neurologic shock.

18. Which of the following would MOST likely result in hemorrhagic shock?
A. severe vomiting
B. liver laceration
C. excessive sweating
D. repeated diarrhea
19. Hypovolemic shock caused by severe burns is the result of a loss of:
A. plasma.
B. platelets.
C. whole blood.
D. red blood cells.

20. When assessing a patient with signs and symptoms of shock, it is MOST important to remember that:
A. the patient’s respirations are deep during the early stages of shock.
B. blood pressure may be the last measurable factor to change in shock.
C. multiple fractures are the most common cause of hypovolemic shock.
D. irreversible shock often responds well to a prompt blood transfusion.

21. Hypotension in a child with blunt or penetrating trauma is particularly significant because:
A. it typically develops earlier in children than it does in adults.
B. the most likely cause of the hypotension is respiratory failure.
C. it often indicates the loss of half of his or her blood volume.
D. most children with hypotension die in the prehospital setting.

22. Clinical signs of compensated shock include all of the following, EXCEPT:
A. cool and clammy skin.
B. absent peripheral pulses.
C. restlessness or anxiety.
D. rapid, shallow breathing.

23. Which of the following patients is in decompensated shock?

A. a 20-year-old female with absent radial pulses and dilated pupils
B. a 23-year-old restless male with cool, clammy skin and tachycardia
C. a 28-year-old female with pale skin and rapid, shallow respirations
D. a 32-year-old male with anxiety and a systolic blood pressure of 110 mm Hg

24. In infants and children, a capillary refill time (CRT) that is greater than ______ second(s) is a sign of poor
peripheral perfusion.
A. 1
B. 2
C. 3
D. 4

25. When treating an 80-year-old patient who is in shock, it is important to remember that:
A. compensation from the respiratory system usually manifests with increased tidal volume.
B. the older patient’s central nervous system usually reacts more briskly to compensate for shock.
C. medications older patients take for hypertension often cause an unusually fast heart rate.
D. changes in gastric motility may delay gastric emptying, which increases the risk for vomiting.

26. All of the following conditions would make you suspect shock, EXCEPT:
A. anaphylaxis.
B. heart attack.
C. severe infection.
D. tachycardia.
27. A 59-year-old male presents with severe vomiting and diarrhea of 3 days’ duration. He is confused and
diaphoretic, and his radial pulses are absent. His blood pressure is 78/50 mm Hg. After applying 100%
supplemental oxygen, you should:
A. perform a head-to-toe exam.
B. allow him to drink plain water.
C. obtain a repeat blood pressure in 5 minutes.
D. prepare for immediate transport.

28. A 25-year-old unrestrained female struck the steering wheel with her chest when her car hit a tree while
traveling at a high rate of speed. She has signs and symptoms of shock, which you suspect are the result of
intrathoracic bleeding. Which of the following interventions will provide this patient with the greatest
chance for survival?
A. 100% oxygen administration
B. full immobilization of her spine
C. application of the pneumatic antishock garment (PASG)
D. rapid transport to a trauma center

29. You are transporting a 33-year-old male who was involved in a motor vehicle crash. You have addressed all
immediate and potentially life-threatening conditions and have stabilized his condition with the appropriate
treatment. With an estimated time of arrival at the hospital of 20 minutes, you should:
A. take his vital signs in 15 minutes.
B. arrange for an ALS rendezvous.
C. reassess his condition in 5 minutes.
D. repeat your secondary assessment.

30. A 27-year-old male was stabbed in the chest during a disagreement at a poker game. As you approach him,
you see that a knife is impaled in his chest. Before you make physical contact with the patient, it is MOST
important to:
A. form a general impression.
B. call for an ALS ambulance.
C. follow standard precautions.
D. ask bystanders what happened.

31. You respond to a residence for a patient with a severe leg injury following an accident with a chainsaw.
When you arrive, you find the patient, a 44-year-old male, lying supine in the backyard. He has a partial
amputation of his right lower leg that is actively bleeding. The patient is conscious and breathing
adequately; however, he is restless and his skin is diaphoretic. You should:
A. immediately evaluate his airway.
B. apply direct pressure to the wound.
C. assess the rate and quality of his pulse.
D. administer 100% supplemental oxygen.

32. A 56-year-old male is found semiconscious by his wife. Your assessment reveals that his respirations are
rapid and shallow, his pulse is rapid and irregular, and his blood pressure is low. The patient’s wife states
that he complained of left arm pain and nausea the day before, but would not allow her to call 9-1-1. The
MOST likely cause of this patient’s present condition is:
A. acute myocardial infarction.
B. cardiogenic hypoperfusion.
C. severe septic hypoperfusion.
D. a ruptured aortic aneurysm.

33. A construction worker fell approximately 30 feet. He is semiconscious with rapid, shallow respirations.
Further assessment reveals deformity to the thoracic region of his spine. His blood pressure is 70/50 mm
Hg, his pulse is 66 beats/min and weak, and his skin is warm and dry. In addition to spinal immobilization
and rapid transport, the MOST appropriate treatment for this patient includes:
A. oxygen via nonrebreathing mask, blankets for warmth, and elevation of his head.
B. assisted ventilation, thermal management, and elevation of the lower extremities.
C. oxygen via nonrebreathing mask, thermal management, and elevation of his legs.
D. assisted ventilation, preventing hyperthermia, and elevating his lower extremities.

34. A 19-year-old male was stung multiple times by fire ants. He is experiencing obvious signs and symptoms
of anaphylactic shock. You administer 100% oxygen and give him epinephrine via subcutaneous injection.
Upon reassessment, you determine that his condition has not improved. You should:
A. transport him immediately and provide supportive care while en route.
B. consider that he may actually be experiencing an acute asthma attack.
C. repeat the epinephrine injection after consulting with medical control.
D. request a paramedic unit that is stationed approximately 15 miles away.

35. You are dispatched to a residence for a 40-year-old female who fainted. Upon your arrival, the patient is
conscious and alert, and states that she is fine. Her husband tells you that she fainted after receiving news
that her sister was killed in a car crash. You offer oxygen to the patient, but she refuses to accept it. At this
point, your primary concern should be to:
A. determine if she was injured when she fainted.
B. provide emotional support regarding her sister.
C. advise her that she needs to go to the hospital.
D. obtain baseline vital signs and a medical history.

CHAPTER 14: MEDICAL OVERVIEW

1. In contrast to the assessment of a trauma patient, assessment of a medical patient:

A. almost exclusively focuses on physical signs that indicate the patient is experiencing a problem.
B. is focused on the nature of illness, the patient’s chief complaint, and his or her symptoms.
C. requires a thorough head-to-toe exam that involves a detailed assessment of all body systems.
D. is not as complex for the EMT because most patients typically present with classic symptoms.

2. Which of the following conditions is NOT categorized as a psychiatric condition?

A. depression
B. schizophrenia
C. substance abuse
D. Alzheimer’s disease

3. The greatest danger in displaying a personal bias or “labeling” a patient who frequently calls EMS is:
A. overlooking a potentially serious medical condition.
B. making the entire EMS system look unprofessional.
C. demeaning or humiliating the patient and his family.
D. discouraging the patient from calling EMS in the future.

4. An index of suspicion is MOST accurately defined as:

A. the EMT’s prediction of the type of illness a patient has based on how the call is dispatched.
B. your awareness and concern for potentially serious underlying and unseen injuries or illness.
C. ruling out specific medical conditions based on the absence of certain signs and symptoms.
D. determining the underlying cause of a patient’s medical condition based on signs and symptoms.
5. You and your EMT partner arrive at the residence of a 50-year-old man who complains of weakness. Your
primary assessment reveals that he is critically ill and will require aggressive treatment. The closest hospital
is 25 miles away. You should:
A. perform a detailed secondary assessment, assess his vital signs, and then transport rapidly.
B. manage all threats to airway, breathing, and circulation and consider requesting an ALS unit.
C. administer oxygen via nonrebreathing mask and obtain as much of his medical history as possible.
D. load him into the ambulance, begin transport, and perform all treatment en route to the hospital.

6. When forming your general impression of a patient with a medical complaint, it is important to remember
that:
A. the majority of medical patients you encounter are also injured.
B. it is during the general impression that assessment of the ABCs occurs.
C. most serious medical conditions do not present with obvious symptoms.
D. the conditions of many medical patients may not appear serious at first.

7. Upon initial contact with a patient who appears to be unconscious, you should:
A. assess breathing depth and determine the respiratory rate.
B. squeeze the trapezius muscle to see if the patient responds.
C. attempt to elicit a verbal response by talking to the patient.
D. direct your partner to apply oxygen via nonrebreathing mask.

8. Your primary assessment of an elderly woman reveals that she is conscious and alert, but is experiencing
difficulty breathing. She has a history of emphysema, hypertension, and congestive heart failure. As you
assess the patient’s circulatory status, you should direct your partner to:
A. perform a head-to-toe secondary assessment.
B. assess her oxygen saturation and blood pressure.
C. retrieve the stretcher and prepare for transport.
D. administer oxygen with the appropriate device.

9. In addition to looking for severe bleeding, assessment of circulation in the conscious patient should involve:
A. palpating the carotid pulse to determine the approximate rate and checking capillary refill time.
B. taking a blood pressure and determining if the patient is alert and oriented or confused.
C. applying a pulse oximeter probe to the finger to determine if peripheral perfusion is adequate.
D. checking the radial pulse and noting the color, temperature, and condition of his or her skin.

10. When assessing a patient with a medical complaint, which of the following would MOST likely reveal the
cause of his or her problem?
A. history taking
B. rapid body scan
C. baseline vital signs
D. primary assessment

11. Which of the following will MOST reliably allow you to determine the nature of a patient’s illness?
A. trending of the patient’s vital signs over time
B. asking questions related to the chief complaint
C. refraining from asking open-ended questions
D. focusing solely on how the call is dispatched

12. A 58-year-old man complains of chest discomfort and nausea. He is conscious and alert; his blood pressure
is 140/90 mm Hg, his pulse is 104 beats/min, and his respirations are 16 breaths/min. Your partner has
applied supplemental oxygen. Prior to assisting the patient with one of his prescribed nitroglycerin tablets,
you ask him if he takes medication to treat erectile dysfunction and he tells you that he does. You should:
A. avoid giving him nitroglycerin and transport him at once.
B. ask him what he takes, how much, and when he last took it.
C. recall that erectile dysfunction drugs can cause hypertension if given with nitroglycerin.
D. administer his nitroglycerin and then reassess his blood pressure.

13. When caring for a patient who takes numerous medications, it is best to:
A. document the medications on your patient care report, but leave them at home so they do not get misplaced.
B. take all of the patient’s medications with you to the hospital and document them on your patient care report.
C. send the patient’s medications to the hospital with a family member or other person who will safeguard
them.
D. let the hospital staff retrieve the patient’s medical records, which should show a list of his or her current
medications.

14. The secondary assessment of a medical patient:

A. should routinely include a comprehensive examination from head to toe.
B. should be performed at the scene, especially if the patient is critically ill.
C. is not practical if the patient is critically ill or your transport time is short.
D. is typically limited to a focused exam for patients who are unconscious.

15. You have just completed your primary assessment of a 48-year-old man with crushing chest pain. The
patient has been given 324 mg of aspirin and is receiving high-flow oxygen via nonrebreathing mask. As
you begin your secondary assessment, you note that his mental status has deteriorated and he is now
bradycardic. You should:
A. continue with your secondary assessment.
B. prepare the patient for immediate transport.
C. insert a nasal airway and assist his breathing.
D. request an ALS unit to respond to the scene.

16. When performing a secondary assessment on a conscious patient with nontraumatic abdominal pain and
stable vital signs, you should:
A. focus on his or her chief complaint.
B. examine him or her from head to toe.
C. prepare the patient for transport first.
D. only palpate tender areas of the abdomen.

17. It is especially important to assess pulse, sensation, and movement in all extremities as well as pupillary
reactions in patients with a suspected ___________ problem.
A. cardiac
B. endocrine
C. respiratory
D. neurologic

18. Which of the following assessment findings is MOST indicative of a cardiovascular problem?
A. unequal breath sounds
B. jugular venous distention
C. use of the accessory muscles
D. palpable pain to the epigastrium

19. A 33-year-old female presents with lower abdominal quadrant pain. She is conscious and alert, but in
moderate pain. While your partner is asking her questions about her medical history, you take her vital
signs. When you assess her radial pulse, you are unable to locate it. You should:
A. assess the rate, regularity, and quality of her carotid pulse.
B. advise your partner that the patient’s blood pressure is low.
C. immediately take her blood pressure to see if she is hypotensive.
D. conclude that she is perfusing adequately since she is conscious.

20. End-tidal carbon dioxide (ETCO2) monitoring is clearly indicated for patients who present with:
A. a headache.
B. abdominal pain.
C. high blood pressure.
D. respiratory distress.

21. Reassessment of a patient with a medical complaint should begin by:

A. reassessing the nature of illness.
B. taking another set of vital signs.
C. repeating the primary assessment.
D. reviewing all treatment performed.

22. The primary prehospital treatment for most medical emergencies:

A. typically does not require the EMT to contact medical control.
B. focuses on definitive care because a diagnosis can usually be made.
C. addresses the patient’s symptoms more than the actual disease process.
D. involves transport only until treatment can be performed at the hospital.

23. Which of the following medications would the EMT LEAST likely administer to a patient with a medical
complaint?
A. naloxone (Narcan)
B. aspirin
C. albuterol
D. oral glucose

24. When caring for a patient with an altered mental status and signs of circulatory compromise, you should:
A. limit your time at the scene to 10 minutes or less, if possible.
B. perform a detailed secondary assessment prior to transporting the patient.
C. transport immediately and begin all emergency treatment en route to the hospital.
D. have a paramedic unit respond to the scene if it is less than 15 minutes away.

25. The determination of whether a medical patient is a high-priority or low-priority transport is typically made:
A. once the patient’s baseline vital signs are known.
B. after the primary assessment has been completed.
C. upon completion of a detailed secondary assessment.
D. as soon as the patient voices his or her chief complaint.

26. In which of the following situations would it be MOST appropriate to utilize an air medical transportation
service?
A. 29-year-old woman who is 18 weeks pregnant, has light vaginal bleeding, and stable vital signs
B. 43-year-old man experiencing a heart attack, and the closest appropriate hospital is 15 minutes away
C. 50-year-old conscious woman with severe nausea and vomiting, fever, and chills of 3 days’ duration
D. 61-year-old man with signs and symptoms of a stroke and your ground transport time is 50 minutes

27. Which of the following conditions often requires transport to a hospital with specialized capabilities that
may not be available at the closest hospital?
A. seizures and infection
B. cardiac arrest and shock
C. stroke and heart attack
D. diabetes and migraines

28. After sizing up the scene of a patient with a possible infectious disease, your next priority should be to:
A. contact medical control.
B. take standard precautions.
C. quickly access the patient.
D. notify law enforcement.

29. Typical chief complaints in patients with an infectious disease include:

A. fever, rash, nausea, and difficulty breathing.
B. crushing chest pain, vomiting, and weakness.
C. headache, low back pain, and arm numbness.
D. joint pain, muscle aches, and blurred vision.

30. In addition to obtaining a SAMPLE history and asking questions related to the chief complaint, what else
should you inquire about when assessing a patient with a potentially infectious disease?
A. recent travel
B. HIV status
C. sexual practices
D. drug allergies

31. An infectious disease is MOST accurately defined as:

A. any disease that enters the body via the bloodstream and renders the immune system nonfunctional.
B. the invasion of the human body by a bacterium that cannot be destroyed by antibiotics or other drugs.
C. a disease that can be spread from one person or species to another through a number of mechanisms.
D. a medical condition caused by the growth and spread of small harmful organisms within the body.

32. Which of the following statements regarding the human immunodeficiency virus (HIV) is correct?
A. HIV is far more contagious than hepatitis B and is easily transmitted in the health care setting.
B. The risk of HIV infection is high, even if an infected person’s blood comes in contact with your intact skin.
C. The risk of HIV infection is greatest when deposited on a mucous membrane or directly into the
bloodstream.
D. Most patients who are infected with HIV experience chronic symptoms that vary in duration and severity.

33. Syphilis is a:
A. high-risk disease to the EMT, especially through a needlestick.
B. bloodborne disease that can successfully be treated with penicillin.
C. sexually transmitted disease that is only found in vaginal secretions.
D. bacterial infection that is typically resistant to antibiotic medications.

34. Early signs and symptoms of viral hepatitis include all of the following, EXCEPT:
A. loss of appetite and a cough.
B. vomiting, fever, and fatigue.
C. pain in the muscles and joints.
D. jaundice and abdominal pain.

35. Which of the following statements regarding hepatitis A is correct?

A. Hepatitis A can only be transmitted by a patient who has an acute infection.
B. Infection with hepatitis A causes chronic illness with a high mortality rate.
C. Hepatitis A is primarily transmitted via contact with blood or other body fluids.
D. Although there is no vaccine against hepatitis A, treatment is usually successful.

36. Hepatitis B is more virulent than hepatitis C, which means that it:
A. is less resistant to treatment.
B. is a more contagious type of disease.
C. has a greater ability to produce disease.
D. leads to chronic infection after exposure.
37. A patient who presents with a headache, fever, confusion, and red blotches on his or her skin should be
suspected of having:
A. hepatitis.
B. meningitis.
C. hantavirus.
D. tuberculosis.

38. Patients with tuberculosis pose the greatest risk for transmitting the disease when they:
A. cough.
B. vomit.
C. are bleeding.
D. have a fever.

39. In contrast to viral hepatitis, toxin-induced hepatitis:

A. is not a communicable disease.
B. typically does not cause yellow skin.
C. is a far more transmittable disease.
D. can be prevented with a vaccination.

40. Ten days after treating a 34-year-old patient with tuberculosis, you are given a tuberculin skin test, which
yields a positive result. This MOST likely indicates that:
A. you are actively infected with tuberculosis and should be treated immediately.
B. the disease is dormant in your body, but will probably never cause symptoms.
C. you contracted the disease by casual contact instead of exposure to secretions.
D. you were exposed to another infected person prior to treating the 34-year-old patient.

41. Which of the following statements regarding methicillin-resistant Staphylococcus aureus (MRSA) is
correct?
A. Most cases of MRSA transmission occur following an accidental needlestick.
B. MRSA is a bacterium that causes infections and is resistant to most antibiotics.
C. The communicable period for MRSA is 10 days to 2 weeks after being infected.
D. Studies have shown that less than 1% of health care providers are MRSA carriers.

42. Factors that increase the risk for developing methicillin-resistant Staphylococcus aureus (MRSA) include:
A. prior exposure to Mycobacterium tuberculosis.
B. failure to be vaccinated against any strain of hepatitis.
C. a history of a respiratory illness within the past 6 to 8 weeks.
D. prolonged hospitalization, especially in an intensive care unit.

43. A patient who was bitten by a mosquito and presents with signs and symptoms of illness should be
suspected of having:
A. avian flu.
B. hantavirus.
C. West Nile virus.
D. lyme disease.

44. Which of the following statements regarding severe acute respiratory syndrome (SARS) is correct?
A. SARS is caused by a virus and usually starts with flulike symptoms that deteriorate to pneumonia and
respiratory failure.
B. Most cases of SARS are caused by a bacterium that is spread from person to person via direct contact with
infected blood.
C. SARS is caused by a virus that occurs naturally in the bird population, although it usually does not cause
illness in humans.
D. Although SARS can cause pneumonia and other respiratory infections, it rarely causes death, even in
immunocompromised patients.

45. Which of the following statements regarding the H1N1 virus is correct?
A. H1N1 has caused more deaths worldwide than all of the other strains of influenza combined.
B. Unlike other strains of the influenza virus, H1N1 is primarily transmitted via the fecal-oral route.
C. It is only one type of influenza among the many other strains of influenza that exist and infect humans.
D. H1N1, also known as the “swine flu,” is a newly discovered strain of influenza for which no vaccine exists.

CHAPTER 15: RESPIRATORY EMERGENCIES

1. Dyspnea is MOST accurately defined as:

A. shortness of breath or difficulty breathing.
B. a complete cessation of respiratory effort.
C. a marked increase in the exhalation phase.
D. labored breathing with reduced tidal volume.

2. In what area of the lungs does respiration occur?

A. alveoli
B. trachea
C. bronchi
D. capillaries

3. The two processes that occur during respiration are:

A. ventilation and diffusion.
B. inspiration and expiration.
C. diffusion and oxygenation.
D. oxygenation and ventilation.

4. In order for efficient pulmonary gas exchange to occur:

A. the percentage of inhaled carbon dioxide must exceed the percentage of inhaled oxygen.
B. there must be low quantities of pulmonary surfactant to allow for full alveolar expansion.
C. the pulmonary capillaries must be completely constricted and the alveoli must be collapsed.
D. oxygen and carbon dioxide must be able to freely diffuse across the alveolar-capillary membrane.

5. In a healthy individual, the brain stem stimulates breathing on the basis of:
A. increased oxygen levels.
B. decreased oxygen levels.
C. increased carbon dioxide levels.
D. decreased carbon dioxide levels.

6. When the level of arterial carbon dioxide rises above normal:

A. the brain stem inhibits respirations.
B. respirations increase in rate and depth.
C. exhalation lasts longer than inhalation.
D. respirations decrease in rate and depth.

7. Which of the following is MOST characteristic of adequate breathing?

A. 22 breaths/min with an irregular pattern of breathing and cyanosis
B. 20 breaths/min with shallow movement of the chest wall and pallor
C. 24 breaths/min with bilaterally equal breath sounds and pink skin
D. 30 breaths/min with supraclavicular retractions and clammy skin

8. An alert patient presents with a regular pattern of inhalation and exhalation and breath sounds that are clear
and equal on both sides of the chest. These findings are consistent with:
A. an obstructed airway.
B. adequate air exchange.
C. respiratory difficulty.
D. respiratory insufficiency.

9. Which of the following statements regarding the hypoxic drive is MOST correct?
A. The hypoxic drive stimulates a person to breathe on the basis of low oxygen levels.
B. Chronic carbon dioxide elimination often results in activation of the hypoxic drive.
C. The hypoxic drive serves as the primary stimulus for breathing in healthy individuals.
D. 100% supplemental oxygen will always cause apnea in patients with a hypoxic drive.

10. When administering supplemental oxygen to a hypoxemic patient with a chronic lung disease, you should:
A. recall that most patients with chronic lung diseases are stimulated to breathe by increased carbon dioxide
levels.
B. adjust the flow rate accordingly until you see symptom improvement, but be prepared to assist his or her
ventilations.
C. begin with a low oxygen flow rate, even if the patient is unresponsive, because high-flow oxygen may
depress his or her breathing.
D. avoid positive-pressure ventilation because the majority of patients with chronic lung disease are at
increased risk for lung trauma.

11. Paroxysmal nocturnal dyspnea (PND), rales, and dependent edema are clinical indicators of:
A. emphysema.
B. severe pneumonia.
C. bronchitis or asthma.
D. congestive heart failure.

12. Which of the following conditions would LEAST likely result in hypoxia?
A. pleural effusion
B. severe anxiety
C. pulmonary edema
D. prolonged seizures

13. Which of the following statements regarding severe acute respiratory syndrome (SARS) is correct?
A. Multiple bacteria have been identified as being the cause of SARS.
B. SARS is most commonly transmitted by direct contact with blood.
C. The onset of SARS is typically marked by acute, severe pneumonia.
D. SARS is a viral infection that often begins with flulike symptoms.

14. Acute pulmonary edema would MOST likely develop as the result of:
A. right-sided heart failure.
B. severe hyperventilation.
C. toxic chemical inhalation.
D. an upper airway infection.
15. Weakening of the airway in patients with chronic bronchitis is the result of:
A. destruction of protective mechanisms that remove foreign particles.
B. loss of the lubricating substance that facilitates alveolar expansion.
C. airway irritation caused by a marked decrease in mucus production.
D. acute constriction of the bronchioles caused by an external irritant.

16. The respiratory distress that accompanies emphysema is caused by:

A. repeated exposure to cigarette smoke.
B. chronic stretching of the alveolar walls.
C. massive constriction of the bronchioles.
D. acute fluid accumulation in the alveoli.

17. Asthma is caused by a response of the:

A. immune system.
B. endocrine system.
C. respiratory system.
D. cardiovascular system.

18. At the onset of an acute asthma attack, patients commonly experience difficulty breathing and:
A. audible stridor.
B. rales and rhonchi.
C. profound cyanosis.
D. expiratory wheezing.

19. Which of the following statements regarding anaphylaxis is correct?

A. Patients with asthma are at lower risk of developing anaphylaxis.
B. Anaphylaxis is characterized by airway swelling and hypotension.
C. Most anaphylactic reactions occur within 60 minutes after exposure.
D. The signs of anaphylaxis are caused by widespread vasoconstriction.

20. A 30-year-old male presents with acute shortness of breath, widespread hives, and facial swelling. He denies
any past medical history and takes no medications. During your assessment, you hear wheezing over all
lung fields. His blood pressure is 90/50 mm Hg and his heart rate is 110 beats/min. In addition to giving him
100% oxygen, the MOST important treatment for this patient is:
A. albuterol.
B. epinephrine.
C. an antihistamine.
D. a beta-antagonist.

21. A 59-year-old male with a history of emphysema complains of an acute worsening of his dyspnea and
pleuritic chest pain following a forceful cough. Your assessment reveals that he has a barrel-shaped chest,
unilaterally diminished breath sounds, and tachycardia. What is the MOST likely cause of this patient’s
condition?
A. rupture of the diaphragm
B. exacerbation of his COPD
C. acute pulmonary embolism
D. spontaneous pneumothorax
22. A pleural effusion is MOST accurately defined as:
A. a unilaterally collapsed lung.
B. diffuse collapsing of the alveoli.
C. fluid accumulation outside the lung.
D. a bacterial infection of the lung tissue.
23. You are dispatched to a residence for a 67-year-old female who was awakened by shortness of breath and
sharp chest pain. Her husband tells you that she was recently discharged from the hospital after having hip
surgery. Your assessment reveals dried blood around her mouth, facial cyanosis, and an oxygen saturation
of 88%. This patient’s presentation is MOST consistent with:
A. acute pulmonary edema.
B. right-sided heart failure.
C. acute pulmonary embolism.
D. spontaneous pneumothorax.

24. Hyperventilation could be associated with all of the following, EXCEPT:

A. a narcotic overdose.
B. a respiratory infection.
C. an overdose of aspirin.
D. high blood glucose levels.

25. A young female is unconscious after intentionally ingesting a large amount of aspirin. You will MOST
likely find her respirations:
A. slow and deep.
B. deep and rapid.
C. slow and shallow.
D. rapid and shallow.

26. Alkalosis is a condition that occurs when:

A. blood acidity is reduced by excessive breathing.
B. dangerous acids accumulate in the bloodstream.
C. the level of carbon dioxide in the blood increases.
D. slow, shallow breathing eliminates too much carbon dioxide.

27. Common signs and symptoms of acute hyperventilation syndrome include:

A. altered mental status and bradycardia.
B. unilateral paralysis and slurred speech.
C. anxiety, dizziness, and severe bradypnea.
D. tachypnea and tingling in the extremities.

28. A 60-year-old male presents with acute respiratory distress. He is conscious and alert, has pink and dry skin,
and has respirations of 24 breaths/min with adequate depth. Which of the following treatment modalities is
MOST appropriate for this patient?
A. assisted ventilation with a bag-mask device and a head-to-toe exam
B. oxygen via nonrebreathing mask and a focused secondary assessment
C. positive-pressure ventilations and immediate transport to the closest hospital
D. oxygen via a nasal cannula, vital signs, and prompt transport to the hospital

29. You receive a call for a 70-year-old female with respiratory distress. Her husband tells you that she has
congestive heart failure; however, he does not think that she has been taking her medications as prescribed.
The patient is laboring to breathe, appears tired, and has cyanosis around her lips. You should:
A. assist her ventilations with a bag-mask device.
B. apply a pulse oximeter and obtain vital signs.
C. administer oxygen via a nonrebreathing mask.
D. obtain a complete list of all of her medications.
30. When auscultating the lungs of a patient with respiratory distress, you hear adventitious sounds. This means
that the patient has:
A. normal breath sounds.
B. abnormal breath sounds.
C. diminished breath sounds.
D. an absence of breath sounds.

31. When assessing for fluid collection in the lungs during auscultation of lung sounds, you should:
A. note the presence of a high-pitched whistling sound, which is an indicator of fluid in the lungs.
B. pay special attention to the exhalation phase since this is when you will likely hear rales or rhonchi.
C. auscultate the posterior chest first and compare the apex of one lung to the base of the opposite lung.
D. start at the lower lung fields and determine at which level you start hearing clear breath sounds.

32. While auscultating an elderly woman’s breath sounds, you hear low-pitched “rattling” sounds at the bases of
both of her lungs. With which of the following conditions is this finding MOST consistent?
A. acute asthma attack
B. widespread atelectasis
C. aspiration pneumonia
D. early pulmonary edema

33. Harsh, high-pitched inspiratory sounds are characteristic of:

A. rales.
B. stridor.
C. rhonchi.
D. wheezing.

34. A conscious and alert 29-year-old female with a history of asthma complains of difficulty breathing that
began after her morning jog. The temperature outside is 40°F (5°C). On exam, you hear bilateral expiratory
wheezing. After providing 100% oxygen, you should:
A. place her in a recumbent position to facilitate breathing.
B. contact medical control and administer an antihistamine.
C. call medical control and ask how to proceed with treatment.
D. determine if she has been prescribed a beta-agonist inhaler.

35. Which of the following statements regarding pulse oximetry is correct?

A. The pulse oximeter is a valuable assessment tool that measures the percentage of red blood cells that contain
hemoglobin molecules.
B. Caution must be exercised when using the pulse oximeter on a patient with carbon monoxide poisoning
because falsely low readings are common.
C. Pulse oximetry measures the percentage of hemoglobin that is saturated with oxygen, but does not measure
the actual hemoglobin content of the blood.
D. Most otherwise healthy patients can maintain adequate oxygenation and good skin color with oxygen
saturation readings as low as 70% to 80%.

36. You are dispatched to an apartment complex where a 21-year-old female has apparently overdosed on
several narcotic medications. She is semiconscious and has slow, shallow respirations. You should:
A. insert an oropharyngeal airway and perform oral suctioning.
B. apply oxygen via a nonrebreathing mask and transport at once.
C. insert a nasopharyngeal airway and begin assisted ventilation.
D. place her in the recovery position and monitor for vomiting.

37. Albuterol is a generic name for:

A. Alupent.
B. Atrovent.
C. Proventil.
D. Singulair.

38. You are assisting an asthma patient with his prescribed metered-dose inhaler. After the patient takes a deep
breath and depresses the inhaler, you should:
A. instruct him to hold his breath for as long as he comfortably can.
B. immediately reapply the oxygen mask and reassess his condition.
C. advise him to exhale forcefully to ensure medication absorption.
D. allow him to breathe room air and assess his oxygen saturation.

39. A 22-year-old female patient is complaining of dyspnea and numbness and tingling in her hands and feet
after an argument with her fiancé. Her respirations are 40 breaths/min. You should:
A. have her breathe into a paper or plastic bag.
B. provide reassurance and give oxygen as needed.
C. request a paramedic to give her a sedative drug.
D. position her on her left side and transport at once.

40. A 62-year-old man with a history of congestive heart failure presents with severe respiratory distress and an
oxygen saturation of 82%. When you auscultate his lungs, you hear widespread rales. He is conscious and
alert, is able to follow simple commands, and can only speak in two- to three-word sentences at a time. You
should:
A. place him in a position of comfort, deliver oxygen via nasal cannula, and closely monitor his breathing.
B. apply a continuous positive airway pressure (CPAP) device, monitor his blood pressure, and observe him
for signs of improvement or deterioration.
C. force fluid from his alveoli by hyperventilating him with a bag-mask device at a rate of at least 20
breaths/min.
D. place him in a supine position and assist his ventilations with a bag-mask device and high-flow oxygen.

CHAPTER 16: CARDIOVASCULAR EMERGENCIES

1. Deoxygenated blood from the body returns to the:

A. right atrium.
B. right ventricle.
C. left atrium.
D. left ventricle.

2. Blood that is ejected from the right ventricle:

A. enters the systemic circulation.
B. flows into the pulmonary arteries.
C. has a high concentration of oxygen.
D. was received directly from the aorta.

3. Which of the following blood vessels transports oxygenated blood?

A. superior vena cava
B. pulmonary arteries
C. inferior vena cava
D. pulmonary veins

4. What is the function of the left atrium?

A. It ejects oxygenated blood into the aorta.
B. It receives oxygenated blood from the lungs.
C. It receives blood from the pulmonary arteries.
D. It receives oxygenated blood from the vena cava.

5. The left ventricle has the thickest walls because it:

A. pumps blood to the lungs to be reoxygenated.
B. uses less oxygen than other chambers of the heart.
C. pumps blood into the aorta and systemic circulation.
D. receives blood directly from the systemic circulation.

6. The electrical impulse generated by the heart originates in the:

A. bundle of His.
B. coronary sinus.
C. sinoatrial (SA) node.
D. atrioventricular (AV) node.

7. When an electrical impulse reaches the AV node, it is slowed for a brief period of time so that:
A. blood can pass from the atria to the ventricles.
B. blood returning from the body can fill the atria.
C. the impulse can spread through the Purkinje fibers.
D. the SA node can reset and generate another impulse.

8. The ability of cardiac muscle cells to contract spontaneously without a stimulus from a nerve source is
called:
A. excitability.
B. contractility.
C. impulsivity.
D. automaticity.

9. The electrical stimulus that originates in the heart’s primary pacemaker is controlled by impulses from the
brain that arrive by way of the:
A. parietal lobe.
B. pons and medulla.
C. somatic nervous system.
D. autonomic nervous system.

10. Which of the following is NOT a function of the sympathetic nervous system?
A. dilation of blood vessels in the muscles
B. constriction of blood vessels in the muscles
C. increases in the heart and respiratory rates
D. constriction of blood vessels in the digestive system

11. In contrast to the sympathetic nervous system, the parasympathetic nervous system:
A. prepares the body to handle stress.
B. causes an increase in the heart rate.
C. slows the heart and respiratory rates.
D. dilates the blood vessels in the muscles.

12. When the myocardium requires more oxygen:

A. the heart contracts with less force.
B. the arteries supplying the heart dilate.
C. the heart rate decreases significantly.
D. the AV node conducts fewer impulses.

13. The myocardium receives oxygenated blood from the __________, which originate(s) from the
__________.
A. coronary sinus, vena cava
B. aorta, inferior vena cava
C. vena cava, coronary veins
D. coronary arteries, aorta

14. Which of the following would cause the greatest increase in cardiac output?
A. increased heart rate and increased stroke volume
B. decreased stroke volume and increased heart rate
C. decreased heart rate and increased stroke volume
D. decreased stroke volume and decreased heart rate

15. The right coronary artery supplies blood to the:

A. left ventricle and inferior wall of the right atrium.
B. right ventricle and inferior wall of the left ventricle.
C. right atrium and posterior wall of the right ventricle.
D. left ventricle and posterior wall of the right ventricle.

16. The head and brain receive their supply of oxygenated blood from the:
A. iliac arteries.
B. brachial arteries.
C. carotid arteries.
D. subclavian arteries.

17. The descending aorta divides into the two iliac arteries at the level of the:
A. nipple line.
B. umbilicus.
C. iliac crest.
D. pubic symphysis.

18. Which of the following veins is located inferior to the trunk?

A. cephalic
B. axillary
C. saphenous
D. subclavian

19. The iliac arteries immediately subdivide into the:

A. femoral arteries.
B. peroneal arteries.
C. anterior tibial arteries.
D. posterior tibial arteries.

20. The inferior vena cava returns deoxygenated blood to the right side of the heart from all of the following
areas, EXCEPT the:
A. brain.
B. kidneys.
C. abdomen.
D. legs.
21. Which of the following is the MOST reliable method of estimating a patient’s cardiac output?
A. Listen to heart sounds with a stethoscope.
B. Connect the patient to an electrocardiogram.
C. Assess the heart rate and strength of the pulse.
D. Determine the average diastolic blood pressure.

22. Cardiac output may decrease if the heart beats too rapidly because:
A. a rapid heart beat causes a decrease in the strength of cardiac contractions.
B. the volume of blood that returns to the heart is not sufficient with fast heart rates.
C. as the heart rate increases, more blood is pumped from the ventricles than the atria.
D. there is not enough time in between contractions for the heart to refill completely.

23. When afterload increases:

A. the volume of venous blood that returns to the right atrium increases.
B. the amount of resistance that the ventricle must beat against decreases.
C. it becomes harder for the ventricle to push blood through the blood vessels.
D. the blood pressure falls because of significant dilation of the blood vessels.

24. The posterior tibial pulse can be palpated:

A. on the dorsum of the foot.
B. above the lateral malleolus.
C. in the fossa behind the knee.
D. behind the medial malleolus.

25. Ischemic heart disease is MOST accurately defined as:

A. absent myocardial blood flow due to a blocked coronary artery.
B. decreased blood flow to one or more portions of the myocardium.
C. death of a portion of the heart muscle due to a decrease in oxygen.
D. decreased blood flow to the heart muscle due to coronary dilation.

26. Narrowing of the coronary arteries due to a buildup of fatty deposits is called:
A. angina pectoris.
B. arteriosclerosis.
C. acute ischemia.
D. atherosclerosis.

27. A patient with atherosclerotic heart disease experiences chest pain during exertion because the:
A. coronary arteries suddenly spasm and cause a marked reduction in myocardial blood flow.
B. lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.
C. tissues of the myocardium undergo necrosis secondary to a prolonged absence of oxygen.
D. ragged edge of a tear in the coronary artery lumen causes local blood clotting and arterial narrowing.

28. An acute myocardial infarction (AMI) occurs when:

A. myocardial tissue dies secondary to an absence of oxygen.
B. the heart muscle progressively weakens and dysfunctions.
C. coronary artery dilation decreases blood flow to the heart.
D. the entire left ventricle is damaged and cannot pump blood.

29. Major risk factors for AMI include all of the following, EXCEPT:
A. hypoglycemia.
B. hypertension.
C. diabetes mellitus.
D. elevated cholesterol.

30. Risk factors for AMI that cannot be controlled include:

A. excess stress.
B. hyperglycemia.
C. family history.
D. lack of exercise.

31. Acute coronary syndrome (ACS) is a term used to describe:

A. the warning signs that occur shortly before a heart attack.
B. a group of symptoms that are caused by myocardial ischemia.
C. a severe decrease in perfusion caused by changes in heart rate.
D. the exact moment that a coronary artery is completely occluded.

32. Angina pectoris occurs when:

A. a coronary artery is totally occluded by plaque.
B. myocardial oxygen demand exceeds the supply.
C. one or more coronary arteries suddenly spasm.
D. myocardial oxygen supply exceeds the demand.

33. Which of the following is a major difference between angina pectoris and AMI?
A. AMI is caused by myocardial ischemia.
B. Anginal pain typically subsides with rest.
C. Nitroglycerin has no effect on angina pectoris.
D. Pain from an AMI subsides within 30 minutes.

34. When treating a patient with chest pain, you should assume that he or she is having an AMI because:
A. angina usually occurs after an AMI.
B. most patients with chest pain are experiencing an AMI.
C. the cause of the pain cannot be diagnosed in the field.
D. angina and AMI present identically.

35. Prompt transport of a patient with a suspected AMI is important because:

A. the patient may be eligible to receive thrombolytic therapy.
B. 90% of the cardiac cells will die within the first 30 minutes.
C. nitroglycerin can only be given in the emergency department.
D. many patients with an AMI die within 6 hours.

36. Common signs and symptoms of AMI include all of the following, EXCEPT:
A. irregular heartbeat.
B. sudden unexplained sweating.
C. shortness of breath or dyspnea.
D. pain exacerbated by breathing.

37. Which of the following statements regarding the pain associated with AMI is correct?
A. It is often described by the patient as a sharp feeling.
B. It often fluctuates in intensity when the patient breathes.
C. Nitroglycerin usually resolves the pain within 30 minutes.
D. It can occur during exertion or when the patient is at rest.
38. The MOST common reason that many people experiencing AMI do not seek immediate medical attention is
because they:
A. are elderly.
B. are in denial.
C. cannot afford it.
D. do not trust EMTs.

39. When documenting a patient’s description of his or her chest pain or discomfort, the EMT should:
A. use medical terminology.
B. use the patient’s own words.
C. underline the patient’s quotes.
D. document his or her own perception.

40. Rapid, labored breathing in a patient with signs and symptoms of AMI should make you suspicious for:
A. a cardiac arrhythmia.
B. congestive heart failure.
C. significant hypotension.
D. right ventricular failure.

41. Sudden death following AMI is MOST often caused by:

A. cardiogenic shock.
B. severe bradycardia.
C. ventricular fibrillation.
D. congestive heart failure.

42. Ventricular tachycardia causes hypotension because:

A. the volume of blood returning to the atria increases.
B. the right ventricle does not adequately pump blood.
C. blood backs up into the lungs and causes congestion.
D. the left ventricle does not adequately fill with blood.

43. Which of the following cardiac arrhythmias has the greatest chance of deteriorating into a pulseless rhythm?
A. sinus tachycardia
B. sinus bradycardia
C. extra ventricular beats
D. ventricular tachycardia

44. The purpose of defibrillation is to:

A. stop the chaotic, disorganized contraction of the cardiac cells.
B. cause a rapid decrease in the heart rate of an unstable patient.
C. improve the chance of cardiopulmonary resuscitation (CPR) being successful in resuscitation.
D. prevent asystole from deteriorating into ventricular fibrillation.

45. Cardiogenic shock following AMI is caused by:

A. decreased pumping force of the heart muscle.
B. a profound increase in the patient’s heart rate.
C. hypovolemia secondary to severe vomiting.
D. widespread dilation of the systemic vasculature.

46. Which of the following signs or symptoms would you NOT expect to encounter in a patient with congestive
heart failure?
A. hypertension and tachycardia
B. hypotension and flat jugular veins
C. the presence of rales in the lungs
D. trouble breathing while lying down

47. You are dispatched to a residence for a 56-year-old male with an altered mental status. Upon arrival at the
scene, the patient’s wife tells you that he complained of chest pain the day before, but would not allow her
to call EMS. The patient is semiconscious; has rapid, shallow respirations; and has a thready pulse. You
should:
A. obtain baseline vital signs.
B. begin ventilatory assistance.
C. attach the automated external defibrillator (AED) immediately.
D. apply a nonrebreathing mask.

48. A 67-year-old female presents with difficulty breathing and chest discomfort that awakened her from her
sleep. She states that she has congestive heart failure, has had two previous heart attacks, and has prescribed
nitroglycerin. She is conscious and alert with adequate breathing. Her blood pressure is 94/64 mm Hg and
her heart rate is 120 beats/min. Treatment for this patient includes:
A. nitroglycerin for her chest pain.
B. ventilations with a bag-mask device.
C. oxygen at 4 L/min via nasal cannula.
D. placing her in an upright position.

49. You are assessing a 49-year-old man who complains of chest pressure that began the night before. He is
conscious, but anxious, and tells you he has a history of angina and hypertension. After applying high-flow
oxygen, you expose his chest to auscultate his lungs and note that he has a nitroglycerin patch on his right
upper chest. His skin is cool and pale, his blood pressure is 78/50 mm Hg, and his pulse is 110 beats/min
and irregular. You should:
A. remove the nitroglycerin patch, place him in a supine position and elevate his lower extremities, and prepare
for immediate transport.
B. immediately remove the nitroglycerin patch, apply the AED in case he develops cardiac arrest, and transport
to the closest hospital.
C. move the nitroglycerin patch to the other side of his chest in case you need to apply the AED, keep him
warm, and transport without delay.
D. ask him if the nitroglycerin patch he is wearing has improved his chest pressure, complete your secondary
assessment, and transport promptly.

50. Which of the following signs is commonly observed in patients with right-sided heart failure?
A. labored breathing
B. dependent edema
C. pulmonary edema
D. flat jugular veins

51. Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who:
A. have chronic hypertension.
B. regularly take illegal drugs.
C. have had a stroke in the past.
D. are older than 40 years of age.

52. Common signs and symptoms of a hypertensive emergency include:

A. pallor, cool skin, and a temporary loss of hearing.
B. syncope, a weak pulse, and bleeding from the ears.
C. tachycardia, pain behind the eyes, and weakness.
D. a bounding pulse, a severe headache, and dizziness.

53. A dissecting aortic aneurysm occurs when:

A. all layers of the aorta suddenly contract.
B. a weakened area develops in the aortic wall.
C. the inner layers of the aorta become separated.
D. the aorta ruptures, resulting in profound bleeding.

54. In contrast to AMI, a dissecting aortic aneurysm:

A. is more commonly associated with pressure in the chest.
B. often presents with pain that is maximal from the onset.
C. usually presents gradually, often over a period of hours.
D. is typically preceded by other symptoms, such as nausea.

55. A 66-year-old woman presents with a stabbing pain in the middle of her chest that radiates to her back. She
tells you that the pain suddenly began about 30 minutes ago and has been severe since the onset. She has a
history of hypertension, but admits to being noncompliant with her antihypertensive medications. When you
assess her, you find that her blood pressure is significantly higher in her left arm than it is in her right arm.
What are her signs and symptoms MOST indicative of?
A. unstable angina
B. dissecting aortic aneurysm
C. AMI
D. hypertensive emergency

56. Upon arriving at the residence of a patient with a possible cardiac problem, it is MOST important to:
A. assess the scene for potential hazards.
B. determine if you need additional help.
C. request a paramedic unit for assistance.
D. gain immediate access to the patient.

57. A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should:
A. administer up to 324 mg of baby aspirin.
B. administer up to three doses of nitroglycerin.
C. obtain vital signs and a SAMPLE history.
D. assess the adequacy of his respirations.

58. A 66-year-old female with a history of hypertension and diabetes presents with substernal chest pressure of
2 hours’ duration. Her blood pressure is 140/90 mm Hg, her pulse is 100 beats/min and irregular, and her
respirations are 22 breaths/min with adequate depth. The patient does not have prescribed nitroglycerin, but
her husband does. You should:
A. administer oxygen, give her 324 mg aspirin, and assess her further.
B. obtain a SAMPLE history and contact medical control for advice.
C. give her 100% oxygen, attach the AED, and transport immediately.
D. give her one nitroglycerin and reassess her systolic blood pressure.

59. Which of the following is of LEAST pertinence when obtaining medical history information from a patient
complaining of chest discomfort?
A. history of cigarette smoking
B. history of previous heart attack
C. presence of personal risk factors
D. family history of hypertension
60. Which of the following medications is commonly given to patients with chest pain to prevent blood clots
from forming or getting bigger?
A. furosemide (Lasix)
B. aspirin
C. oxygen
D. digoxin (Lanoxin)

61. Nitroglycerin relieves cardiac-related chest pain by:

A. dilating the coronary arteries and improving cardiac blood flow.
B. increasing the amount of work that is placed on the myocardium.
C. contracting the smooth muscle of the coronary and cerebral arteries.
D. constricting the coronary arteries and improving cardiac blood flow.

62. Common side effects of nitroglycerin include all of the following, EXCEPT:
A. bradycardia.
B. hypertension.
C. hypotension.
D. severe headache.

63. Nitroglycerin is contraindicated in patients:

A. who have taken up to two doses.
B. who have experienced a head injury.
C. with a history of an ischemic stroke.
D. with a systolic blood pressure less than 120 mm Hg.

64. Prior to assisting a patient with his or her prescribed nitroglycerin, the EMT must:
A. ensure the medication is in tablet form.
B. obtain authorization from medical control.
C. determine who prescribed the nitroglycerin.
D. wait at least 5 minutes after assessing the blood pressure.

65. Which of the following statements regarding nitroglycerin is correct?

A. The potency of nitroglycerin is increased when exposed to light.
B. A maximum of five nitroglycerin doses should be given to a patient.
C. Nitroglycerin should be administered between the cheek and gum.
D. Nitroglycerin usually relieves anginal chest pain within 5 minutes.

66. When would it be MOST appropriate for a patient to take his or her prescribed nitroglycerin?
A. sharp chest pain that lasts longer than 10 to 15 minutes
B. an acute onset of dizziness during a period of exertion
C. chest pain that does not immediately subside with rest
D. difficulty breathing that awakens the patient from sleep

67. Most patients are instructed by their physician to take up to _______ doses of nitroglycerin before calling
EMS.
A. two
B. three
C. four
D. five
68. Which of the following represents the MOST appropriate method of assisting a patient with his or her
prescribed nitroglycerin tablet or spray?
A. Encourage the patient to chew the tablet to increase its effectiveness.
B. Place the medication under the tongue and have the patient swallow it.
C. Administer the medication sublingually and allow it to dissolve or absorb.
D. Wait 15 minutes and reassess the blood pressure prior to administering another dose.

69. After assisting your patient with his or her nitroglycerin, you should:
A. place the patient in a recumbent position in case he or she faints.
B. reassess the blood pressure within 5 minutes to detect hypotension.
C. avoid further dosing if the patient complains of a severe headache.
D. perform a secondary assessment before administering further doses.

70. A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium
by:
A. scraping fatty deposits off of the lumen of the coronary artery.
B. bypassing the coronary artery with a vessel from the chest or leg.
C. placing a stent inside the coronary artery to keep it from narrowing.
D. dilating the affected coronary artery with a small inflatable balloon.

71. Which of the following is NOT a common sign or symptom associated with malfunction of an implanted
cardiac pacemaker?
A. a rapid heart rate
B. syncope or dizziness
C. heart rate less than 60 beats/min
D. generalized weakness

72. A 40-year-old man is in cardiac arrest. Your partner is performing CPR. You are attaching the AED when
the patient’s wife tells you that he has an automatic implanted cardiac defibrillator (AICD). The AED
advises that a shock is indicated. What should you do?
A. Avoid defibrillation as this will damage the patient’s AICD.
B. Contact medical control and request permission to defibrillate.
C. Deliver the shock followed by immediate resumption of CPR.
D. Continue CPR and transport the patient to the closest appropriate hospital.

73. The EMT should use an AED on a child between 1 month and 8 years of age if:
A. he or she is not breathing and has a weakly palpable pulse.
B. his or her condition is rapidly progressing to cardiac arrest.
C. pediatric pads and an energy-reducing device are available.
D. special pads are used and the child has profound tachycardia.

74. In contrast to monophasic defibrillation, biphasic defibrillation:

A. requires a lower energy setting.
B. delivers all shocks at 360 joules.
C. begins with 300 joules and escalates.
D. is only effective for ventricular tachycardia.

75. The AED is MOST advantageous to the EMT because:

A. it is lightweight, easy to use, and safe for the EMT who is using it.
B. it delivers prompt defibrillation to patients with ventricular fibrillation.
C. its use does not require the presence of ALS personnel.
D. it delivers an unlimited number of shocks with the same amount of energy

76. During your treatment of a woman in cardiac arrest, you apply the AED, analyze her cardiac rhythm, and
receive a “no shock advised” message. This indicates that:
A. the AED has detected asystole.
B. the AED detected patient motion.
C. she is not in ventricular fibrillation.
D. she has a pulse and does not need CPR.

77. The MOST common error associated with the use of the AED is:
A. failure of the EMT to ensure the battery is charged.
B. malfunction of the AED’s internal computer processor.
C. inappropriately placed adhesive defibrillation electrodes.
D. inability of the EMT to recognize ventricular fibrillation.

78. Which of the following statements regarding the AED and defibrillation is correct?
A. The AED will not analyze the rhythm of a moving patient.
B. Defibrillation is the first link in the American Heart Association chain of survival.
C. The AED will shock any rhythm not accompanied by a pulse.
D. CPR should be performed for 5 minutes before using the AED.

79. The main legal risk in using the AED is:

A. negligence on the part of the manufacturer.
B. failure of the AED’s internal computer chip.
C. failing to deliver a shock when one is needed.
D. not assessing for a pulse after a shock is delivered.

80. Prior to defibrillating a patient with an AED, it is MOST important that you:
A. properly position the defibrillation pads.
B. perform up to 5 minutes of effective CPR.
C. confirm that the patient is in cardiac arrest.
D. ensure that no one is touching the patient.

81. Prior to attaching the AED to a cardiac arrest patient, the EMT should:
A. contact medical control.
B. dry the chest off if it is wet.
C. perform CPR for 30 seconds.
D. assess for a pulse for 20 seconds.

82. You are dispatched to a convenience store for a patient who passed out. Upon arriving at the scene, you find
two bystanders performing CPR on the patient, a 58-year-old male. Your initial action should be to:
A. assess the effectiveness of the bystanders’ CPR.
B. quickly attach the AED and push the analyze button.
C. have the bystanders stop CPR and assess the patient.
D. request a paramedic unit and quickly attach the AED.

83. Defibrillator pads are placed on the patient’s chest with one pad to the:
A. left of the upper sternum and the other pad just to the right of the left nipple.
B. right of the upper sternum and the other pad just to the right of the right nipple.
C. left of the upper sternum and the other pad just to the right and below the left nipple.
D. right of the upper sternum and the other pad just to the left and below the left nipple.

84. You and your partner arrive at the scene of a middle-aged man who collapsed about 5 minutes ago. He is
unresponsive, apneic, and pulseless. Bystanders are present, but have not provided any care. You should:
A. begin high-quality CPR and apply the AED without delay.
B. have your partner perform CPR while you question the bystanders.
C. perform two-rescuer CPR for 5 minutes and request ALS backup.
D. immediately apply the AED pads and analyze his cardiac rhythm.

85. Your EMS team is performing CPR on a 60-year-old male in cardiac arrest. You connect the AED, push the
analyze button, and receive a “no shock advised” message. You should:
A. reanalyze the patient’s cardiac rhythm.
B. perform CPR for 2 minutes and reassess.
C. determine if a palpable pulse is present.
D. immediately assess the patient’s airway.

86. After the AED has delivered a shock, the EMT should:
A. assess for a carotid pulse.
B. immediately resume CPR.
C. reanalyze the cardiac rhythm.
D. transport the patient at once.

87. The AED has delivered a shock to an elderly male in cardiac arrest. Following 2 minutes of CPR, you
reanalyze the patient’s cardiac rhythm and receive a “no shock advised” message. After further
resuscitation, you restore a palpable carotid pulse. Your next action should be to:
A. obtain a blood pressure and apply the pulse oximeter.
B. place him in the recovery position and apply oxygen.
C. transport at once and reanalyze his rhythm en route.
D. reassess airway and breathing and treat accordingly.

88. A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport.
You should:
A. defibrillate with the AED while continuing transport to the hospital.
B. stop the ambulance, begin CPR, and attach the AED as soon as possible.
C. perform CPR for 1 to 2 minutes and then analyze her rhythm with an AED.
D. alert the receiving hospital and perform CPR for the duration of the transport.

CHAPTER 17: NEUROLOGIC EMERGENCIES

1. The three major parts of the brain are the:

A. cerebellum, medulla, and occiput.
B. brain stem, midbrain, and spinal cord.
C. midbrain, cerebellum, and spinal cord.
D. cerebrum, cerebellum, and brain stem.

2. The most basic functions of the body, such as breathing, blood pressure, and swallowing, are controlled by
the:
A. brain stem.
B. cerebrum.
C. cerebellum.
D. cerebral cortex.

3. Muscle control and body coordination are controlled by the:

A. cerebrum.
B. cerebellum.
C. brain stem.
D. cerebral cortex.
4. The left cerebral hemisphere controls:
A. the right side of the face.
B. heart rate and pupil reaction.
C. the right side of the body.
D. breathing and blood pressure.

5. The anterior aspect of the cerebrum controls:

A. touch.
B. emotion.
C. movement.
D. vision.

6. The spinal cord exits the cranium through the:

A. foramen magnum.
B. vertebral foramen.
C. foramen lamina.
D. cauda equina.

7. Which of the following conditions would MOST likely affect the entire brain?
A. blocked cerebral artery in the frontal lobe
B. reduced blood supply to the left hemisphere
C. ruptured cerebral artery in the occipital lobe
D. respiratory failure or cardiopulmonary arrest

8. Interruption of cerebral blood flow may result from all of the following, EXCEPT:
A. a thrombus.
B. an embolism.
C. cerebral vasodilation.
D. an acute arterial rupture.

9. Which of the following MOST accurately describes the cause of an ischemic stroke?
A. blockage of a cerebral artery
B. acute atherosclerotic disease
C. rupture of a cerebral artery
D. narrowing of a carotid artery

10. You are assessing a 49-year-old man who, according to his wife, experienced a sudden, severe headache and
then passed out. He is unresponsive and has slow, irregular breathing. His blood pressure is 190/94 mm Hg
and his pulse rate is 50 beats/min. His wife tells you that he has hypertension and diabetes. He has MOST
likely experienced:
A. acute hypoglycemia.
B. a ruptured cerebral artery.
C. a complex partial seizure.
D. an occluded cerebral artery.

11. The MOST significant risk factor for a hemorrhagic stroke is:
A. severe stress.
B. hypertension.
C. heavy exertion.
D. diabetes mellitus.

12. An area of swelling or enlargement in a weakened arterial wall is called:

A. a thrombus.
B. an aneurysm.
C. an embolism.
D. atherosclerosis.

13. Which of the following clinical signs is MOST suggestive of a ruptured cerebral artery?
A. unilateral hemiparesis
B. confusion and weakness
C. nasal discharge of blood
D. sudden, severe headache

14. A transient ischemic attack (TIA) occurs when:

A. medications are given to dissolve a cerebral blood clot.
B. a small cerebral artery ruptures and causes minimal damage.
C. the normal body processes destroy a clot in a cerebral artery.
D. signs and symptoms resolve spontaneously within 48 hours.

15. A patient who is experiencing aphasia is:

A. not able to swallow without choking.
B. experiencing a right hemispheric stroke.
C. unable to produce or understand speech.
D. usually conscious but has slurred speech.

16. A patient whose speech is slurred and difficult to understand is experiencing:

A. aphasia.
B. dysarthria.
C. dysphagia.
D. paraplegia.

17. Which of the following conditions would be the LEAST likely to mimic the signs and symptoms of a
stroke?
A. hypoglycemia
B. hypovolemia
C. a postictal state
D. intracranial bleeding

18. A generalized seizure is characterized by:

A. severe twitching of all the body’s muscles.
B. a blank stare and brief lapse of consciousness.
C. unconsciousness for greater than 30 minutes.
D. a core body temperature of greater than 103°F (40°C).

19. An absence seizure is also referred to as a:

A. petit mal seizure.
B. grand mal seizure.
C. total body seizure.
D. generalized motor seizure.

20. Which of the following MOST accurately describes a simple partial seizure?
A. a seizure that begins in one extremity
B. a seizure that causes the patient to stare blankly
C. a seizure that is not preceded by an aura
D. a generalized seizure without incontinence

21. The mental status of a patient who has experienced a typical seizure:
A. progressively worsens over a period of a few hours.
B. is easily differentiated from that of acute hypoglycemia.
C. is likely to improve over a period of 5 to 30 minutes.
D. typically does not improve, even after several minutes.

22. Which of the following MOST accurately describes what the patient will experience during the postictal
state that follows a seizure?
A. hyperventilation and hypersalivation
B. a rapidly improving level of consciousness
C. confusion and fatigue
D. a gradually decreasing level of consciousness

23. Status epilepticus is characterized by:

A. generalized seizures that last less than 5 minutes.
B. an absence seizure that is not preceded by an aura.
C. profound tachycardia and total muscle flaccidity.
D. prolonged seizures without a return of consciousness.

24. Which of the following conditions is NOT a common cause of seizures?

A. poisoning or overdose
B. severe hypovolemia
C. acute hypoglycemia
D. acute alcohol withdrawal

25. Which of the following is a metabolic cause of a seizure?

A. poisoning
B. head trauma
C. brain tumor
D. massive stroke

26. Which of the following medications is NOT used to treat patients with a history of seizures?
A. phenytoin (Dilantin)
B. hydromorphone (Dilaudid)
C. carbamazepine (Tegretol)
D. phenobarbital

27. Febrile seizures:

A. often result in permanent brain damage.
B. are also referred to as petit mal seizures.
C. are usually benign but should be evaluated.
D. occur when a child’s fever progressively rises.

28. You respond to a residence for a child who is having a seizure. Upon arrival at the scene, you enter the
residence and find the mother holding her child, a 2-year-old male. The child is conscious and crying.
According to the mother, the child had been running a high fever and then experienced a seizure that lasted
approximately 3 minutes. You should:
A. cover the child with wet towels and give oxygen via nasal cannula.
B. transport the child to the hospital and reassure the mother en route.
C. advise the mother to take her child to the doctor the following day.
D. call medical control and request permission to give the child aspirin.

29. You arrive at a grocery store shortly after a 35-year-old male stopped seizing. Your assessment reveals that
he is confused and incontinent of urine. The patient’s girlfriend tells you that he has a history of seizures and
takes carbamazepine (Tegretol). When obtaining further medical history from the girlfriend, it is MOST
important to:
A. determine if the patient is a known alcohol abuser.
B. obtain a description of how the seizure developed.
C. determine when he was last seen by his physician.
D. ask her how long the patient has been taking his medication.

30. A patient with an altered mental status is:

A. completely unresponsive to all forms of stimuli.
B. typically alert but is confused as to preceding events.
C. usually able to be aroused with a painful stimulus.
D. not thinking clearly or is incapable of being aroused.

31. The principal clinical difference between a stroke and hypoglycemia is that patients with hypoglycemia:
A. always take oral medications to maintain normal blood glucose levels.
B. do not present with slurred speech or weakness to one side of the body.
C. are typically alert and attempt to communicate with health care providers.
D. usually have an altered mental status or decreased level of consciousness.

32. When caring for a patient with documented hypoglycemia, you should be MOST alert for:
A. a seizure.
B. an acute stroke.
C. respiratory distress.
D. a febrile convulsion.

33. You arrive at a local grocery store approximately 5 minutes after a 21-year-old female stopped seizing. She
is confused and disoriented; she keeps asking you what happened and tells you that she is thirsty. Her
brother, who witnessed the seizure, tells you that she takes phenytoin (Dilantin) for her seizures, but has not
taken it in a few days. He also tells you that she has diabetes. In addition to applying high-flow oxygen, you
should:
A. administer one tube of oral glucose and prepare for immediate transport.
B. place her in the recovery position and transport her with lights and siren.
C. monitor her airway and breathing status and assess her blood glucose level.
D. give her small cups of water to drink and observe for further seizure activity.

34. Individuals with chronic alcoholism are predisposed to intracranial bleeding and hypoglycemia secondary to
abnormalities in the:
A. brain.
B. kidneys.
C. liver.
D. pancreas.

35. Which of the following patients would MOST likely demonstrate typical signs of infection, such as a fever?
A. a 3-month-old female who was born prematurely
B. a 17-year-old male with depression and anxiety
C. a 35-year-old female in the later stages of AIDS
D. an 88-year-old male with chronic renal problems
36. During the primary assessment of a semiconscious 70-year-old female, you should:
A. insert a nasopharyngeal airway and assist ventilations.
B. immediately determine the patient’s blood glucose level.
C. ask family members if the patient has a history of stroke.
D. ensure a patent airway and support ventilation as needed.

37. You are dispatched to a residence for a 66-year-old male who, according to family members, has suffered a
massive stroke. Your primary assessment reveals that the patient is unresponsive, apneic, and pulseless. You
should:
A. assess the patient for a facial droop and hemiparesis.
B. initiate cardiopulmonary resuscitation (CPR) and attach an automated external defibrillator (AED) as soon
as possible.
C. obtain a blood glucose sample to rule out hypoglycemia.
D. perform CPR for 5 minutes before applying the AED.

38. You are caring for a semiconscious man with left-sided paralysis. His airway is patent and his respirations
are 14 breaths/min with adequate tidal volume. Treatment for this patient should include:
A. oxygen via a nonrebreathing mask, left lateral recumbent position, and transport.
B. assisted ventilation with a bag-mask device, right lateral recumbent position, and transport.
C. an oral airway, assisted ventilation with a bag-mask device, Fowler’s position, and transport.
D. oxygen via a nonrebreathing mask, supine position with legs elevated 6″ to 12″, and transport.

39. Law enforcement has summoned you to a nightclub, where a 22-year-old female was found unconscious in
an adjacent alley. Your primary assessment reveals that her respirations are rapid and shallow and her pulse
is rapid and weak. She is wearing a medical alert bracelet that identifies her as an epileptic. There is an
empty bottle of vodka next to the patient. You should:
A. place a bite block in her mouth in case she has a seizure and transport at once.
B. apply oxygen via a nonrebreathing mask, place her on her left side, and transport.
C. assist ventilations, perform a rapid exam, and prepare for immediate transport.
D. apply oxygen via nonrebreathing mask and transport her for a blood-alcohol test.

40. You are caring for a 70-year-old female with signs and symptoms of an acute stroke. She is conscious, has
secretions in her mouth, and is breathing at a normal rate with adequate depth. You should:
A. suction her oropharynx and apply 100% oxygen.
B. insert an oral airway, apply oxygen, and transport.
C. use a bag-mask device to assist her ventilations.
D. place her on her side and prepare for rapid transport.

41. You arrive at the residence of a 33-year-old woman who is experiencing a generalized seizure. She has a
small amount of vomitus draining from the side of her mouth. After protecting her from further injury, you
should:
A. place a bite block in between her teeth, apply high-flow oxygen via a nonrebreathing mask, and consider
inserting a nasopharyngeal airway.
B. wait for the seizure to stop, manually open her airway, insert an oropharyngeal airway, and assess her
oxygen saturation with the pulse oximeter.
C. restrain her extremities to prevent her from injuring herself, suction her airway to remove the vomitus, and
assist her ventilations with a bag-mask device.
D. maintain her airway with manual head positioning, suction her airway to remove the vomitus, insert a
nasopharyngeal airway, and administer high-flow oxygen.

42. When obtaining medical history information from the family of a suspected stroke patient, it is MOST
important to determine:
A. when the patient last appeared normal.
B. if there is a family history of a stroke.
C. if the patient has been hospitalized before.
D. the patient’s overall medication compliance.

43. A 58-year-old male presents with confusion, right-sided weakness, and slurred speech. His wife is present
and is very upset. As your partner is applying oxygen, it is MOST important for you to:
A. list all of the patient’s current medications.
B. obtain a complete set of baseline vital signs.
C. administer glucose to rule out hypoglycemia.
D. ask his wife when she noticed the symptoms.

44. A patient without a history of seizures experiences a sudden convulsion. The LEAST likely cause of this
seizure is:
A. epilepsy.
B. a brain tumor.
C. a serious infection.
D. intracranial bleeding.

45. Which of the following is NOT an assessment parameter included in the Cincinnati Prehospital Stroke
Scale?
A. speech
B. arm drift
C. memory
D. facial droop

46. When assessing arm movement of a patient with a suspected stroke, you should:
A. observe for approximately 5 minutes.
B. expect to see one arm slowly drift down to the patient’s side.
C. ask the patient to close his or her eyes during the assessment.
D. ask the patient to hold his or her arms up with the palms down.

47. You are assessing the arm drift component of the Cincinnati Prehospital Stroke Scale on a 60-year-old
woman. When she holds both of her arms out in front of her and closes her eyes, both of her arms
immediately fall to her sides. You should:
A. repeat the arm drift test and ensure that her palms are facing downward.
B. repeat the arm drift test, but move the patient’s arms into position yourself.
C. instruct the patient to keep her eyes open and then repeat the arm drift test.
D. defer this part of the test and assess her for facial droop and slurred speech.

48. What Glasgow Coma Scale (GCS) score would you assign to a patient who responds to painful stimuli, uses
inappropriate words, and maintains his or her arms in a flexed position?
A. 6
B. 8
C. 9
D. 10

49. A 29-year-old male complains of a severe headache and nausea that has gradually worsened over the past 12
hours. He is conscious, alert, and oriented and tells you that his physician diagnosed him with migraine
headaches. He further tells you that he has taken numerous different medications, but none of them seem to
help. His blood pressure is 132/74 mm Hg, his pulse is 110 beats/min and strong, and his respirations are 20
breaths/min and adequate. In addition to high-flow oxygen, further treatment should include:
A. assisting him with his migraine medication and transporting without lights and siren.
B. placing him in a supine position and transporting with lights and siren to a stroke center.
C. applying warm compresses to the back of his neck and transporting with lights and siren.
D. dimming the lights in the back of the ambulance and transporting without lights and siren.

50. When transporting a stable stroke patient with unilateral paralysis, it is best to place the patient in a:
A. recumbent position with the paralyzed side up.
B. recumbent position with the paralyzed side down.
C. sitting position with the head at a 45° to 90° angle.
D. supine position with the legs elevated 6″ to 12″.

51. A patient who is possibly experiencing a stroke is NOT eligible for thrombolytic (fibrinolytic) therapy if he
or she:
A. has had a prior heart attack.
B. is older than 60 years of age.
C. has a GCS score that is less than 8.
D. has bleeding within the brain.

52. Successful treatment of a stroke depends on whether:

A. surgical intervention is performed to remove obstructive clots.
B. medications are given to restore the function of infarcted cells.
C. the stroke occurs within the left or right hemisphere of the brain.
D. thrombolytic therapy is given within 3 hours after symptoms began.

CHAPTER 18: GASTROINTESTINAL AND UROLOGIC EMERGENCIES

1. Solid abdominal organs include the:

A. stomach and small intestine.
B. spleen, kidneys, and pancreas.
C. gallbladder and large intestine.
D. urinary bladder, colon, and ureters.

2. Which of the following organs would MOST likely bleed profusely if injured?
A. liver
B. stomach
C. appendix
D. gallbladder

3. Which of the following organs lies in the retroperitoneal space?

A. liver
B. spleen
C. pancreas
D. gallbladder

4. Injury to a hollow abdominal organ would MOST likely result in:

A. pain secondary to blood in the peritoneum.
B. profound shock due to severe internal bleeding.
C. impairment in the blood’s clotting abilities.
D. leakage of contents into the abdominal cavity.

5. Functions of the liver include:

A. storage of bile, which is produced in the gallbladder.
B. production of substances necessary for blood clotting.
C. production of hormones that regulate blood sugar levels.
D. release of amylase, which breaks down starches into sugar.

6. Which of the following organs assists in the filtration of blood, serves as a blood reservoir, and produces
antibodies?
A. liver
B. kidney
C. spleen
D. pancreas

7. The kidneys help to regulate blood pressure by:

A. retaining key electrolytes, such as potassium.
B. eliminating toxic waste products from the body.
C. removing sodium, and thus water, from the body.
D. accommodating a large amount of blood volume.

8. The parietal peritoneum lines the:

A. retroperitoneal space.
B. lungs and chest cavity.
C. walls of the abdominal cavity.
D. surface of the abdominal organs.

9. The MOST common and significant complication associated with an acute abdomen is:
A. peritonitis.
B. high fever.
C. severe pain.
D. internal bleeding.

10. In the presence of ileus, the only way the stomach can empty itself is by:
A. diarrhea.
B. vomiting.
C. muscular contraction.
D. spontaneous rupture.

11. Peritonitis may result in shock because:

A. intra-abdominal hemorrhage is typically present.
B. fluid shifts from the bloodstream into body tissues.
C. abdominal distention impairs cardiac contractions.
D. severe pain causes systemic dilation of the vasculature.

12. In contrast to the parietal peritoneum, the visceral peritoneum:

A. is supplied by the same nerves from the spinal cord that supply the skin of the abdomen.
B. lines the walls of the abdominal cavity and is stimulated when the solid abdominal organs contract.
C. is less likely to become inflamed or infected because it lines the abdominal organs themselves.
D. is supplied by nerves of the autonomic nervous system, which are less able to localize pain or sensation.
13. Pain that may be perceived at a distant point on the surface of the body, such as the back or shoulder, is
called:
A. referred pain.
B. radiating pain.
C. visceral pain.
D. remote pain.

14. A 35-year-old mildly obese woman is complaining of localized pain in the right upper quadrant with
referred pain to the right shoulder. The MOST likely cause of her pain is:
A. acute cystitis.
B. acute cholecystitis.
C. appendicitis.
D. pancreatitis.

15. A young female presents with costovertebral angle tenderness. She is conscious and alert with stable vital
signs. Which of the following organs is MOST likely causing her pain?
A. liver
B. kidney
C. pancreas
D. gallbladder

16. Pain that is localized to the lower back and/or lower abdominal quadrants is MOST suggestive of:
A. acute pancreatitis.
B. an aortic aneurysm.
C. a kidney infection.
D. acute appendicitis.

17. Which of the following statements regarding the acute abdomen is correct?
A. The most common cause of an acute abdomen is inflammation of the gallbladder and liver.
B. The parietal peritoneum is typically the first abdominal layer that becomes inflamed or irritated.
C. The initial pain associated with an acute abdomen tends to be vague and poorly localized.
D. An acute abdomen almost always occurs as the result of blunt trauma to solid abdominal organs.

18. Erosion of the protective layer of the stomach or duodenum secondary to overactivity of digestive juices
results in:
A. ileus.
B. an ulcer.
C. appendicitis.
D. cholecystitis.

19. Which of the following is characteristic of peptic ulcer disease (PUD)?

A. the passage of bright red blood in the stool or coughing up blood
B. symptom relief after taking nonsteroidal anti-inflammatory drugs
C. sharp pain that is typically located in both lower abdominal quadrants
D. burning or pain in the stomach that subsides immediately after eating

20. Pain that radiates to the right lower quadrant from the umbilical area, nausea and vomiting, and anorexia are
MOST indicative of:
A. pancreatitis.
B. appendicitis.
C. cholecystitis.
D. gastroenteritis.
21. Which of the following statements regarding gastrointestinal bleeding is correct?
A. In the majority of cases, bleeding within the gastrointestinal tract occurs acutely and is severe.
B. Bleeding within the gastrointestinal tract is a symptom of another disease, not a disease itself.
C. Lower gastrointestinal bleeding results from conditions such as Mallory-Weiss syndrome.
D. Chronic bleeding within the gastrointestinal tract is usually more severe than bleeding that occurs acutely.
22. Esophageal varices MOST commonly occur in patients who:
A. drink a lot of alcohol.
B. have severe diabetes.
C. have a history of esophagitis.
D. have weak immune systems.

23. Which of the following conditions is more common in women than in men?
A. cystitis
B. hepatitis
C. pancreatitis
D. cholecystitis

24. Chronic renal failure is a condition that:

A. can be reversed with prompt treatment.
B. occurs from conditions such as dehydration.
C. is often caused by hypertension or diabetes.
D. causes dehydration from excessive urination.

25. A strangulated hernia is one that:

A. spontaneously reduces without any surgical intervention.
B. can be pushed back into the body cavity to which it belongs.
C. is reducible if surgical intervention occurs within 2 hours.
D. loses its blood supply due to compression by local tissues.

26. You are dispatched to an apartment complex for a young male with abdominal pain. Your priority upon
arriving at the scene should be to:
A. quickly gain access to the patient.
B. notify the dispatcher of your arrival.
C. assess the scene for potential hazards.
D. place a paramedic ambulance on standby.

27. Most patients with abdominal pain prefer to:

A. lie on their side with their knees drawn into the abdomen.
B. sit in a semi-Fowler position with their knees slightly bent.
C. lie in a supine position with their knees in a flexed position.
D. sit fully upright because it helps relax the abdominal muscles.

28. A 30-year-old woman with a history of alcoholism presents with severe upper abdominal pain and is
vomiting large amounts of bright red blood. Her skin is cool, pale, and clammy; her heart rate is 120
beats/min and weak; and her blood pressure is 70/50 mm Hg. Your MOST immediate action should be to:
A. protect her airway from aspiration.
B. keep her supine and elevate her legs.
C. rapidly transport her to the hospital.
D. give her high-flow supplemental oxygen.

29. Patients with acute abdominal pain should not be given anything to eat or drink because:
A. it will create referred pain and obscure the diagnosis.
B. food will rapidly travel through the digestive system.
C. substances in the stomach increase the risk of aspiration.
D. digestion prevents accurate auscultation of bowel sounds.
30. When assessing a patient with abdominal pain, you should:
A. palpate the abdomen in a clockwise direction beginning with the quadrant after the one the patient indicates
is painful.
B. ask the patient to point to the area of pain or tenderness and assess for rebound tenderness over that specific
area.
C. visually assess the painful area of the abdomen, but avoid palpation because this could worsen his or her
condition.
D. observe for abdominal guarding, which is characterized by sudden relaxation of the abdominal muscles
when palpated.

31. Elderly patients with abdominal problems may not exhibit the same pain response as younger patients
because of:
A. chronic dementia, which inhibits communication.
B. interactions of the numerous medications they take.
C. progressive deterioration of abdominal organ function.
D. age-related deterioration of their sensory systems.

32. An important aspect in the treatment of a patient with severe abdominal pain is to:
A. provide emotional support en route to the hospital.
B. administer analgesic medications to alleviate pain.
C. encourage the patient to remain in a supine position.
D. give 100% oxygen only if signs of shock are present.

33. A 47-year-old male presents with severe abdominal pain of 3 hours’ duration. His abdomen is distended and
guarded. Your MOST important consideration for this patient should be to:
A. transport him in a supine position.
B. be alert for signs and symptoms of shock.
C. assess his blood pressure to determine perfusion adequacy.
D. determine the exact location and cause of his pain.

34. The MOST important treatment for a patient with severe abdominal pain and signs of shock includes:
A. administering high-flow oxygen.
B. giving oral fluids to maintain perfusion.
C. transporting the patient without delay.
D. positioning the patient on his or her side.

35. A 59-year-old male presents with a sudden onset of severe lower back pain. He is conscious and alert, but
very restless and diaphoretic. Your assessment reveals a pulsating mass to the left of his umbilicus. You
should:
A. vigorously palpate the abdomen to establish pain severity.
B. administer oxygen and prepare for immediate transport.
C. place the patient in a sitting position and transport at once.
D. request a paramedic unit to give the patient pain medication.

36. You are transporting a 49-year-old male with “tearing” abdominal pain. You are approximately 30 miles
away from the closest hospital. During your reassessment, you determine that the patient’s condition has
deteriorated significantly. You should:
A. assist his ventilations with a bag-mask device.
B. immediately perform a rapid physical examination.
C. continue transporting and alert the receiving hospital.
D. consider requesting a rendezvous with an ALS unit.
37. Which of the following statements regarding dialysis is correct?
A. Acute hypertension is a common adverse effect of dialysis.
B. Hemodialysis is effective but carries a high risk of peritonitis.
C. Patients who miss a dialysis treatment often present with weakness.
D. The purpose of dialysis is to help the kidneys retain salt and water.

38. You respond to the residence of a 70-year-old male who complains of weakness and severe shortness of
breath. His wife tells you that he is a dialysis patient, but has missed his last two treatments. After applying
high-flow oxygen, you auscultate his lungs and hear diffuse rhonchi. The patient is conscious, but appears
confused. His blood pressure is 98/54 mm Hg, his pulse rate is 120 beats/min and irregular, and his
respirations are 24 breaths/min and labored. You should:
A. leave him in a sitting position, keep him warm, and prepare for immediate transport.
B. place him in a supine position, elevate his lower extremities, and transport at once.
C. treat for shock and request a paramedic unit to respond to the scene and assist you.
D. perform a detailed secondary assessment and then transport him to a dialysis center.

CHAPTER 19: ENDOCRINE AND HEMATOLOGIC EMERGENCIES

1. Diabetes is MOST accurately defined as a(n):

A. disorder of carbohydrate metabolism.
B. abnormally high blood glucose level.
C. mass excretion of glucose by the kidneys.
D. lack of insulin production in the pancreas.

2. Type 1 diabetes:
A. is typically treated with medications such as metformin (Glucophage).
B. is a condition in which no insulin is produced by the body.
C. typically occurs in patients between 50 and 70 years of age.
D. is defined as a blood sugar level that is less than 120 mg/dL.

3. Patients with type 2 diabetes usually control their disease with all of the following, EXCEPT:
A. diet and exercise.
B. tolbutamide (Orinase).
C. glyburide (Micronase).
D. supplemental insulin.

4. Glipizide, a non–insulin-type medication, is another name for:

A. Glucophage.
B. Glucotrol.
C. Micronase.
D. Diabinese.

5. Which of the following statements regarding glucose is correct?

A. Most cells will function normally without glucose.
B. Blood glucose levels decrease in the absence of insulin.
C. The brain requires glucose as much as it requires oxygen.
D. The brain requires insulin to allow glucose to enter the cells.

6. Insulin functions in the body by:

A. producing new glucose as needed.
B. enabling glucose to enter the cells.
C. increasing circulating blood glucose.
D. metabolizing glucose to make energy.

7. Patients with uncontrolled diabetes experience polyuria because:

A. they drink excess amounts of water due to dehydration.
B. excess glucose in the blood is excreted by the kidneys.
C. low blood glucose levels result in cellular dehydration.
D. high blood sugar levels cause permanent kidney damage.

8. Excessive eating caused by cellular “hunger” is called:

A. polyphagia.
B. polydipsia.
C. dysphasia.
D. dyspepsia.

9. Ketone production is the result of:

A. acidosis when blood glucose levels are low.
B. blood glucose levels higher than 120 mg/dL.
C. fat metabolization when glucose is unavailable.
D. rapid entry of glucose across the cell membrane.

10. A 37-year-old female with a history of diabetes presents with excessive urination and weakness of 2 days’
duration. You apply 100% oxygen and assess her blood glucose level, which reads 320 mg/dL. If this
patient’s condition is not promptly treated, she will MOST likely develop:
A. severe insulin shock.
B. acidosis and dehydration.
C. complete renal failure.
D. hypoxia and overhydration.

11. Kussmaul respirations are an indication that the body is:

A. attempting to eliminate acids from the blood.
B. trying to generate energy by breathing deeply.
C. severely hypoxic and is eliminating excess CO2.
D. compensating for decreased blood glucose levels.

12. The normal blood glucose level, as measured by a glucometer, is between:

A. 60 and 80 mg/dL.
B. 80 and 120 mg/dL.
C. 130 and 150 mg/dL.
D. 160 and 200 mg/dL.

13. Diabetic ketoacidosis occurs when:

A. blood glucose levels rapidly fall.
B. the cells rapidly metabolize glucose.
C. the pancreas produces excess insulin.
D. insulin is not available in the body.

14. A 28-year-old female patient is found to be responsive to verbal stimuli only. Her roommate states that she
was recently diagnosed with type 1 diabetes and has had difficulty controlling her blood sugar level. She
further tells you that the patient has been urinating excessively and has progressively worsened over the last
24 to 36 hours. On the basis of this patient’s clinical presentation, you should suspect that she:
A. is significantly hyperglycemic.
B. has a low blood glucose level.
C. has a urinary tract infection.
D. has overdosed on her insulin.

15. Diabetic coma is a life-threatening condition that results from:

A. hypoglycemia, excess insulin, and dehydration.
B. hyperglycemia, ketoacidosis, and dehydration.
C. hypoglycemia, dehydration, and ketoacidosis.
D. hyperglycemia, excess insulin, and ketoacidosis.

16. Which of the following statements regarding diabetic coma is correct?

A. Diabetic coma can be prevented by taking smaller insulin doses.
B. Diabetic coma typically develops over a period of hours or days.
C. Patients with low blood glucose levels are prone to diabetic coma.
D. Diabetic coma rapidly progresses once hyperglycemia develops.

17. Common signs and symptoms of diabetic coma include all of the following, EXCEPT:
A. warm, dry skin.
B. cool, clammy skin.
C. rapid, thready pulse.
D. acetone breath odor.

18. The signs and symptoms of insulin shock are the result of:
A. increased blood glucose levels.
B. fat metabolism within the cells.
C. decreased blood glucose levels.
D. prolonged and severe dehydration.

19. Insulin shock will MOST likely develop if a patient:

A. takes too much of his or her prescribed insulin.
B. markedly overeats and misses an insulin dose.
C. eats a regular meal followed by mild exertion.
D. misses one or two prescribed insulin injections.

20. Hypoglycemic crisis tends to develop more often and more severely in children because:
A. they have larger glucose stores than adults do.
B. they do not always eat correctly and on schedule.
C. their cells do not uptake glucose as fast as adults’ do.
D. their low activity levels cause rapid glucose depletion.

21. Classic signs and symptoms of hypoglycemia include:

A. warm, dry skin; irritability; bradycardia; and rapid respirations.
B. cool, clammy skin; weakness; tachycardia; and rapid respirations.
C. warm, dry skin; hunger; abdominal pain; and deep, slow respirations.
C. cold, clammy skin; bradycardia; hunger; and deep, rapid respirations

22. Assessment of a patient with hypoglycemia will MOST likely reveal:

A. sunken eyes.
B. hyperactivity.
C. warm, dry skin.
D. combativeness.
23. In contrast to insulin shock, diabetic coma:
A. is rapidly reversible if oral glucose is given.
B. commonly results in excess water retention.
C. can only be corrected in the hospital setting.
D. is a rapidly developing metabolic disturbance.

24. A 75-year-old male with type 1 diabetes presents with chest pain and a general feeling of weakness. He tells
you that he took his insulin today and ate a regular meal approximately 2 hours ago. You should treat this
patient as though he is experiencing:
A. hypoglycemia.
B. an acute stroke.
C. hyperglycemia.
D. a heart attack.

25. You respond to a residence for a patient who is “not acting right.” As you approach the door, the patient, a
35-year-old male, begins shouting profanities at you and your partner while holding a baseball bat. The man
is confused and diaphoretic, and is wearing a medical identification bracelet. You should:
A. calm him down so you can assess him.
B. be assertive and talk the patient down.
C. contact medical control for instructions.
D. retreat at once and call law enforcement.

26. A 29-year-old female presents with confusion and disorientation. Her respirations are rapid and shallow and
her pulse is 120 beats/min and thready. She is markedly diaphoretic and has an oxygen saturation of 89%.
You should:
A. transport immediately.
B. administer oral glucose.
C. provide ventilatory support.
D. treat her for hyperglycemia.

27. A man finds his 59-year-old wife unconscious on the couch. He states that she takes medications for type 2
diabetes. He further tells you that his wife has been ill recently and has not eaten for the past 24 hours. Your
assessment reveals that the patient is unresponsive. You should:
A. quickly assess for the presence of a medical identification tag.
B. administer 100% oxygen via a nonrebreathing mask.
C. open and maintain her airway and assess breathing.
D. administer oral glucose between her cheek and gum.

28. You respond to a movie theater for a 70-year-old male who is confused. His wife tells you he has type 2
diabetes but refuses to take his pills. Your assessment reveals that the patient is diaphoretic, tachycardic, and
tachypneic. Initial management for this patient should include:
A. administering one to two tubes of oral glucose.
B. applying a nonrebreathing mask at 15 L/min.
C. assisting the patient with his diabetic medication.
D. performing a rapid exam and obtaining vital signs.
29. When obtaining a SAMPLE history from a patient with diabetes, it would be MOST important to determine:
A. if he or she has had any recent illnesses or excessive stress.
B. approximately how much water the patient drank that day.
C. if there is a family history of diabetes or related conditions.
D. the name of the physician who prescribed his or her insulin.
30. When assessing an unconscious diabetic patient, the primary visible difference between hyperglycemia and
hypoglycemia is the:
A. patient’s mental status.
B. rate of the patient’s pulse.
C. presence of a medical identification tag.
D. rate and depth of breathing.

31. You are treating a 40-year-old male with a documented blood sugar reading of 300 mg/dL. The patient is
semiconscious and breathing shallowly, and is receiving assisted ventilation from your partner. You should
recognize that definitive treatment for this patient includes:
A. oxygen.
B. glucagon.
C. insulin.
D. dextrose.

32. A 19-year-old male complains of “not feeling right.” His insulin and a syringe are on a nearby table. The
patient says he thinks he took his insulin and cannot remember whether he ate. He is also unable to tell you
the time or what day it is. The glucometer reads “error” after several attempts to assess his blood glucose
level. In addition to administering oxygen, you should:
A. contact medical control and administer oral glucose.
B. assist him with his insulin injection and reassess him.
C. request a paramedic ambulance to administer IV glucose.
D. transport only with close, continuous monitoring en route.

33. Which of the following conditions is the diabetic patient at an increased risk of developing?
A. blindness
B. depression
C. alcoholism
D. hepatitis B

34. Glutose is a trade name for:

A. glucotrol.
B. oral glucose.
C. micronase.
D. glucophage.

35. To which of the following diabetic patients should you administer oral glucose?
A. an unconscious 33-year-old male with cool, clammy skin
B. a conscious 37-year-old female with nausea and vomiting
C. a semiconscious 40-year-old female without a gag reflex
D. a confused 55-year-old male with tachycardia and pallor

36. Proper procedure for administering oral glucose to a patient includes all of the following, EXCEPT:
A. assessing the patient’s mental status.
B. ensuring the absence of a gag reflex.
C. checking the medication’s expiration date.
D. requesting permission from medical control.

37. Hemoglobin is:

A. the fluid portion of the blood that transports cells throughout the body.
B. essential for the formation of clots, such as when vessel damage occurs.
C. found within the red blood cells and is responsible for carrying oxygen.
D. a key component of the blood and is produced in response to an infection.

38. Which of the following statements regarding sickle cell disease is correct?
A. Sickle cell disease is an inherited blood disorder that causes the blood to clot too quickly.
B. In sickle cell disease, the red blood cells are abnormally shaped and are less able to carry oxygen.
C. The red blood cells of patients with sickle cell disease are round and contain hemoglobin A.
D. Because of their abnormal shape, red blood cells in patients with sickle cell disease are less apt to lodge in a
blood vessel.

39. A 30-year-old female presents with severe acute pain to the left upper quadrant of her abdomen. During
your assessment, she tells you that she has sickle cell disease. You should suspect that:
A. her spleen is enlarged because of red blood cell engorgement.
B. the pain in her abdomen is referred pain from an enlarged liver.
C. she has gastrointestinal bleeding due to large blood vessel rupture.
D. she is experiencing an aplastic crisis and needs a blood transfusion.

40. An acute accelerated drop in the hemoglobin level, which is caused by red blood cells breaking down at a
faster rate than normal, occurs during a(n) __________ crisis.
A. aplastic
B. hemolytic
C. vaso-occlusive
D. splenic sequestration

41. Patients with thrombophilia are at an increased risk for:

A. various cancers.
B. hemorrhagic stroke.
C. acute arterial rupture.
D. pulmonary embolism.

42. During your assessment of a 19-year-old male, you are told that he is being treated with factor VIII. This
indicates that:
A. he has a thrombosis.
B. he has hemophilia B.
C. he has hemophilia A.
D. his blood clots too quickly.

43. A 42-year-old male is found unresponsive on his couch by a neighbor. During your assessment, you find no
signs of trauma and the patient’s blood glucose level is 75 mg/dL. His blood pressure is 168/98 mm Hg, his
heart rate is 45 beats/min and bounding, and his respirations are 8 breaths/min and irregular. The patient is
wearing a medical alert bracelet that states he has hemophilia. You should:
A. administer oxygen via a nonrebreathing mask, apply oral glucose in between his cheek and gum, and
transport.
B. suspect that he has internal bleeding and is in shock, administer high-flow oxygen, and transport at once.
C. administer high-flow oxygen, perform a detailed secondary assessment at the scene, and transport promptly.
D. suspect that he has intracranial bleeding, assist his ventilations, and transport rapidly to an appropriate
hospital.
CHAPTER 20: IMMUNOLOGICAL EMERGENCIES

1. Which of the following MOST accurately defines an allergic reaction?

A. an exaggerated immune system response to any substance
B. destruction of the immune system by an external substance
C. a release of erythrocytes in response to a foreign substance
D. a direct negative effect on the body by an external substance

2. Chemicals that are responsible for the signs and symptoms of an allergic reaction to a bee sting include:
A. the bee venom itself.
B. adrenaline and histamines.
C. leukocytes and epinephrine.
D. histamines and leukotrienes.

3. Anaphylaxis is MOST accurately defined as a(n):

A. moderate allergic reaction that primarily affects the vasculature.
B. extreme allergic reaction that may affect multiple body systems.
C. severe allergic reaction that typically resolves without treatment.
D. allergic reaction that causes bronchodilation and vasoconstriction.

4. The two MOST common signs of anaphylaxis are:

A. wheezing and widespread urticaria.
B. watery eyes and localized itching.
C. expiratory stridor and tachycardia.
D. hypertension and swollen hands.

5. Urticaria is the medical term for:

A. hives.
B. burning.
C. swelling.
D. a wheal.

6. The foreign substance responsible for causing an allergic reaction is called a(n):
A. allergen.
B. antibody.
C. histamine.
D. leukotriene.

7. Which of the following patients would MOST likely have a delayed onset of an allergic reaction?
A. a 21-year-old female who inhaled pollen
B. a 30-year-old male who was stung by a bee
C. a 45-year-old male who ingested penicillin
D. a 50-year-old male who was exposed to latex

8. Which of the following statements regarding fire ants is correct?

A. Fire ants often bite a person repeatedly.
B. Fire ant bites rarely cause anaphylaxis.
C. Fire ant bites typically occur on the face.
D. Most people are allergic to fire ant toxin.

9. A raised, swollen, well-defined area on the skin that is the result of an insect bite or sting is called:
A. a pustule.
B. purpura.
C. urticaria.
D. a wheal.

10. Because the stinger of a honeybee remains in the wound following a sting:
A. the stinger can easily be removed with tweezers.
B. the body’s immune system deactivates the venom.
C. the toxicity of the venom decreases within 10 minutes.
D. it can continue to inject venom for up to 20 minutes.

11. The stinger from a honeybee should be:

A. left in place and covered.
B. scraped away from the skin.
C. squeezed with tweezers and removed.
D. irrigated with copious amounts of water.

12. Most patients who die of anaphylaxis do so within the first __________ following exposure.
A. 5 minutes
B. 30 minutes
C. 60 minutes
D. 90 minutes

13. You are assessing a young male who was stung on the leg by a scorpion. He is conscious and alert, his
breathing is regular and unlabored, and his blood pressure is 122/64 mm Hg. Assessment of his leg reveals a
wheal surrounded by an area of redness. He states that he had a “bad reaction” the last time he was stung by
a scorpion, and carries his own epinephrine auto-injector. You should:
A. apply high-flow oxygen, apply a chemical cold pack directly to the injection site, and transport at once.
B. apply high-flow oxygen, obtain approval from medical control to assist him with his epinephrine, and
transport.
C. assess his ABCs and vital signs in 15 minutes and allow him to drive himself to the hospital if he remains
stable.
D. apply oxygen as needed, clean the area with soap and water or a mild antiseptic, and transport him to the
hospital.

14. Which of the following would MOST likely provide clues regarding the source of a patient’s allergic
reaction?
A. the patient’s family history
B. the patient’s general physical appearance
C. the environment in which the patient is found
D. the time of season in which the exposure occurred

15. A 73-year-old man presents with a generalized rash, which he thinks may have been caused by an antibiotic
that he recently began taking. He has a history of coronary artery disease, hypertension, and emphysema. He
is conscious and alert, his blood pressure is 144/94 mm Hg, and his pulse is 64 beats/min and regular. You
auscultate his breath sounds and hear scattered wheezing, although he is not experiencing respiratory
distress. In addition to administering oxygen, you should:
A. contact medical control if needed, transport the patient, and monitor him for signs of deterioration.
B. ask him if he has epinephrine and request approval from medical control to administer it to the patient.
C. avoid the use of epinephrine because of his cardiac history, even if his symptoms become severe.
D. begin transport and request to administer epinephrine if his systolic blood pressure falls below 110 mm Hg.
16. A 37-year-old male is having a severe allergic reaction to penicillin. He does not have an epinephrine auto-
injector and your protocols do not allow you to carry epinephrine on the ambulance. How should you
proceed with the treatment of this patient?
A. Ask the patient if he has any diphenhydramine (Benadryl) tablets that you can administer.
B. Administer oxygen, transport at once, and request a paramedic intercept.
C. Remain at the scene with the patient and request a paramedic ambulance.
D. Quickly determine if there are any bystanders who may carry epinephrine.
17. Which of the following negative effects of anaphylaxis will be the MOST rapidly fatal if not treated
immediately?
A. diffuse urticaria
B. severe hypotension
C. upper airway swelling
D. systemic vasodilation

18. A 38-year-old female was bitten by fire ants while at the park with her kids. Your primary assessment
reveals that she is semiconscious, has profoundly labored breathing, and has a rapid, thready pulse. She has
a red rash on her entire body and her face is very swollen. You should:
A. perform a rapid secondary assessment.
B. assist her ventilations with 100% oxygen.
C. administer 0.3 mg of epinephrine.
D. place her supine with her legs elevated 6″ to 12″.

19. A 48-year-old male is found unconscious in the garden by his wife. When you arrive at the scene and assess
the man, you find that he is unresponsive, has severely labored breathing, and has hives over his entire
trunk. You should:
A. perform a detailed secondary assessment.
B. maintain his airway and assist his ventilations.
C. ask his wife if he has any known allergies.
D. apply the automated external defibrillator (AED) in the event that cardiac arrest occurs.

20. You respond to the residence of a 55-year-old female with a possible allergic reaction to peanuts that she ate
approximately 30 minutes ago. The patient is conscious and alert, but has diffuse urticaria and the feeling
that she has a lump in her throat. As your partner applies oxygen to the patient, you should:
A. ask her if she has prescribed epinephrine.
B. obtain a complete set of baseline vital signs.
C. ascertain if she has a family history of allergies.
D. ask her when her last allergic reaction occurred.

21. Which of the following medications blocks the release of histamines?

A. albuterol (Ventolin)
B. epinephrine
C. acetaminophen (Tylenol)
D. diphenhydramine (Benadryl)

22. Common signs and symptoms of an allergic reaction include all of the following, EXCEPT:
A. abdominal cramps.
B. drying of the eyes.
C. flushing of the skin.
D. persistent dry cough.

23. Which of the following sounds indicates swelling of the upper airway?
A. rales
B. stridor
C. rhonchi
D. wheezing

24. While auscultating breath sounds of a patient who was stung multiple times by a yellow jacket, you hear
bilateral wheezing over all lung fields. This indicates:
A. rapid swelling of the upper airway tissues.
B. a significant amount of fluid in the alveoli.
C. narrowing of the bronchioles in the lungs.
D. enlargement of the bronchioles in the lungs.

25. Which of the following physiologic actions does epinephrine produce when given for an allergic reaction?
A. bronchodilation and vasodilation
B. vasoconstriction and bronchodilation
C. bronchoconstriction and vasoconstriction
D. blocking of further histamine release

26. Epinephrine is indicated for patients with an allergic reaction when:

A. wheezing and hypotension are present.
B. the patient is anxious and tachycardic.
C. a paramedic is present at the scene.
D. the reaction produces severe urticaria.

27. The adult epinephrine auto-injector delivers ______ mg of epinephrine, and the pediatric auto-injector
delivers ______ mg.
A. 0.1, 0.01
B. 0.01, 0.1
C. 0.03, 0.3
D. 0.3, 0.15

28. When using an auto-injector to give epinephrine, the primary injection site is the:
A. medial part of the buttocks.
B. lateral portion of the arm.
C. lateral portion of the thigh.
D. medial portion of the thigh.

29. When administering epinephrine via auto-injector, you should hold the injector in place for:
A. 5 seconds.
B. 10 seconds.
C. 15 seconds.
D. 20 seconds.

30. Immediately after giving an epinephrine injection, you should:

A. properly dispose of the syringe.
B. record the time and dose given.
C. reassess the patient’s vital signs.
D. notify medical control of your action.

31. A 50-year-old male was stung by a honeybee approximately 15 minutes ago. He presents with respiratory
distress, facial swelling, and hypotension. After placing him on oxygen and administering his epinephrine
via auto-injector, you note that his breathing has improved. Additionally, his facial swelling is resolving and
his blood pressure is stable. Your next action should be to:
A. reassess his breathing and blood pressure in 15 minutes.
B. visualize his airway to assess for oropharyngeal swelling.
C. notify medical control of the patient’s response to your treatment.
D. record the time and dose of the injection, and transport promptly.
32. You have administered one dose of epinephrine to a 40-year-old female to treat an allergic reaction that she
developed after being stung by a scorpion. Your reassessment reveals that she is still having difficulty
breathing, has a decreasing mental status, and has a blood pressure of 80/50 mm Hg. You should:
A. monitor her en route to the hospital and call medical control if she worsens.
B. crush up an antihistamine tablet and place it in between her cheek and gum.
C. request permission from medical control to give another dose of epinephrine.
D. administer a nebulized bronchodilator to improve the status of her breathing.

33. The effects of epinephrine are typically observed within _________ following administration.
A. 30 seconds
B. 1 minute
C. 30 minutes
D. 1 hour

34. Common side effects of epinephrine include all of the following, EXCEPT:
A. drowsiness.
B. tachycardia.
C. headache.
D. dizziness.

35. A 19-year-old female was stung multiple times on the legs by fire ants. She states that she is allergic to fire
ants, but does not carry her own epinephrine. The patient is conscious and alert and complains of pain to the
area of the bites. Her blood pressure is 122/70 mm Hg, her pulse is 100 beats/min and strong, and her
respirations are 18 breaths/min and unlabored. You should:
A. position her legs well above the level of her heart.
B. administer oxygen and transport her to the hospital.
C. request a paramedic unit to administer epinephrine.
D. advise her to see her physician as soon as possible.

36. After administering 0.3 mg of epinephrine via auto-injector to a 22-year-old female with an allergic
reaction, you note improvement in her breathing and dissipation of her hives. However, she is still anxious
and tachycardic. You should:
A. contact medical control and obtain authorization to administer another 0.3 mg of epinephrine.
B. transport her rapidly, as it is obvious that she is having a severe reaction to the epinephrine.
C. monitor her closely but recall that anxiety and tachycardia are side effects of epinephrine.
D. consider administering 0.15 mg of epinephrine to completely resolve her allergic reaction.

CHAPTER 21: TOXICOLOGY

1. Substance abuse is MOST accurately defined as:

A. knowingly selling illicit drugs in order to buy more drugs.
B. willfully using a therapeutic drug to treat a medical illness.
C. unwillingly and unknowingly consuming drugs or alcohol.
D. knowingly misusing a substance to produce a desired effect.

2. The EMT’s primary responsibility to the patient who has been poisoned is to:
A. administer the appropriate antidote.
B. recognize that a poisoning occurred.
C. administer 25 g of activated charcoal.
D. contact poison control immediately.

3. Heroin is an example of a(n):

A. opioid.
B. hypnotic.
C. cholinergic.
D. sympathomimetic.

4. Hypotension, hypoventilation, and pinpoint pupils would be expected following an overdose of:
A. ecstasy.
B. oxycodone (Percocet).
C. amphetamine sulfate (Benzedrine).
D. crack cocaine.

5. Signs and symptoms of a sympathomimetic drug overdose include:

A. sedation.
B. tachycardia.
C. hypotension.
D. slurred speech.

6. Which of the following drugs is NOT a sedative-hypnotic?

A. secobarbital (Seconal)
B. diazepam (Valium)
C. cocaine
D. flunitrazepam (Rohypnol)

7. Your paramedic partner administers atropine to a 49-year-old male with bradycardia. Which of the
following side effects would you expect the patient to experience?
A. pupillary constriction
B. excessive lacrimation
C. a fall in blood pressure
D. dry mucous membranes

8. Which of the following questions would be of LEAST pertinence during the initial questioning of a patient
who ingested a substance?
A. How much of the substance was taken?
B. How long ago was it taken?
C. What type of substance was taken?
D. Why was the substance ingested?

9. A poison that enters the body by __________ is the MOST difficult to treat.
A. injection
B. ingestion
C. inhalation
D. absorption

10. The poison control center will be able to provide you with the most information regarding the appropriate
treatment for a patient with a drug overdose if the center:
A. knows the location of the closest hospital.
B. is aware of the patient’s age and gender.
C. is aware of the substance that is involved.
D. knows why the patient overdosed on the drug.

11. Which of the following statements regarding inhaled poisons is correct?

A. Lung damage may progress after the patient is removed from the environment.
B. Carbon monoxide is very irritating to the upper airway and may cause swelling.
C. Burns around the eyes are the most common indication of an inhalation poisoning.
D. Chlorine is a colorless and odorless gas that causes hypoxia and pulmonary edema.

12. Your priority in caring for a patient with a surface contact poisoning is to:
A. move the patient to a safe area.
B. avoid contaminating yourself.
C. decontaminate the patient’s skin.
D. obtain and maintain a patent airway.

13. Phosphorus or elemental sodium should be brushed off of the skin instead of irrigated with water because:
A. water makes these chemicals impossible to remove.
B. severe swelling will occur when mixed with water.
C. this will eliminate the chances of you being exposed.
D. these chemicals may ignite upon contact with water.

14. Most poisonings occur via the __________ route.

A. ingestion
B. injection
C. inhalation
D. absorption

15. Syrup of ipecac is no longer recommended to treat patients who have ingested a poisonous substance
because it:
A. has been linked to hypotension.
B. does not effectively induce vomiting.
C. may result in aspiration of vomitus.
D. has toxic effects on the myocardium.

16. Activated charcoal is given to patients who have ingested certain substances because it:
A. induces vomiting and empties the stomach.
B. binds to the substance and prevents absorption.
C. decreases absorption of poisons into the lungs.
D. is a direct antidote for many toxic substances.

17. In general, injected poisons are impossible to dilute or remove because they:
A. are usually absorbed quickly into the body.
B. are usually fatal within 30 minutes of exposure.
C. absorb slowly into the body, despite their potency.
D. react with the blood, which increases their toxicity.

18. As you enter the residence of a patient who has possibly overdosed, you should:
A. be alert for personal hazards.
B. look for drug paraphernalia.
C. observe the scene for drug bottles.
D. quickly gain access to the patient.

19. Your unit is dispatched to the county jail for an intoxicated inmate. Upon arrival, you find the patient, a 33-
year-old male, lying supine in a jail cell. He is responsive to painful stimuli only and has slow, shallow
respirations. You should be MOST concerned that this patient:
A. might become violent.
B. may vomit and aspirate.
C. may experience a seizure.
D. is severely hypoglycemic.

20. You receive a call to a residence where a man found his wife unconscious on the couch. The patient is
unresponsive, her respiratory rate is 8 breaths/min, her breathing is shallow, her heart rate is 40 beats/min,
and her pulse is weak. The husband hands you an empty bottle of hydrocodone (Vicodin), which was
refilled the day before. You should:
A. initiate ventilatory assistance.
B. contact the poison control center.
C. perform a rapid head-to-toe exam.
D. apply oxygen via a nonrebreathing mask.

21. It is MOST important to determine a patient’s weight when asking questions pertaining to a toxic ingestion
because:
A. additional help may be needed at the scene to lift the patient.
B. this will allow you to predict if the exposure is lethal.
C. this will determine whether or not to give syrup of ipecac.
D. activated charcoal is given based on a patient’s weight.

22. Airborne substances are diluted with:

A. oxygen.
B. syrup of ipecac.
C. activated charcoal.
D. an alkaline antidote.

23. Activated charcoal administration is contraindicated in patients who have ingested:

A. ibuprofen.
B. acetaminophen (Tylenol).
C. acids or alkalis.
D. steroid drugs.

24. Common names for activated charcoal include all of the following, EXCEPT:
A. Fructose.
B. Actidose.
C. LiquiChar.
D. InstaChar.

25. The usual dose for activated charcoal is up to ______ for a pediatric patient and up to ______ for an adult
patient.
A. 5 g, 10 g
B. 10 g, 20 g
C. 12.5 g, 25 g
D. 25 g, 50 g
26. A 4-year-old male ingested an unknown quantity of acetaminophen (Tylenol). The child’s mother states that
the ingestion occurred approximately 20 minutes ago. The child is conscious and alert and in no apparent
distress. After contacting medical control, you should:
A. induce vomiting with syrup of ipecac.
B. transport the child for definitive care.
C. administer up to 25 g of activated charcoal.
D. give the child cold milk to absorb the Tylenol.

27. Before giving activated charcoal, you should:

A. obtain approval from medical control.
B. have the patient drink a glass of milk.
C. mix it with an equal amount of water.
D. mix the suspension by stirring the bottle.

28. The major side effect associated with ingestion of activated charcoal is:
A. headache.
B. black stools.
C. abdominal pain.
D. ringing in the ears.

29. After administering activated charcoal to a patient, it is MOST important to:

A. call medical control.
B. be alert for vomiting.
C. reassess the patient’s blood pressure.
D. document the intervention.

30. A person who routinely misuses a substance and requires increasing amounts to achieve the same effect is
experiencing a(n):
A. addiction.
B. dependence.
C. withdrawal.
D. tolerance.

31. The MOST commonly abused drug in the United States is:
A. cocaine.
B. alcohol.
C. codeine.
D. marijuana.

32. A hypnotic drug is one that:

A. induces sleep.
B. prevents amnesia.
C. increases the pulse.
D. increases the senses.

33. When caring for a known alcoholic patient with severe trauma to the chest and abdomen, you should be
concerned that:
A. delirium tremens (DTs) are commonly induced by physical trauma and can lead to life-threatening seizures.
B. internal bleeding may be profuse because prolonged alcohol use may impair the blood’s ability to clot.
C. long bone fractures are likely because chronic alcohol consumption weakens the structure of the bones.
D. signs and symptoms of shock may be masked by the stimulant effects produced by alcohol.

34. DTs is a syndrome associated with withdrawal from:

A. cocaine.
B. opioids.
C. alcohol.
D. sedatives.
35. A 49-year-old male presents with confusion, sweating, and visual hallucinations. The patient’s wife tells
you that he is a heavy drinker and she thinks he had a seizure shortly before your arrival. This patient is
MOST likely experiencing:
A. acute hypovolemia.
B. alcohol intoxication.
C. acute schizophrenia.
D. DTs.

36. During your assessment of a 50-year-old male who was found unconscious in an alley, you note that he has
slow, shallow respirations; significant bradycardia; facial cyanosis; and pinpoint pupils. As your partner
begins assisting the patient’s ventilations, he directs your attention to the patient’s arms, which have
multiple needle tracks on them. This patient’s clinical presentation is MOST consistent with:
A. a heroin overdose.
B. alcohol intoxication.
C. a closed head injury.
D. an overdose of diazepam (Valium).

37. You and your paramedic partner are caring for a patient who ingested codeine, acetaminophen (Tylenol),
and propoxyphene (Darvon). The patient is unresponsive, his breathing is slow and shallow, and his pulse is
slow and weak. Treatment for this patient will include:
A. assisted ventilation, naloxone (Narcan), and rapid transport.
B. oxygen via a nonrebreathing mask and rapid transport.
C. assisted ventilation, flumazenil (Romazicon), and rapid transport.
D. oxygen via a nasal cannula, atropine, and rapid transport.

38. You respond to a local motel for a young female who was sexually assaulted. The patient is conscious but
confused. She tells you that the last thing she remembers was drinking beer at a club with her friends the
night before. When she awoke, she was in the bed of the motel room. You should be MOST suspicious that
this patient:
A. is a heroin abuser.
B. is acutely intoxicated.
C. was given flunitrazepam (Rohypnol).
D. is abusing marijuana.

39. You respond to a college campus for a young male who is acting strangely. After law enforcement has
secured the scene, you enter the patient’s dorm room and find him sitting on the edge of the bed; he appears
agitated. As you approach him, you note that he has dried blood around both nostrils. He is breathing
adequately, his pulse is rapid and irregular, and his blood pressure is 200/110 mm Hg. Treatment for this
patient includes:
A. requesting a paramedic to administer naloxone (Narcan).
B. assisting his ventilations with a bag-mask device.
C. asking law enforcement to place handcuffs on the patient.
D. attempting to calm him and giving him oxygen if tolerated.

40. In an apparent suicide attempt, a 19-year-old female ingested a full bottle of amitriptyline (Elavil). At
present, she is conscious and alert and states that she swallowed the pills approximately 30 minutes earlier.
Her blood pressure is 90/50 mm Hg, her pulse is 140 beats/min and irregular, and her respirations are 22
breaths/min with adequate depth. When transporting this patient, you should be MOST alert for:
A. acute respiratory depression.
B. a sudden outburst of violence.
C. an increase in her blood pressure.
D. seizures and cardiac arrhythmias.
41. You are dispatched to a local nursery for a 39-year-old female who is sick. When you arrive, you find the
patient lying on the floor. She is semiconscious, has copious amounts of saliva coming from her mouth, and
is incontinent of urine. You quickly feel her pulse and note that it is very slow. Initial management for this
patient should include:
A. thoroughly suctioning her oropharynx.
B. assisted ventilation with a bag-mask device.
C. performing a rapid secondary assessment.
D. requesting a paramedic to give her atropine.

42. Atropine sulfate and pralidoxime chloride are antidotes for:

A. lysergic acid diethylamide (LSD).
B. diphenhydramine (Benadryl).
C. nerve gas agents.
D. anticholinergic drugs.

43. A patient who presents with rapid breathing, nausea and vomiting, ringing in the ears, and a high fever
should be suspected of ingesting a significant quantity of:
A. cocaine.
B. aspirin.
C. Tylenol.
D. ibuprofen.

44. An overdose on acetaminophen, the active ingredient in Tylenol, will MOST likely cause:
A. liver failure.
B. gastric ulcers.
C. kidney failure.
D. central nervous system (CNS) depression.

45. Which of the following statements regarding the Salmonella bacterium is correct?
A. Refrigeration of food will prevent salmonellosis.
B. Symptoms of salmonellosis appear within 12 hours.
C. The Salmonella bacterium produces toxins that cause food poisoning.
D. The Salmonella bacterium itself causes food poisoning.

46. A 3-year-old female ingested several leaves from a plant in the living room. The child’s mother is not sure
what type of plant it is, stating that she bought it simply because it was pretty. After completing your initial
assessment of the child, you should:
A. administer 25 g of activated charcoal.
B. induce vomiting with syrup of ipecac.
C. contact the regional poison control center.
D. immediately transport the child to the hospital.

CHAPTER 22: PSYCHIATRIC EMERGENCIES

1. ____________ is what you can see of a person’s response to the environment.

A. Affect
B. Behavior
C. Neurosis
D. Psychosis
2. The term “behavioral crisis” is MOST accurately defined as:
A. a sudden, violent outburst of an otherwise mentally stable person toward a family member.
B. any reaction that interferes with activities of daily living or is deemed unacceptable by others.
C. a situation in which a patient demonstrates bizarre behavior and becomes a risk to other people.
D. a period of severe depression that lasts longer than 2 weeks and cannot be controlled with medications.

3. From a mental health standpoint, an abnormal or disturbing pattern of behavior is a matter of concern if it
lasts for at least:
A. 1 week.
B. 2 weeks.
C. 3 weeks.
D. 1 month.

4. In contrast to a behavioral crisis, a psychiatric emergency occurs when a person:

A. demonstrates agitation or violence or becomes a threat to himself or herself, or to others.
B. experiences feelings of sadness and despair for longer than a month.
C. exhibits impaired functioning due to a chemical or genetic disturbance.
D. experiences a sudden attack of panic secondary to a stressful situation.

5. When assessing a patient who is displaying bizarre behavior, the EMT should:
A. consider that an acute medical illness may be causing the patient’s behavior.
B. avoid asking questions about suicide because this may give the patient ideas.
C. check his or her blood glucose level only if he or she has a history of diabetes.
D. carefully document his or her perception of what is causing the patient’s behavior.

6. Organic brain syndrome is MOST accurately defined as:

A. bizarre behavior secondary to a chemical imbalance or disturbance in the brain.
B. a dysfunction of the brain caused by abnormal physical or physiological function.
C. a disorder that cannot be traced to the abnormal structure or function of an organ.
D. a change in behavior or mental status secondary to inadequate cerebral blood flow.

7. A 78-year-old female presents with an acute change in her behavior. The patient’s son tells you that his
mother has type 2 diabetes and was diagnosed with Alzheimer’s disease 6 months ago. The patient’s speech
is slurred and she is not alert to her surroundings. You should:
A. transport the patient to a psychiatric facility.
B. inquire about the possibility of head trauma.
C. conclude that the patient’s blood sugar is high.
D. allow the patient to refuse transport if she wishes.

8. Which of the following conditions or factors would be the LEAST likely to result in a change in behavior?
A. low blood glucose levels
B. antihypertensive medications
C. exposure to excess heat or cold
D. inadequate blood flow to the brain

9. Which of the following is an example of a functional behavioral disorder?

A. head trauma
B. drug addiction
C. schizophrenia
D. Alzheimer’s disease
10. The first step in assessing a patient with a behavioral emergency is to:
A. take vital signs.
B. restrain the patient.
C. ensure your safety.
D. obtain proper consent.

11. You respond to a call for an unknown emergency. When you arrive at the scene, the patient’s husband meets
you at the door and states that his wife has been depressed and has locked herself in an upstairs bedroom.
He further tells you that he keeps his handgun in the bedroom. You should:
A. ask the husband to attempt to reason with his wife.
B. remain in a safe place and request law enforcement.
C. get in your ambulance and leave the scene immediately.
D. go upstairs with caution and attempt to talk to the patient.

12. General guidelines for managing a patient with a behavioral emergency include:
A. firmly identifying yourself as an EMS provider.
B. placing the patient between yourself and an exit.
C. allowing the patient to be alone if he or she wishes.
D. being prepared to spend extra time with the patient.

13. A 40-year-old male intentionally cut his wrist out of anger after losing his job. Law enforcement has secured
the scene prior to your arrival. As you enter the residence and visualize the patient, you can see that he has a
towel around his wrist and a moderate amount of blood has soaked through it. You should:
A. approach the patient with caution.
B. quickly tend to the bleeding wound.
C. tell the patient that you want to help.
D. calmly identify yourself to the patient.

14. When assessing a patient with a behavioral crisis, you should:

A. be direct and clearly state your intentions.
B. frisk the patient for the presence of weapons.
C. spend as little time with the patient as possible.
D. ask the police to handcuff the patient for safety.

15. A 22-year-old male with a history of clinical depression called 9-1-1 and stated that he has attempted to kill
himself. Your unit and law enforcement officers arrive at the scene simultaneously. You find the patient
lying supine on the living room floor. He is unconscious and cyanotic. An empty bottle of hydromorphone
(Dilaudid) is found on an adjacent table. You should:
A. open the patient’s airway and assess his respirations.
B. ask the police to handcuff the patient for safety purposes.
C. provide care after determining what Dilaudid is used for.
D. wait for the police to examine him before providing care.

16. A 66-year-old male presents with bizarre behavior. His daughter states that he did not seem to recognize her
and was very rude to her. The patient is conscious, and has a patent airway and adequate breathing. You
should:
A. conclude that the patient has Alzheimer’s disease.
B. ask the daughter how her father normally behaves.
C. carefully restrain the patient and transport at once.
D. advise the patient that his behavior is unacceptable.
17. A technique used to gain insight into a patient’s thinking, which involves repeating in question form what
the patient has said, is called:
A. active listening.
B. passive listening.
C. intuitive listening.
D. reflective listening.

18. Which of the following statements regarding the physical examination of a patient with a behavioral
problem is correct?
A. It is only appropriate to perform a physical examination on a patient with a behavioral problem if he or she
is unconscious or is being physically restrained.
B. A physical examination for a behavioral problem may be difficult to perform but may provide clues to the
patient’s state of mind and thought processes.
C. The physical examination of a patient with a behavioral problem often yields crucial information and should
always be performed, even if the patient is violent.
D. Performing a physical examination on a patient with a behavioral problem will likely cause him or her to
become violent and should be avoided in the field.

19. You are assessing a conscious 55-year-old male with a sudden change in behavior. Which of the following
clinical findings would be MOST suggestive of dysfunction of this patient’s central nervous system?
A. an irregular pulse
B. rapid eye movement
C. excessive tearing or crying
D. consistent eye contact

20. Assessing the blood pressure and oxygen saturation of a patient with a behavioral crisis should be
performed:
A. within the first few minutes after making patient contact.
B. at least every 5 minutes in order to detect signs of shock.
C. only if you will be transporting the patient to the hospital.
D. if doing so will not worsen his or her emotional distress.

21. In addition to ensuring his or her own safety, the EMT’s responsibility when caring for a patient with a
behavioral emergency is to:
A. diffuse and control the situation and safely transport the patient.
B. diagnose the patient’s problem and provide definitive treatment.
C. transport the patient directly to a specialized psychiatric facility.
D. determine the underlying cause of the problem and offer advice.

22. Common causes of acute psychotic behavior include all of the following, EXCEPT:
A. intense stress.
B. schizophrenia.
C. Alzheimer’s disease.
D. mind-altering substance use.
23. The single most significant factor that contributes to suicide is:
A. depression.
B. drug abuse.
C. advanced age.
D. a chronic illness.
24. You are assessing a 45-year-old female who is severely depressed. She states that it seems as though her
entire world is crashing down around her. She further states that she has had frequent thoughts of suicide,
but is not sure if she can actually go through with it. How should you manage this situation?
A. Ask the patient if she has developed a suicidal plan.
B. Leave the scene and have a neighbor check in on her.
C. Have law enforcement place her in protective custody.
D. Encourage the patient to remain quiet during transport.

25. People at risk for suicide include all of the following, EXCEPT:
A. married males older than 30 years.
B. those with a recent diagnosis of a serious illness.
C. children with parents addicted to alcohol.
D. substance abusers.

26. It is MOST important for the EMT to remember that suicidal patients may:
A. inject illicit drugs.
B. be self-destructive.
C. be homicidal as well.
D. have a definitive plan.

27. Signs of agitated delirium include:

A. pallor, hypotension, and constricted pupils.
B. diaphoresis, tachycardia, and hallucinations.
C. slurred speech, bradycardia, and a high fever.
D. subdued behavior, crying, and suicidal thoughts.

28. Law enforcement personnel request your assistance for a 30-year-old man who they pulled over for erratic
driving. The patient became acutely violent while he was being questioned, which required one of the
officers to subdue him with a Taser. When you arrive and assess the patient, you find that he is very agitated
and is experiencing apparent hallucinations. His skin is flushed and diaphoretic. You should:
A. quickly rule out any life-threatening conditions and then perform a detailed secondary assessment as he is
being restrained.
B. suspect that he is acutely hypoglycemic, consider giving him one tube of oral glucose, and transport with
lights and siren.
C. limit physical contact with the patient as much as possible and avoid interrupting him if he is attempting to
communicate with you.
D. recognize that he is experiencing a complex psychiatric crisis, quickly load him into the ambulance, and
transport without delay.

29. A 38-year-old male with a history of schizophrenia is reported by neighbors to be screaming and throwing
things in his house. You are familiar with the patient and have cared for him in the past for unrelated
problems. Law enforcement officers escort you into the residence when you arrive. The patient tells you that
he sees vampires and is attempting to ward them off by screaming and throwing things at them. He has
several large lacerations to his forearms that are actively bleeding. The MOST appropriate way to manage
this situation is to:
A. try to gain the patient’s trust by telling him that you see the vampires too.
B. request that the police officers arrest him and take him to the hospital.
C. restrain the patient with appropriate force in order to treat his injuries.
D. approach the patient and calm him by placing your hand on his shoulder.

30. You receive a call for a domestic dispute. When you arrive at the scene, you find a young male standing on
the front porch of his house. You notice that an adjacent window is broken. The patient has a large body, is
 clenching his fists, and is yelling obscenities at you. Which of the following findings is LEAST predictive
of this patient’s potential for violence?
A. his clenched fists
B. the broken window
C. his shouting of obscenities
D. his large body

CHAPTER 23: OBGYN EMERGENCIES

1. Each ovary produces an ovum in alternating months and releases it into the:
A. vagina.
B. uterus.
C. cervix.
D. fallopian tube.

2. In anticipation of receiving a fertilized ovum, the lining of the uterine wall:

A. thins and begins to separate.
B. becomes engorged with blood.
C. diverts blood flow to the vagina.
D. sheds and is expelled externally.

3. The onset of menstruation is called menarche and usually occurs in women who are:
A. between 12 and 14 years of age.
B. between 11 and 16 years of age.
C. between 25 and 35 years of age.
D. between 45 and 50 years of age.

4. When a female has reached menarche:

A. she is capable of becoming pregnant.
B. she can no longer produce an ovum.
C. she usually requires hormone therapy.
D. menstrual periods become less frequent.

5. It is not uncommon for young females who experience their first menstrual period to:
A. have a falsely positive home pregnancy test result.
B. lose up to 500 mL of blood within the first 24 hours.
C. experience abdominal cramping, which may be misinterpreted.
D. become so emotionally distraught that they contemplate suicide.

6. Which of the following statements regarding pelvic inflammatory disease (PID) is correct?
A. The most severe cases of PID occur in women who are not sexually active.
B. PID can scar the fallopian tubes, which increases the risk of an ectopic pregnancy.
C. PID most commonly affects women who have had an ectopic pregnancy in the past.
D. The most common presenting symptom of PID is generalized upper abdominal pain.

7. PID typically does NOT affect the:

A. uterus.
B. ovaries.
C. urinary bladder.
D. fallopian tubes.
8. Potentially life-threatening consequences of PID include:
A. ovarian cysts and gonorrhea.
B. bacterial vaginosis and chlamydia.
C. uterine rupture with severe bleeding.
D. ovarian abscess and ectopic pregnancy.

9. Which of the following clinical presentations is MOST consistent with PID?

A. left lower quadrant pain, referred pain to the left shoulder, and fever
B. pain around the umbilicus, low-grade fever, and generalized weakness
C. upper abdominal cramping, severe headache, and heavy vaginal bleeding
D. lower abdominal pain, fever, general malaise, and foul-smelling vaginal discharge

10. Which of the following conditions does NOT typically present with vaginal discharge?
A. chlamydia
B. gonorrhea
C. genital herpes
D. PID

11. As a woman approaches menopause:

A. her menstrual periods may become irregular and vary in severity.
B. she cannot become pregnant because of fluctuating hormone levels.
C. she usually experiences abdominal cramping without vaginal bleeding.
D. her risk of developing PID lowers significantly.

12. Which of the following conditions would MOST likely lead to PID if left untreated?
A. chlamydia
B. ovarian cysts
C. genital herpes
D. ectopic pregnancy

13. Bacterial vaginosis is a condition that occurs when:

A. harmful bacteria infect and cause damage to the uterus, cervix, and fallopian tubes.
B. normal bacteria in the vagina are replaced by an overgrowth of other bacterial forms.
C. numerous bacteria enter the uterus through the cervix and cause severe tissue damage.
D. abnormal bacteria enter the vagina and cause damage without causing any symptoms.

14. Which of the following statements regarding gonorrhea is correct?

A. Most men who are infected with gonorrhea do not experience symptoms.
B. Painful urination is a common symptom of gonorrhea in men and women.
C. Symptoms of gonorrhea usually appear within 3 months after being infected.
D. Mild infections with gonorrhea cause abdominal pain, vomiting, and fever.

15. In contrast to bleeding caused by external trauma to the vagina, bleeding caused by conditions such as
polyps or cancer:
A. may be relatively painless.
B. is typically not as severe.
C. can be controlled in the field.
D. often presents with acute pain.

16. Whenever possible, a female sexual assault victim should be:

A. given the option of being treated by a female EMT.
B. encouraged to take a shower and change her clothes.
C. thoroughly assessed, even if no signs of injury exist.
D. asked to provide a brief description of the perpetrator.

17. When a woman presents with abdominal pain or other vague symptoms, the EMT is often unable to
determine the nature of the problem until he or she:
A. has gathered patient history information.
B. has obtained a complete set of vital signs.
C. ascertains if the patient was ever pregnant.
D. has formed a general impression of the patient.

18. During your assessment of a young female with nontraumatic vaginal bleeding, you note that her level of
consciousness is decreased, her respirations are rapid and shallow, her skin is cool and moist, and her pulse
is rapid and weak. You should:
A. perform a rapid secondary assessment.
B. assist her ventilations with a bag-mask device.
C. assess her blood pressure and elevate her legs.
D. perform a visual assessment of her vaginal area.

19. If a woman with vaginal bleeding reports syncope, the EMT must assume that she:
A. is pregnant.
B. is in shock.
C. has an infection.
D. has an ectopic pregnancy.

20. When caring for a woman who is experiencing a gynecologic emergency, the EMT’s main focus should be
to:
A. determine the underlying cause of her problem.
B. ask questions related to her gynecologic history.
C. maintain her ABCs and transport without delay.
D. keep assessment and treatment to a minimum.

21. A 26-year-old female presents with heavy vaginal bleeding. She is conscious, but restless. Her blood
pressure is 84/54 mm Hg, her pulse is 120 beats/min and weak, and her respirations are 22 breaths/min with
adequate depth. She tells you that she inserted a tampon about 2 hours ago. You should:
A. administer high-flow oxygen, ask her to remove the tampon, perform a detailed secondary assessment, and
transport promptly.
B. administer high-flow oxygen, perform a detailed assessment of her vaginal area for signs of trauma, place
her on her side, and transport.
C. administer high-flow oxygen, place a sterile pad over her vagina, keep her warm, elevate her lower
extremities, and transport without delay.
D. assist her ventilations with a bag-mask device, place one sterile dressing into her vagina, perform a rapid
secondary assessment, and transport.

22. General treatment for a woman with vaginal bleeding and shock following sexual assault includes all of the
following, EXCEPT:
A. supplemental oxygen and lower extremity elevation.
B. refraining from placing any dressings into the vagina.
C. carefully removing any foreign bodies from the vagina.
D. treating external lacerations with moist, sterile compresses.
23. You are dispatched to a residence for a 40-year-old female who complains of lower abdominal pain, fever
and chills, and a foul-smelling vaginal discharge. Which of the following additional assessment findings
would increase your index of suspicion for PID?
A. a shuffling gait when walking
B. bright red blood in the urine
C. a history of ectopic pregnancy
D. vaginal passage of blood clots

24. Which of the following statements regarding rape is correct?

A. The EMT should try to determine if rape occurred.
B. Rape is a legal diagnosis, not a medical diagnosis.
C. Rape causes more physical harm than emotional harm.
D. Only a licensed physician can make a diagnosis of rape.

25. When caring for a female patient who has been sexually assaulted, you should:
A. ask the patient for a concise, detailed report of what happened to her.
B. allow law enforcement to take her statement before you begin treatment.
C. advise her that she will not be allowed to shower or change her clothes.
D. place any bloodstained clothing or other articles in separate paper bags.

26. Law enforcement personnel request your assistance to assess a 31-year-old female who was sexually
assaulted. When you arrive at the scene, you find the patient sitting on a curb outside her apartment. She is
conscious, alert, and crying. When you ask her what happened, she tells you that she does not want to be
treated or transported to the hospital. She further tells you that all she wants to do is clean up. You should:
A. provide emotional support and visually assess her for obvious trauma.
B. advise her that she cannot clean herself up because this will destroy evidence.
C. ask her if there is anyone you can contact, such as a friend or relative.
D. perform a limited hands-on assessment to detect life-threatening injuries.

27. The physical examination of a sexual assault victim should be:

A. limited to a brief survey for life-threatening injuries.
B. performed in the presence of at least two police officers.
C. as detailed as possible so all injuries can be documented.
D. deferred until the patient can be evaluated by a physician.

28. When documenting a call in which a female was sexually assaulted, you should:
A. only use quotation marks when recording any statements made by witnesses.
B. translate the patient’s words or statements using proper medical terminology.
C. record your opinion only if you have reasonable proof to justify the statement.
D. keep the report concise and record only what the patient stated in her own words.

CHAPTER 24: TRAUMA OVERVIEW

1. The index of suspicion is MOST accurately defined as:

A. the way in which traumatic injuries occur.
B. a predictable pattern that leads to serious injuries.
C. your concern for potentially serious underlying injuries.
D. the detection of less obvious life-threatening injuries.
2. When assessing the interior of a crashed motor vehicle for damage, you are gathering information regarding
the:
A. index of suspicion.
B. mechanism of injury.
C. kinetic energy.
D. potential energy.

3. When a motor vehicle strikes a tree while traveling at 40 mph, the unrestrained occupant:
A. will most likely be thrown over the steering column.
B. remains in motion until acted upon by an external force.
C. will decelerate at the same rate as the motor vehicle.
D. is thrust under the steering column onto the floorboard.

4. Force acting over a distance defines the concept of:

A. work.
B. latent energy.
C. kinetic energy.
D. potential energy.

5. The energy of a moving object is called:

A. latent energy.
B. kinetic energy.
C. potential energy.
D. converted energy.

6. When the speed of a motor vehicle doubles, the amount of kinetic energy:
A. doubles.
B. triples.
C. quadruples.
D. is not affected.

7. Which of the following statements regarding gunshot wounds is correct?

A. High-velocity bullets will cause less severe internal injuries.
B. The size of a bullet has the greatest impact on producing injury.
C. Low-velocity bullets will cause the greatest amount of trauma.
D. The speed of a bullet has the greatest impact on producing injury.

8. By what mechanism is a person injured when he or she falls from a significant height?
A. Kinetic energy is converted to potential energy; the potential energy is then converted into the work of
bringing the body to a stop.
B. Potential energy is created as the person is falling; the potential energy is then converted into kinetic energy
upon impact.
C. As the person falls, the amount of kinetic energy is converted into work; work is then converted to kinetic
energy upon impact.
D. Potential energy is converted to kinetic energy; the kinetic energy is then converted into the work of
bringing the body to a stop.

9. Two of the MOST common mechanisms of injury for blunt trauma are:
A. falls and motor vehicle collisions.
B. low-caliber gunshot wounds and falls.
C. gunshot wounds and vehicle ejections.
D. motor vehicle collisions and stabbings.

10. What types of motor vehicle collisions present the greatest potential for multiple impacts?
A. lateral and rollover
B. frontal and rotational
C. Rear-end and rotational
D. rotational and rollover

11. With regard to the three collisions that occur during a motor vehicle crash, which of the following
statements regarding the first collision is correct?
A. It provides the least amount of information about the mechanism of injury.
B. It has a direct effect on patient care because of the obvious vehicular damage.
C. It is the most dramatic part of the collision and may make extrication difficult.
D. It occurs when the unrestrained occupant collides with the interior of the vehicle.

12. Which of the following findings would be LEAST suggestive of the presence of high-energy trauma?
A. dismounted seats
B. steering wheel deformity
C. intrusion into the vehicle
D. deployment of the air bag

13. Which of the following would MOST likely occur as the direct result of the second collision in a motor
vehicle crash?
A. collapsed dashboard
B. deformed steering wheel
C. caved-in passenger door
D. intrathoracic hemorrhage

14. Which of the following injuries would MOST likely occur as a direct result of the third collision in a motor
vehicle crash?
A. flail chest
B. aortic rupture
C. extremity fractures
D. forehead lacerations

15. If one or more occupants in the same vehicle are killed in a crash, the EMT should:
A. suspect that all living occupants experienced the same serious trauma.
B. transport the survivors only if they have injuries or complain of pain.
C. allow the survivors to refuse transport if they have no obvious injuries.
D. rapidly assess only the survivors who have experienced obvious trauma.

16. The driver of a sport utility vehicle lost control and struck a utility pole head-on. The driver was killed
instantly. The passenger, a young female, is conscious and alert and has several small abrasions and
lacerations to her left forearm. Treatment for the passenger should include:
A. transport to a trauma center.
B. a focused exam of her forearm.
C. transport to a community hospital.
D. a secondary assessment at the scene.

17. Air bags are designed to:

A. prevent a second collision inside the car.
B. be used with or without a shoulder harness.
C. decrease the severity of deceleration injuries.
D. prevent the driver from sustaining head trauma.

18. When caring for an occupant inside a motor vehicle equipped with an air bag that did not deploy upon
impact, it is MOST important to:
A. realize that the air bag malfunctioned at the time of impact.
B. remember that it could still deploy and seriously injure you.
C. suspect that the patient may have experienced serious injuries.
D. recognize that the force of impact was most likely not severe.

19. When a driver is in a car equipped with an air bag, but is not wearing a seatbelt, he or she will MOST likely
strike the __________ when the air bag deploys upon impact.
A. door
B. dashboard
C. windshield
D. steering wheel

20. While en route to a major motor vehicle crash, an on-scene police officer advises you that a 6-year-old male
who was riding in the front seat is involved. He further states that the child was only wearing a lap belt and
that the air bag deployed. On the basis of this information, you should be MOST suspicious that the child
has experienced:
A. open abdominal trauma.
B. neck and facial injuries.
C. blunt trauma to the head.
D. lower extremity fractures.

21. Evaluation of the interior of a crashed motor vehicle during extrication will allow the EMT to:
A. determine the vehicle’s speed at the time of impact.
B. assess the severity of the third collision of the crash.
C. recognize if the driver hit the brakes before impact.
D. identify contact points and predict potential injuries.

22. The cervical spine is MOST protected from whiplash-type injuries when the:
A. headrest is appropriately positioned.
B. air bag correctly deploys upon impact.
C. patient tenses up at the time of impact.
D. rear end of the vehicle is initially struck.

23. Passengers who are seated in the rear of a vehicle and are wearing only lap belts have a higher incidence of
injuries to the:
A. thoracic and sacral spine.
B. lumbar and coccygeal spine.
C. thoracic and lumbar spine.
D. lumbar and sacral spine.

24. Approximately 25% of severe injuries to the aorta occur during:

A. frontal collisions.
B. lateral collisions.
C. rollover collisions.
D. rear-end collisions.
25. A driver involved in a rollover motor vehicle crash will MOST likely experience serious injuries or death if
he or she:
A. is wearing only a lap belt.
B. remains within the vehicle.
C. experiences multiple impacts.
D. is ejected or partially ejected.

26. A small compact car was involved in a rollover crash. As you are approaching the vehicle, you note that the
roof is significantly collapsed. The patient, a 29-year-old male, is complaining of severe pain in his neck and
to the top of his head as well as numbness and tingling in his extremities. Witnesses who removed the
patient from the vehicle state that he was wearing his seatbelt. What injury mechanism is MOST likely
responsible for this patient’s condition?
A. compression of the head against the roof
B. lateral bending of the neck during the crash
C. impact of the head against the steering wheel
D. whiplash injury to the neck during the rollover

27. When evaluating the mechanism of injury of a car versus pedestrian collision, you should first:
A. determine if the patient was propelled away from the vehicle.
B. approximate the speed of the vehicle that struck the pedestrian.
C. evaluate the vehicle that struck the patient for structural damage.
D. determine if the patient was struck and pulled under the vehicle.

28. A 15-year-old female was struck by a small car while riding her bicycle. She was wearing a helmet and was
thrown to the ground, striking her head. In addition to managing problems associated with airway,
breathing, and circulation, it is MOST important for you to:
A. stabilize her entire spine.
B. obtain baseline vital signs.
C. inspect the helmet for cracks.
D. leave her bicycle helmet on.

29. Which of the following patients has experienced the MOST significant fall?
A. a 4′8″ patient who fell 13′
B. a 5′0″ patient who fell 13′
C. a 4′6″ patient who fell 13′
D. a 5′9″ patient who fell 14′

30. A 12-year-old male jumped approximately 12′ from a tree and landed on his feet. He complains of pain to
his lower back. What injury mechanism is MOST likely responsible for his back pain?
A. lateral impact to the spine
B. energy transmission to the spine
C. direct trauma to the spinal column
D. secondary fall after the initial impact

31. Factors that should be considered when assessing a patient who has fallen include all of the following,
EXCEPT:
A. the speed of the fall.
B. the surface struck.
C. the height of the fall.
D. the primary impact point.
32. When assessing an elderly patient who fell, it is important to remember that:
A. osteoporosis can cause a fracture that may have resulted in the fall.
B. any fall in the elderly is considered to be high-energy trauma.
C. elderly patients who fall usually have a secondary head injury.
D. bilateral hip fractures usually occur when an elderly person falls.

33. Which of the following statements regarding low-energy penetrating injuries is correct?
A. Internal injuries caused by low-velocity bullets are usually easy to predict.
B. Exit wounds are typically easy to locate with low-energy penetrating injuries.
C. It is usually easy to differentiate between an entrance wound and an exit wound.
D. The area of injury is usually close to the path the object took through the body.

34. Internal injuries caused by gunshot wounds are difficult to predict because:
A. the caliber of the bullet is frequently unknown.
B. the area of damage is usually smaller than the bullet.
C. the bullet may tumble or ricochet within the body.
D. exit wounds caused by the bullet are usually small.

35. The phenomenon of pressure waves emanating from the bullet, causing damage remote from its path, is
known as:
A. capitation.
B. cavitation.
C. congruent.
D. conversion.

36. A young male sustained a gunshot wound to the abdomen during an altercation with a rival gang member.
As your partner is assessing and managing his airway, you should control the obvious bleeding and then:
A. apply a cervical collar.
B. obtain baseline vital signs.
C. auscultate bowel sounds.
D. assess for an exit wound.

37. A 40-year-old unrestrained female impacted the steering wheel of her vehicle with her chest when she hit a
tree while traveling at 45 mph. She is conscious and alert, but is experiencing significant chest pain and
shortness of breath. Which of the following injuries did this patient likely NOT experience?
A. head injury
B. cardiac contusion
C. pulmonary contusion
D. multiple rib fractures

38. If a person is standing near a building that explodes, which of the following injuries would he or she MOST
likely experience as a result of the pressure wave?
A. severe burns
B. fractured bones
C. stomach rupture
D. impaled objects

39. During your assessment of a patient who experienced a blast injury, you note that he has a depressed area to
the front of his skull. This injury MOST likely occurred:
A. during the tertiary phase.
B. during the secondary phase.
C. during the primary phase.
D. as a direct result of the pressure wave.

40. When assessing a patient who experienced a blast injury, it is important to remember that:
A. secondary blast injuries are usually the least obvious.
B. primary blast injuries are typically the most obvious.
C. solid organs usually rupture from the pressure wave.
D. primary blast injuries are the most easily overlooked.

41. Signs of a pulmonary blast injury include:

A. vomiting blood.
B. coughing up blood.
C. an irregular pulse.
D. multiple rib fractures.

42. When treating a patient who experienced a pulmonary blast injury, you should:
A. use a demand valve to ventilate the patient.
B. suspect an accompanying cardiac tamponade.
C. avoid giving oxygen under positive pressure.
D. administer large amounts of intravenous fluid.

43. Which of the following interventions is the MOST critical to the outcome of a patient with multisystem
trauma?
A. intravenous fluid administration
B. early administration of oxygen
C. elevation of the lower extremities
D. rapid transport to a trauma center

44. Following a blunt injury to the head, a 22-year-old female is confused and complains of a severe headache
and nausea. On the basis of these signs and symptoms, you should be MOST concerned with the possibility
of:
A. spinal cord injury.
B. airway compromise.
C. intracranial bleeding.
D. a fracture of the skull.

45. A 30-year-old male sustained a stab wound to the neck when he was attacked outside a nightclub. During
your assessment, you should be MOST alert for:
A. injury to the cervical spine.
B. potential airway compromise.
C. damage to internal structures.
D. alterations in his mental status.

46. While assessing a young male who was struck in the chest with a steel pipe, you note that his pulse is
irregular. You should be MOST suspicious for:
A. underlying cardiac disease.
B. a lacerated coronary artery.
C. bruising of the heart muscle.
D. traumatic rupture of the aorta.

47. According to the Association of Air Medical Services (AAMS), you should consider air medical transport of
a trauma patient if:
A. traffic conditions hamper the ability to get the patient to a trauma center by ground within the ideal time
frame for the best clinical outcome.
B. ground transport will take your ambulance out of service for an extended period of time, regardless of the
severity of the patient’s injuries.
C. the patient requires advanced life support care and stabilization, and the nearest ALS-ground ambulance is
more than 5 to 10 minutes away.
D. he or she was involved in a motor vehicle crash in which another occupant in the same vehicle was killed,
even if your patient’s injuries are minor.

48. In contrast to a Level III trauma center, a Level I trauma center must:
A. be involved in trauma prevention programs.
B. have general surgeons that are in-house 24 hours a day.
C. have access to an emergency physician within 30 minutes.
D. be able to stabilize patients before transferring to a higher level facility.

49. Your patient has a Glasgow Coma Scale (GCS) score of 13, a systolic blood pressure of 80 mm Hg, and a
respiratory rate of 8 breaths/min, his Revised Trauma Score (RTS) is:
A. 8.
B. 9.
C. 10.
D. 11.

50. During your assessment of a patient with a head injury, you note that he opens his eyes when you pinch his
trapezius muscle, is mumbling, and has his arms curled in toward his chest. You should assign him a GCS
score of:
A. 7.
B. 8.
C. 9.
D. 10.

51. According to the American College of Surgeons, an adult trauma patient meets Level I criteria if he or she:
A. was involved in a motor vehicle crash in which another patient in the same vehicle was killed.
B. has a systolic blood pressure of less than 110 mm Hg or a heart rate greater than 110 beats/min.
C. has a bleeding disorder or takes anticoagulant medications and has any blunt or penetrating injury.
D. has a GCS score of less than or equal to 8 with a mechanism attributed to trauma.

CHAPTER 25: BLEEDING

1. Which of the following body systems or components is the LEAST critical for supplying and maintaining
adequate blood flow to the body?
A. an effectively pumping heart
B. an intact system of blood vessels
C. adequate blood in the vasculature
D. the filtering of blood cells in the spleen

2. The systemic veins function by:

A. returning deoxygenated blood back to the heart.
B. delivering oxygen-poor blood to the capillaries.
C. returning oxygen-rich blood back to the left atrium.
D. delivering deoxygenated blood to the capillaries.
3. The smaller vessels that carry blood away from the heart and connect the arteries to the capillaries are called
the:
A. venules.
B. arterioles.
C. vena cavae.
D. capillary arteries.

4. Blood stasis, changes in the vessel wall, and certain medications affect the:
A. systolic blood pressure exclusively.
B. ability of the blood to effectively clot.
C. ability of red blood cells to carry oxygen.
D. white blood cell’s ability to fight infection.

5. As red blood cells begin to clump together to form a clot, __________ reinforces the clumped red blood
cells.
A. fibrin
B. plasma
C. fibrinogen
D. plasminogen

6. Hypoperfusion is another name for:

A. shock.
B. cyanosis.
C. hypoxemia.
D. cellular death.

7. Perfusion is MOST accurately defined as the:

A. effective transfer of oxygen from the venules across the systemic capillary membrane walls.
B. ability of the systemic arteries to constrict as needed to maintain an adequate blood pressure.
C. effective removal of carbon dioxide and other metabolic waste products from the body’s cells.
D. circulation of blood within an organ in adequate amounts to meet the body’s metabolic needs.

8. Which of the following organs can tolerate inadequate perfusion for up to 2 hours?
A. brain
B. heart
C. kidneys
D. skeletal muscle

9. An organ or tissue may be better able to resist damage from hypoperfusion if the:
A. body’s demand for oxygen is markedly increased.
B. body’s temperature is considerably less than 98.6°F (37.0°C).
C. systolic arterial blood pressure is at least 60 mm Hg.
D. heart rate is maintained at more than 100 beats/min.

10. Significant vital sign changes will occur if the typical adult acutely loses more than ______ of his or her
total blood volume.
A. 5%
B. 10%
C. 15%
D. 20%
11. What is the approximate blood volume of a 75-kg adult?
A. 5.25 L
B. 5.50 L
C. 6.25 L
D. 6.50 L

12. An infant with a total blood volume of 800 mL would start showing signs of shock when as little as ______
of blood is lost.
A. 50 mL
B. 100 mL
C. 150 mL
D. 200 mL

13. The ability of a person’s cardiovascular system to compensate for blood loss is MOST related to:
A. his or her baseline blood pressure.
B. the part of the body injured.
C. how rapidly he or she bleeds.
D. how fast his or her heart beats.

14. Hypovolemic shock occurs when:

A. the clotting ability of the blood is enhanced.
B. the body cannot compensate for rapid blood loss.
C. the patient’s systolic blood pressure is less than 100 mm Hg.
D. at least 10% of the patient’s blood volume is lost.

15. The severity of bleeding should be based on all of the following findings, EXCEPT:
A. systolic blood pressure.
B. poor general appearance.
C. the mechanism of injury.
D. clinical signs and symptoms.

16. In which of the following situations would external bleeding be the MOST difficult to control?
A. femoral artery laceration and a blood pressure of 140/90 mm Hg
B. jugular vein laceration and a systolic blood pressure of 90 mm Hg
C. carotid artery laceration and a systolic blood pressure of 60 mm Hg
D. antecubital vein laceration and a blood pressure of 138/92 mm Hg

17. External bleeding from a vein is relatively easy to control because:

A. veins carry deoxygenated blood.
B. veins hold smaller blood volume.
C. veins are under a lower pressure.
D. blood typically oozes from a vein.

18. Which of the following statements regarding the clotting of blood is correct?
A. Venous and capillary blood typically does not clot spontaneously.
B. Bleeding begins to clot when the end of a damaged vessel dilates.
C. Direct contact with the environment prevents blood from clotting.
D. A person taking aspirin will experience slower blood clotting.

19. Which of the following statements regarding hemophilia is correct?

A. Hemophilia is defined as a total lack of platelets.
B. Patients with hemophilia may bleed spontaneously.
C. Hemophiliacs take aspirin to enhance blood clotting.
D. Approximately 25% of the population has hemophilia.

20. A fractured femur can result in the loss of ______ or more of blood into the soft tissues of the thigh.
A. 250 mL
B. 500 mL
C. 1 L
D. 2 L

21. In older patients, the first indicator of nontraumatic internal bleeding may be:
A. weakness or dizziness.
B. a low blood pressure.
C. diaphoresis and pale skin.
D. a heart rate over 120 beats/min.

22. Early signs and symptoms of intra-abdominal bleeding include:

A. bruising only.
B. pain and distention.
C. widespread ecchymosis.
D. significant hypotension.

23. A 67-year-old male presents with weakness, dizziness, and melena that began approximately 2 days ago. He
denies a history of trauma. His blood pressure is 90/50 mm Hg and his pulse is 120 beats/min and thready.
You should be MOST suspicious that this patient is experiencing:
A. an aortic aneurysm.
B. acute appendicitis.
C. gastrointestinal bleeding.
D. intrathoracic hemorrhaging.

24. Gastrointestinal bleeding should be suspected if a patient presents with:

A. dyspnea.
B. hematuria.
C. hemoptysis.
D. hematemesis.

25. A 22-year-old male was kicked in the abdomen multiple times during an attack by a gang. He is conscious
but restless and his pulse is rapid. Your assessment reveals a large area of bruising to the right upper
quadrant of his abdomen. The MOST appropriate treatment for this patient includes:
A. preparing for immediate transport.
B. applying oxygen via nasal cannula.
C. performing a focused physical exam.
D. a detailed assessment of his abdomen.

26. Following blunt trauma to the abdomen, a 21-year-old female complains of left upper quadrant abdominal
pain with referred pain to the left shoulder. Your assessment reveals that her abdomen is distended and
tender to palpation. On the basis of these findings, you should be MOST suspicious of injury to the:
A. liver.
B. spleen.
C. pancreas.
D. gallbladder.

27. In nontrauma patients, an early indicator of internal bleeding is:

A. a rapid, thready pulse.
B. rapid, shallow breathing.
C. dizziness upon standing.
D. a decreasing blood pressure.

28. A young male was shot in the abdomen by an unknown type of gun. He is semiconscious, has shallow
breathing, and is bleeding externally from the wound. As you control the external bleeding, your partner
should:
A. obtain baseline vital signs.
B. apply a nonrebreathing mask.
C. perform a secondary assessment.
D. assist the patient’s ventilations.

29. A 39-year-old male accidentally cut his wrist while sharpening his hunting knife. He is conscious and alert
with adequate breathing, but is bleeding significantly from the wound. You should:
A. ensure the patient has a patent airway.
B. control the bleeding with direct pressure.
C. apply oxygen with a nonrebreathing mask.
D. apply a tourniquet proximal to the wound.

30. During transport of a 40-year-old female with acute abdominal pain, you note that she has stopped talking to
you and has become extremely diaphoretic. You should:
A. assess the quality of her pulse.
B. repeat the primary assessment.
C. begin assisting her ventilations.
D. perform a secondary assessment.

31. A 39-year-old male sustained a large laceration to his leg during an accident with a chainsaw and is
experiencing signs and symptoms of shock. You should:
A. apply direct pressure to the wound.
B. place the patient on 100% oxygen.
C. follow appropriate standard precautions.
D. perform a rapid head-to-toe assessment.

32. Most cases of external bleeding from an extremity can be controlled by:
A. elevating the injured extremity.
B. packing the wound with gauze.
C. compressing a pressure point.
D. applying local direct pressure.

33. After applying a pressure dressing to a laceration on a patient’s arm, you notice that blood is slowly
beginning to saturate it. You should:
A. replace the dressing with another dressing.
B. apply a tourniquet proximal to the wound.
C. splint the arm and keep it below heart level.
D. place additional dressings over the wound.

34. If direct pressure with a sterile dressing fails to immediately stop severe bleeding from an extremity, you
should apply:
A. additional sterile dressings.
B. a splint and elevate the extremity.
C. a tourniquet proximal to the injury.
D. digital pressure to a proximal artery.

35. When using a stick and square knot as a tourniquet to control severe bleeding from an amputated arm, the
EMT should:
A. cover the tourniquet with a sterile dressing.
B. stop twisting the stick when the bleeding stops.
C. twist the stick until the radial pulse disappears.
D. remove the tourniquet if the bleeding has stopped.

36. Whether you are using a commercial device or a stick and triangular bandage as a tourniquet, it is important
to remember that:
A. you should try to control the bleeding by applying pressure to a proximal arterial pressure point first.
B. the tourniquet should only be removed at the hospital because bleeding may return if the tourniquet is
released.
C. bulky dressings should be securely applied over the tourniquet to further assist in controlling the bleeding.
D. the tourniquet should be applied directly over a joint if possible because this provides better bleeding
control.

37. Which of the following splinting devices would be MOST appropriate to use for a patient who has an open
fracture of the forearm with external bleeding?
A. air splint
B. vacuum splint
C. sling and swathe
D. cardboard splint

38. You arrive at the home of a 50-year-old female with severe epistaxis. As you are treating her, it is MOST
important to recall that:
A. the patient may be significantly hypertensive.
B. the patient is at risk for vomiting and aspiration.
C. a detailed exam is needed to determine the cause.
D. many medications interfere with blood clotting.

39. A 43-year-old man is experiencing a severe nosebleed. His blood pressure is 190/110 mm Hg and his heart
rate is 90 beats/min and bounding. Appropriate treatment for this patient includes:
A. having the patient pinch his own nostrils and then lie supine.
B. pinching the patient’s nostrils and having him lean forward.
C. placing a rolled 4″ 4″ dressing between his lower lip and gum.
D. packing both nostrils with gauze pads until the bleeding stops.

40. Bleeding from the nose following head trauma:

A. is a sign of a skull fracture and should not be stopped.
B. should be controlled by packing the nostril with gauze.
C. should be assumed to be caused by a fractured septum.
D. is usually due to hypertension caused by the head injury.

CHAPTER 26: SOFT-TISSUE INJURIES

1. Which of the following areas of the body has the thinnest skin?
A. scalp
B. back
C. ears
D. soles of the feet
2. What layer of the skin forms a watertight, protective seal for the body?
A. dermis
B. epidermis
C. muscular layer
D. subcutaneous layer

3. The germinal layer of the epidermis contains pigment granules that are responsible for skin:
A. color.
B. texture.
C. moisture.
D. temperature.

4. Which of the following statements regarding the dermis is correct?

A. The dermis produces a substance that provides color to the skin.
B. The dermis contains hair follicles, sweat glands, and nerve endings.
C. The cells of the dermis are worn away and are constantly replaced.
D. The dermis lies above the germinal layer and provides protection.

5. The sebaceous glands produce sebum, a material that:

A. facilitates shedding of the epidermis.
B. pulls the hair erect when you are cold.
C. discharges sweat onto the skin’s surface.
D. waterproofs the skin and keeps it supple.

6. All of the following body structures are lined with mucous membranes, EXCEPT for the:
A. lips.
B. nose.
C. anus.
D. mouth.

7. Functions of the skin include all of the following, EXCEPT:

A. maintenance of water balance.
B. regulation of body temperature.
C. the production of key antibodies.
D. sending information to the brain.

8. When a person is exposed to a cold environment:

A. sweat is produced and is warmed when the vessels constrict.
B. blood vessels dilate and divert blood to the core of the body.
C. the skin becomes flushed secondary to peripheral vasodilation.
D. peripheral vessels constrict and divert blood away from the skin.

9. Which of the following processes occurs during the inflammation phase of the healing process?
A. The immune system releases histamines, which cause vasodilation and increased capillary permeability,
resulting in local redness and swelling.
B. White blood cells are forced away from the injury site, thus allowing an increase in the flow of red blood
cells, resulting in increased blood flow.
C. The blood vessels in and around the injury site constrict, which forces bacteria and other microorganisms
away, thus preventing significant infection.
D. The veins and arteries at the injury site constrict and platelets aggregate, which stops bleeding and causes a
temporary increase in the size of the wound.
10. During the normal wound healing process, bleeding may occur from even a minor injury because:
A. there is a substantial decrease in the number of platelets in and around the wound, which increases the risk
of bleeding.
B. histamines released by the immune system constrict the blood vessels, which increases the pressure within
them.
C. new capillaries that stem from intact capillaries are delicate and take time to become as stable as the
preexisting capillaries.
D. bacteria and other microorganisms invade the wound site and damage the capillaries, which makes them
more prone to bleeding.

11. A closed soft-tissue injury characterized by swelling and ecchymosis is called a(n):
A. abrasion.
B. contusion.
C. hematoma.
D. crush injury.

12. A hematoma develops when:

A. small amounts of blood leak into the epidermis.
B. large blood vessels beneath the skin are damaged.
C. severe swelling compromises arterial circulation.
D. cells and small vessels in the dermis are damaged.

13. Which of the following statements regarding crush syndrome is correct?

A. With crush syndrome, massive blood vessel damage occurs following severe soft-tissue injuries, such as
amputation of an extremity.
B. Compromised arterial blood flow leads to crush syndrome and can occur when an area of the body is
trapped for longer than 4 hours.
C. Tissue damage that occurs in crush syndrome is severe, but kidney injury is unlikely because toxins are
quickly eliminated from the body.
D. Provided that a patient with a crush injury is freed from entrapment within 6 hours, the amount of tissue
damaged is generally minimal.

14. The hallmark sign of compartment syndrome is:

A. a lack of pain despite the severity of the injury.
B. extreme redness to the injury site.
C. a bounding pulse distal to the injury.
D. pain out of proportion to the injury.

15. A 30-year-old male experienced a crushing injury when his arm was trapped between the back of a truck
and a loading dock. Upon your arrival, the man’s arm has been freed. Your assessment reveals that his arm
is obviously deformed and swollen and is cold and pale. Further assessment reveals an absent radial pulse.
You should be MOST concerned that this patient has:
A. internal hemorrhage.
B. compartment syndrome.
C. a severe closed fracture.
D. damage to the radial nerve.

16. When assessing a patient with a closed soft-tissue injury, it is MOST important to:
A. manipulate the injury site for signs of a fracture.
B. assess circulation distal to the site of the injury.
C. remain alert for more severe underlying injuries.
D. recognize that the integrity of the skin is broken.

17. In addition to external bleeding, the MOST significant risk that an open soft-tissue injury exposes a patient
to is:
A. infection.
B. hypothermia.
C. nerve damage.
D. vessel damage.

18. Which of the following open soft-tissue injuries is limited to the superficial layer of the skin and results in
the least amount of blood loss?
A. avulsion
B. abrasion
C. incision
D. laceration

19. A laceration:
A. is an injury that separates various layers of soft tissue.
B. is a sharp, smooth cut that is made by a surgical scalpel.
C. is a jagged cut caused by a sharp object or blunt force trauma.
D. rarely penetrates through the subcutaneous tissue to the muscle.

20. An injury that separates various layers of soft tissue, resulting in complete detachment or a flap of skin, is
called a(n):
A. incision.
B. avulsion.
C. laceration.
D. amputation.

21. A 56-year-old male has an incomplete avulsion to his right forearm. After controlling any bleeding from the
wound, you should:
A. carefully probe the wound to determine if the bleeding is venous or arterial.
B. carefully remove the avulsed flap and wrap it in a moist, sterile trauma dressing.
C. replace the avulsed flap to its original position and cover it with a sterile dressing.
D. thoroughly irrigate the wound with sterile water and cover it with a sterile dressing.

22. Which of the following statements regarding penetrating injuries is correct?

A. External bleeding may be minimal but internal injuries can be extensive.
B. The degree of internal injury can often be estimated by the external injury.
C. It is important to distinguish between entrance and exit wounds in the field.
D. The depth of a penetrating injury should be thoroughly assessed by the EMT.

23. During your assessment of a patient who was shot in the abdomen, you notice a large entrance wound with
multiple small puncture wounds surrounding it. This wound pattern is MOST consistent with a:
A. handgun.
B. shotgun.
C. .22-caliber pistol.
D. .357 magnum.
24. A 39-year-old male was struck in the head by a baseball during a game. He is confused, has a large
hematoma in the center of his forehead, and cannot remember the events preceding the injury. After
manually stabilizing his head and assessing his airway, you should:
A. perform a neurologic exam.
B. palpate his radial pulses.
C. administer high-flow oxygen.
D. apply ice to the hematoma.

25. During your assessment of a 22-year-old male who was assaulted, you note widespread contusions and
abrasions to his face, chest, and abdomen. His pulse is rapid and weak, and his skin is cool and clammy.
You should:
A. perform a focused physical exam of his abdomen.
B. administer oxygen and prepare for rapid transport.
C. place him in a sitting position and give him oxygen.
D. conclude that he is experiencing intracranial bleeding.

26. As you approach a young male who was involved in an industrial accident, you note that his eyes are closed
and that he is not moving. You can see several large contusions to his arms, a laceration to his forehead with
minimal bleeding, and a closed deformity to his right leg. You should:
A. open his airway and assess his breathing status.
B. perform an immediate head-to-toe assessment.
C. assess his pulse for rate, regularity, and quality.
D. apply high-flow oxygen and assess his injuries.

27. You are assessing a 30-year-old woman with multiple large bruises to her chest and abdomen that she
experienced during an assault. She is conscious but restless, and her skin is cool and pale. You should be
MOST concerned with:
A. performing a detailed secondary assessment to locate all of her injuries.
B. assessing the bruises that overlie major organs in the chest and abdomen.
C. the fact that her clinical signs could indicate that she is bleeding internally.
D. obtaining a complete set of vital signs to rule out the possibility of shock.

28. A 17-year-old male was shot in the right anterior chest during an altercation with a gang member. As your
partner is applying 100% oxygen, you perform a rapid secondary assessment and find an open chest wound
with a small amount of blood bubbling from it. You should:
A. place a sterile dressing over the wound and apply direct pressure.
B. control the bleeding from the wound and prepare to transport at once.
C. apply an occlusive dressing to the wound and continue your assessment.
D. direct your partner to assist the patient’s ventilations with a bag-mask device.

29. An abdominal evisceration:

A. is most commonly the result of blunt force trauma.
B. should be covered with bulky dry, sterile dressings.
C. often causes severe hypothermia because of heat loss.
D. occurs when organs protrude through an open wound.

30. A 33-year-old male sustained an abdominal evisceration to the left lower quadrant of his abdomen after he
was cut with a large knife. After appropriately managing his ABCs and assessing him for other life-
threatening injuries, how you should care for his wound?
A. Irrigate it with sterile water and cover it with a dry dressing.
B. Cover the exposed bowel and keep his legs in a straight position.
C. Carefully replace the exposed bowel into the abdomen and transport.
D. Cover it with moist, sterile gauze and secure with an occlusive dressing.

31. In which of the following patients should you remove an impaled object?
A. a semiconscious patient with an ice pick impaled in the chest
B. an apneic patient with a shard of glass impaled in the abdomen
C. a pulseless and apneic patient with a knife impaled in the back
D. a conscious and alert patient with a fishhook impaled in the eye

32. A construction worker fell approximately 30′ and landed in a pile of steel rods. Your assessment reveals that
he is pulseless and apneic and has a 10″ steel rod impaled in his left leg. You should:
A. control the bleeding, begin cardiopulmonary resuscitation (CPR), stabilize the steel rod, immobilize his
spine, and transport immediately.
B. remove the steel rod, control the bleeding, apply an automated external defibrillator (AED), begin CPR, and
transport to a trauma center.
C. stabilize the steel rod, control the bleeding, begin CPR, and rapidly transport to a trauma center.
D. control the bleeding, carefully remove the steel rod, begin CPR, and transport as soon as possible.

33. A teenage boy who was involved in a bicycle accident has a puncture wound where the bicycle kickstand
impaled his leg. The MOST appropriate method for treating this injury is to:
A. remove the kickstand in a circular motion and apply a dry, sterile dressing.
B. cut the kickstand off just above the skin, and stabilize it with sterile dressings.
C. leave the kickstand attached to the bike until the physician can remove it safely.
D. unbolt the kickstand from the bike frame and stabilize it with bulky dressings.

34. In addition to severe bleeding, the MOST life-threatening complication associated with an open neck injury
is:
A. an air embolism.
B. a spinal fracture.
C. an ischemic stroke.
D. nerve fiber damage.

35. An 8-year-old male was bitten by a stray dog. He has a large laceration to the back of his left hand, which
your partner covered with a sterile dressing and bandage. In addition to transporting the child to the hospital,
you should:
A. administer oxygen via a nonrebreathing mask.
B. ask the child’s father to try to locate the dog.
C. advise the child that he will need rabies shots.
D. report the incident to the appropriate authorities.

36. In contrast to animal bites, the bite of a human:

A. is usually less severe because the human mouth is cleaner.
B. typically results in a minor infection that is slow-spreading.
C. carries with it a wide variety of virulent bacteria and viruses.
D. is associated with a much higher incidence of rabies infection.

37. During an altercation in a bar, two patrons got into a fist fight. The first patient, a 44-year-old female, was
struck in the mouth and refuses EMS care. The second patient, a 39-year-old female, has a small laceration
to her left knuckle and also refuses EMS care. Which of the following statements regarding this scenario is
MOST correct?
A. You should contact the police and have the patients arrested.
B. The 39-year-old female is at high risk for an infection.
C. The patient struck in the mouth should be immobilized.
D. The 44-year-old female is at high risk for an infection.

38. Burns are classified according to:

A. depth and extent.
B. location and pain.
C. degree and location.
D. extent and location.

39. Which of the following is a severe burn in a 35-year-old patient?

A. circumferential partial-thickness burn to the chest
B. full-thickness burn to 5% of the body surface area (BSA)
C. partial-thickness burn to 20% of the BSA
D. superficial burn covering 50% of the BSA

40. Which of the following is a severe burn in a 65-year-old patient?

A. superficial burn to 30% of the BSA
B. full-thickness burn to 1% of the BSA
C. partial-thickness burn to 20% of the BSA
D. second-degree burn covering 10% of the BSA

41. Which of the following is of LEAST importance when initially assessing the severity of a burn?
A. area(s) burned
B. age of the patient
C. past medical history
D. known drug allergies

42. A burn that is characterized by redness and pain is classified as a:

A. third-degree burn.
B. first-degree burn.
C. second-degree burn
D. partial-thickness burn

43. A partial-thickness burn involves the outer layer of skin and a portion of the:
A. epidermis.
B. fatty layer.
C. muscle fascia.
D. dermal layer.

44. Patients with full-thickness (third-degree) burns generally do not complain of pain because:
A. blister formation protects the burn.
B. he or she is generally not conscious.
C. the nerve endings have been destroyed.
D. subcutaneous vessels are usually clotted.

45. Which of the following statements regarding severe burns is correct?

A. Severe burns involving the airway have a 100% mortality rate.
B. The majority of severe burns involve full-thickness burns only.
C. Patients with severe burns are especially prone to hyperthermia.
D. Severe burns are typically a combination of all degrees of burn.

46. Common signs and symptoms of an airway burn include all of the following, EXCEPT:
A. hoarseness.
B. chest pressure.
C. singed nasal hair.
D. soot around the mouth.

47. Burns to pediatric patients are generally considered more serious than burns to adults because:
A. pediatric patients are more prone to hyperthermia.
B. most burns in children are the result of child abuse.
C. pediatric patients have a proportionately larger volume of blood.
D. pediatric patients have more surface area relative to total body mass.

48. According to the rule of palm method for estimating the extent of a patient’s burns, the palm of the patient’s
hand is equal to _____ of his or her total BSA.
A. 1%
B. 2%
C. 4%
D. 6%

49. Which of the following statements regarding the rule of nines is correct?
A. A child’s head is equal to 14% of his or her total BSA.
B. The anterior trunk of an adult is equal to 18% of the BSA.
C. The posterior of a child’s leg is equal to 13.5% of the BSA.
D. The anterior arm in the adult is equal to 9% of the total BSA.

50. With regard to the pediatric rule of nines, the:

A. head is proportionately smaller than an adult’s.
B. thorax is proportionately larger than an adult’s.
C. legs are proportionately smaller than an adult’s.
D. arms are proportionately larger than an adult’s.

51. A 21-year-old male was working in an auto repair shop and sustained radiator burns to the anterior aspect of
both arms and to his anterior chest. According to the rule of nines, this patient has burns that cover _____ of
his BSA.
A. 18%
B. 27%
C. 36%
D. 45%

52. A 5-year-old female pulled a pot of boiling water from the stove. She has superficial and partial-thickness
burns to her head and anterior trunk. What percentage of her body surface area has been burned?
A. 18%
B. 27%
C. 30%
D. 36%

53. Which of the following is a severe burn in a 2-year-old child?

A. superficial burn that covers 25% of the BSA
B. any full-thickness burn, regardless of its location on the body
C. partial-thickness burn that covers 10% of the BSA
D. any burn that involves the arms, legs, or posterior part of the body

54. When caring for a patient whose arm is covered with a dry chemical, you should:
A. deactivate the chemical with a 5% vinegar solution.
B. quickly irrigate the arm with large amounts of water.
C. use forceful streams of water to remove the chemical.
D. brush away the chemical before flushing with water.

55. In order for electricity to flow through the body and cause damage:
A. an insulator must exist between the electrical source and the patient.
B. a complete circuit must exist between the electrical source and the ground.
C. the part of the body that is in contact with the electrical source must be dry.
D. the person must make direct physical contact with the source of electricity.

56. A utility worker was trimming branches and was electrocuted when he accidentally cut a high-power line.
He fell approximately 20′ and is lying unconscious on the ground; the power line is lying across his chest.
You should:
A. rapidly assess the patient after ensuring that the power line is not live.
B. apply insulated gloves and assume manual control of his c-spine.
C. quickly but carefully move the patient away from the power line.
D. manually stabilize his head as your partner assesses for breathing.

57. Which of the following statements regarding electrical burns is correct?

A. Entrance wounds are small relative to the amount of internal tissue damage.
B. Respiratory or cardiac arrest following an electrical burn is very uncommon.
C. The exit wound caused by electrical burns is smaller than the entrance wound.
D. The size of the entry and exit wounds is a reliable indicator of internal damage.

58. A 38-year-old male was electrocuted while attempting to wire a house. Your assessment reveals that he is
unresponsive, pulseless, and apneic. A coworker has shut off the power to the house. You should:
A. begin CPR and apply the AED.
B. begin CPR and transport at once.
C. assess for entry and exit wounds.
D. fully immobilize his spinal column.

59. You and your partner arrive at the scene of a house fire where fire fighters have rescued a 50-year-old male
from his burning house. The patient has superficial and partial-thickness burns to his face and chest. His
nasal hairs are singed and he is coughing up sooty sputum. You should be MOST concerned with:
A. treating him for hypothermia.
B. preventing the risk of infection.
C. estimating the extent of his burns.
D. the potential for airway swelling.

60. When treating a partial-thickness burn, you should:

A. immerse the affected part in warm water.
B. rupture any blisters to prevent an infection.
C. cover the burn with a moist, sterile dressing.
D. avoid the use of creams, lotions, or antiseptics.

61. Functions of dressings and bandages include all of the following, EXCEPT:
A. immobilization of the injury.
B. prevention of contamination.
C. protection from further injury.
D. control of external hemorrhage.
62. You have applied a dressing and roller-gauze bandage to a laceration on the arm of a young female. During
transport, she begins to complain of numbness and tingling in her hand. You should:
A. remove the bandage and dressing and apply another one.
B. carefully manipulate her arm until the symptoms subside.
C. assess distal circulation and readjust the bandage as needed.
D. remove the gauze bandage and replace it with an elastic one.

CHAPTER 27: FACE AND NECK INJURIES

1. The upper jawbones are called the:

A. mandible.
B. mastoid.
C. zygoma.
D. maxillae.

2. The lower jawbone is called the:

A. zygoma.
B. maxillae.
C. mandible.
D. mastoid.

3. The small, rounded, fleshy bulge immediately anterior to the ear canal is called the:
A. incus.
B. pinna.
C. tragus.
D. stapes.

4. The superficial temporal artery can be palpated:

A. slightly above the ear.
B. at the angle of the jaw.
C. over the mastoid process.
D. just anterior to the tragus.

5. The mastoid process is located approximately:

A. 1″ posterior to the external opening of the ear.
B. ½″ anterior to the external opening of the ear.
C. 1″ inferior to the external opening of the ear.
D. 1″ posterior to the angle of the mandible.

6. The Adam’s apple is:

A. the upper part of the larynx that is formed by the thyroid cartilage.
B. the lower part of the larynx that is formed by the cricoid cartilage.
C. the small indentation in between the thyroid and cricoid cartilages.
D. below the thyroid cartilage and forms the upper part of the trachea.

7. The cricoid cartilage:

A. lies superior to the thyroid cartilage in the neck.
B. is the only complete circular cartilage of the trachea.
C. is easier to see and palpate than the thyroid cartilage.
D. lies superior to the cricothyroid membrane in the neck.
8. What is the function of the sternocleidomastoid muscle?
A. allows flexion of the neck
B. provides respiration
C. connects the scapulae together
D. allows movement of the head

9. The eyeball itself is referred to as the:

A. orbit.
B. globe.
C. sclera.
D. cornea.

10. Which of the following statements regarding the vitreous humor is correct?
A. It is a clear, watery fluid that cannot be replaced if it is lost during an eye injury.
B. It is a clear, jellylike fluid near the back of the eye that cannot be replaced if it is lost.
C. It is a clear, watery fluid that is located in front of the lens and can be replaced if it is lost.
D. It is a clear fluid that is produced by the lacrimal glands and cannot be replaced if it is lost.

11. The inner surface of the eyelids and the exposed surface of the eye itself are covered by a delicate
membrane called the:
A. sclera.
B. cornea.
C. retina.
D. conjunctiva.

12. The conjunctiva are kept moist by fluid produced by the:

A. corneal duct.
B. posterior orbit.
C. optic chiasma.
D. lacrimal gland.

13. The white portion of the eye is called the:

A. iris.
B. retina.
C. sclera.
D. cornea.

14. The opening in the center of the iris, which allows light to move to the back of the eye, is called the:
A. pupil.
B. sclera.
C. cornea.
D. conjunctiva.

15. When a light is shone into the pupil:

A. the opposite pupil should dilate.
B. it should become smaller in size.
C. it should become larger in size.
D. both pupils should dilate together.

16. Abnormal variations in pupil size and reaction would MOST likely be observed in a patient with:
A. retinitis.
B. contact lenses.
C. conjunctivitis.
D. a brain injury.

17. The optic nerve endings are located within the:

A. retina.
B. sclera.
C. pupil.
D. cornea.

18. The MOST significant complication associated with facial injuries is:
A. damage to the eyes.
B. airway compromise.
C. cervical spine injury.
D. mandibular immobility.

19. The skin and underlying tissues of the face:

A. have a rich blood supply and bleed profusely.
B. swell minimally when exposed to blunt trauma.
C. are well protected by the maxillae and mandible.
D. contain a relatively small number of nerve fibers.

20. When caring for a patient with an open facial injury, the EMT must:
A. closely assess the patient’s airway.
B. consider the mechanism of injury.
C. wear gloves and facial protection.
D. manually stabilize the patient’s head.

21. Facial injuries should be identified and treated as soon as possible because:
A. of the risk for airway problems.
B. bleeding must be controlled early.
C. the spine may be injured as well.
D. swelling may mask hidden injuries.

22. Significant trauma to the face should increase the EMT’s index of suspicion for a(n):
A. airway obstruction.
B. displaced mandible.
C. basilar skull fracture.
D. spinal cord injury.

23. A 30-year-old female was robbed and assaulted by a gang as she was leaving a nightclub. She has massive
facial trauma and slow, gurgling respirations. As your partner manually stabilizes her head, you should:
A. begin immediate ventilatory assistance.
B. visualize her mouth for obvious wounds.
C. apply oxygen via a nonrebreathing mask.
D. suction her oropharynx for 15 seconds.

24. A young female was involved in a motor vehicle crash. She complains of pain to her left eye, which appears
to have a piece of glass impaled in it. Further assessment reveals a large laceration to her left forearm with
active venous bleeding. As your partner manually stabilizes the patient’s head, you should:
A. stabilize the impaled glass in her eye.
B. administer 100% supplemental oxygen.
C. apply direct pressure to her arm wound.
D. carefully remove the glass from her eye.

25. You are assessing a 59-year-old male and note that his pupils are unequal. He is conscious and alert. When
obtaining his medical history, it is MOST pertinent to ask him if he:
A. is allergic to any medications.
B. has a history of eye surgeries.
C. regularly sees a family physician.
D. noticed the change during a meal.

26. Frequent reassessments of the patient with face or neck injuries are MOST important because:
A. they lend credibility to your documentation.
B. such injuries can affect the respiratory system.
C. hospital staff require frequent patient updates.
D. rapid facial swelling may mask hidden injuries.

27. When transporting a patient with a facial injury, it is MOST important to be as descriptive as possible with
the hospital regarding the patient’s injuries because:
A. they must make arrangements for an ICU bed.
B. a specialist may need to be called.
C. it saves time on repeat assessments at the hospital.
D. most patients with facial trauma will need surgery.

28. You are transporting an immobilized patient with severe facial trauma. As you are preparing to give your
radio report to the hospital, the patient begins vomiting large amounts of blood. You should:
A. quickly suction his oropharynx.
B. turn the backboard onto its side.
C. reassess his breathing adequacy.
D. alert the hospital of the situation.

29. Bleeding from soft-tissue injuries to the face is MOST effectively controlled with:
A. pressure dressings and chemical ice packs.
B. digital pressure to an adjacent pulse point.
C. direct pressure using dry, sterile dressings.
D. ice packs and elevation of the patient’s head.

30. A 30-year-old female presents with redness, inflammation, and pain to her left eye. During your assessment,
you note that she is having difficulty keeping her eyes open. You should suspect that she is experiencing:
A. acute retinitis.
B. conjunctivitis.
C. a detached retina.
D. a corneal abrasion.

31. A 22-year-old male was walking on the beach and had sand blown into his eyes. He complains of pain and
decreased vision to his right eye. Treatment should include:
A. irrigating his right eye laterally.
B. flushing his eye starting laterally.
C. irrigating both eyes simultaneously.
D. covering both eyes and transporting.

32. A 40-year-old male was in his woodworking shop when he felt a sudden, sharp pain in his left eye. Your
assessment reveals a small splinter of wood embedded in his cornea. You should:
A. scrape the splinter away with moist, sterile gauze.
B. cover his right eye and flush the left eye with saline.
C. cover both of his eyes and transport to the hospital.
D. remove the object with a cotton-tipped applicator.

33. A factory worker was splashed in the eyes with a strong acid chemical. He complains of intense pain and
blurred vision. Your ambulance does not carry bottles of sterile saline or water. You should:
A. flush both eyes with an alcohol-based solution and transport.
B. irrigate both eyes continuously for 20 minutes with plain water.
C. neutralize the acid chemical in his eye with an alkaline chemical.
D. mix baking soda with water and irrigate his eyes with the solution.

34. A young female experienced a laceration to her left eyeball from flying glass when her boyfriend broke a
soda bottle against a wall. There is moderate bleeding and the patient states that she cannot see out of the
injured eye. You should:
A. carefully examine her eye and remove any foreign objects if needed.
B. avoid applying pressure to the globe when you are covering the eye.
C. ask her to move the injured eye to assess the integrity of the optic nerve.
D. apply firm direct pressure to the injured eye and cover the opposite eye.

35. The term “hyphema” is defined as:

A. blood in the anterior chamber of the eye.
B. an acute rupture of the globe of the eye.
C. inflammation of the iris, cornea, and lens.
D. compression of one or both optic nerves.

36. Following blunt trauma to the face, a 21-year-old male complains of a severe headache and decreased
ability to move his eyes. This patient’s clinical presentation is MOST consistent with:
A. a lacerated globe.
B. a blowout fracture.
C. a ruptured eyeball.
D. optic vessel compression.

37. A patient who is complaining of seeing flashing lights, specks, or “floaters” in his or her field of vision has
MOST likely experienced:
A. conjunctivitis.
B. acute hyphema.
C. a blowout fracture.
D. a detached retina.

38. Which of the following findings would be LEAST suggestive of a head injury?
A. one pupil larger in size than the other pupil
B. failure of the eyes to move in the same direction
C. briskly constricting pupils when exposed to light
D. failure of the eyes to follow movement of an object

39. A 39-year-old female experienced a severe closed head injury. She is unconscious with her eyes slightly
open; her pupils are bilaterally dilated and slow to react. In addition to managing problems with airway,
breathing, and circulation, you should:
A. close her eyes and cover them with a moist dressing.
B. secure her eyes open so you can reassess her pupils.
C. inspect her eyes and gently remove impaled objects.
D. irrigate her eyes with water to prevent mucosal drying.
40. A 50-year-old male was splashed in the eyes with radiator fluid when he was working on his car. During
your assessment, he tells you that he wears soft contact lenses. You should:
A. leave the contact lenses in place and flush his eyes with sterile water.
B. remove the contact lenses and cover his eyes with a dry, sterile dressing.
C. leave the contact lenses in place and cover both eyes with a dry dressing.
D. carefully remove the contact lenses and then irrigate his eyes with saline.

41. Which of the following statements regarding anterior nosebleeds is correct?

A. They cause blood to drain into the posterior pharynx.
B. They are usually severe and require aggressive treatment to control.
C. They are usually caused by a fracture of the basilar skull.
D. They usually originate from the septum area and bleed slowly.

42. A 29-year-old male has an anterior nosebleed after he was accidentally elbowed in the nose. His is
conscious and alert with adequate breathing. The MOST appropriate care for this patient includes:
A. leaning him forward and pinching his nostrils together.
B. packing the nasopharynx with moist, sterile dressings.
C. applying a gauze pad in between his lower lip and gum.
D. placing him supine and pinching his nostrils together.

43. A 44-year-old male sustained a laceration to his left ear during a minor car accident. Your assessment
reveals minimal bleeding. Appropriate care for this injury includes:
A. applying a tight pressure dressing.
B. padding between the ear and the scalp.
C. packing the ear with sterile gauze pads.
D. covering the wound with a moist dressing.

44. A 4-year-old female has a peanut lodged in the external auditory canal of her right ear. You should:
A. use tweezers to try to remove the object.
B. remove the peanut with a cotton-tipped swab.
C. transport her to the emergency department.
D. thoroughly flush her ear with sterile saline.

45. A 52-year-old unrestrained female struck the steering wheel with her face when her truck collided with
another vehicle. She has obvious swelling to her face and several dislodged teeth. A visual exam of her
mouth reveals minimal bleeding. She is conscious and alert with a blood pressure of 130/80 mm Hg, a pulse
of 110 beats/min, and respirations of 22 breaths/min with adequate tidal volume. You should:
A. apply supplemental oxygen, immobilize her spine, attempt to locate the dislodged teeth, suction as needed,
and transport.
B. assist ventilations with a bag-mask device, immobilize her spine, suction her oropharynx for 30 seconds,
and transport.
C. fully immobilize her spine, attempt to locate the dislodged teeth, tilt the backboard to the left side, and
transport.
D. apply oxygen via a nonrebreathing mask, suction her airway as needed, disregard the dislodged teeth, and
transport.

46. A 6-year-old female was riding her bicycle and struck a clothesline with her throat. She is breathing, but
with obvious difficulty. Your assessment reveals a crackling sensation in the soft tissues of her neck and
facial cyanosis. In addition to the appropriate airway management, the intervention that will MOST likely
improve her chance of survival is:
A. requesting a paramedic ambulance.
B. careful monitoring her vital signs.
C. rapidly transporting her to the hospital.
D. quickly immobilizing her spinal column.

47. Following direct trauma to the upper part of the anterior neck, a young male presents with labored
breathing, loss of voice, and subcutaneous emphysema in the soft tissues around his neck. You should
suspect a(n):
A. esophageal tear.
B. crushed cricoid.
C. collapsed trachea.
D. laryngeal fracture.

48. You are dispatched to a convenience store, where the clerk sustained a laceration to the side of his neck
during a robbery attempt. During your assessment, you note bright red blood spurting from the laceration.
You should:
A. apply direct pressure below the lacerated vessel.
B. circumferentially wrap a dressing around his neck.
C. apply pressure to the closest arterial pressure point.
D. apply direct pressure above and below the wound.

CHAPTER 28: HEAD AND SPINE INJURIES

1. The central nervous system (CNS) is composed of the:

A. cerebellum and brain.
B. brain and spinal cord.
C. cerebrum and meninges.
D. meninges and spinal cord.

2. The _________ contain(s) about 75% of the brain’s total volume.

A. cerebrum
B. cerebellum
C. brain stem
D. meninges

3. Coordination of balance and body movement is controlled by the:

A. medulla.
B. cerebrum.
C. cerebellum.
D. brain stem.

4. The _________ is the best-protected part of the CNS and controls the functions of the cardiac and
respiratory systems.
A. brain stem
B. cerebellum
C. spinal cord
D. cerebral cortex

5. The tough, fibrous outer meningeal layer is called the:

A. pia mater.
B. arachnoid.
C. gray mater.
D. dura mater.
6. The meninges, along with the cerebrospinal fluid (CSF) that circulates in between each meningeal layer,
function by:
A. regenerating brain cells after they have been damaged.
B. acting as a shock absorber for the brain and spinal cord.
C. delivering oxygen directly to the CNS.
D. producing leukocytes that protect the brain from infection.

7. The _________ nervous system consists of 31 pairs of spinal nerves and 12 pairs of cranial nerves.
A. central
B. somatic
C. autonomic
D. peripheral

8. Which of the following nerves carry information from the body to the brain via the spinal cord?
A. motor
B. central
C. somatic
D. sensory

9. Which of the following statements regarding motor nerves is correct?

A. They carry information from the CNS to the muscles.
B. They perform special functions such as sight, smell, and hearing.
C. They transmit information from the body to the brain via the spinal cord.
D. They are part of the CNS and control reflexes.

10. Which of the following nerves allow sensory and motor impulses to be sent from one nerve directly to
another?
A. somatic
B. connecting
C. peripheral
D. autonomic

11. A reflex arc occurs when:

A. the motor nerves function automatically without receiving a message from the CNS.
B. a sensory nerve sends a message to the brain but the motor nerve fails to send the appropriate response to
the body.
C. the brain interprets sensory information that it receives from peripheral and cranial nerves and sends a signal
to the muscles.
D. a sensory nerve detects an irritating stimulus and bypasses the brain by sending a direct message to the
motor nerve.

12. What part of the nervous system controls the body’s voluntary activities?
A. central
B. sensory
C. somatic
D. autonomic

13. The body’s functions that occur without conscious effort are regulated by the _________ nervous system.
A. sensory
B. somatic
C. autonomic
D. voluntary
14. When activated, the sympathetic nervous system produces all of the following effects, EXCEPT:
A. pupillary constriction.
B. increase in heart rate.
C. shunting of blood to vital organs.
D. dilation of the bronchiole smooth muscle.

15. The hormone responsible for the actions of the sympathetic nervous system is:
A. insulin.
B. thyroxine.
C. epinephrine.
D. aldosterone.

16. When the parasympathetic nervous system is activated:

A. blood is shunted away from the digestive organs.
B. the heart rate decreases and the blood vessels dilate.
C. hormones are released that prepare the body for stress.
D. heart rate and blood pressure increase.

17. Which of the following statements regarding the cranium is correct?

A. The skull is a subdivision of the cranium.
B. Thirty percent of the cranium is occupied by blood.
C. The cranium protects the structures of the face.
D. Eighty percent of the cranium is occupied by brain tissue.

18. The five sections of the spinal column, in descending order, are the:
A. thoracic, cervical, lumbar, coccygeal, and sacral.
B. cervical, thoracic, lumbar, sacral, and coccygeal.
C. coccygeal, sacral, lumbar, thoracic, and cervical.
D. cervical, coccygeal, thoracic, sacral, and lumbar.

19. The spinal cord is encased in and protected by the:

A. spinal canal.
B. vertebral body.
C. vertebral arch.
D. intervertebral disc.

20. The cervical spine is composed of _____ vertebrae.

A. 5
B. 6
C. 7
D. 8

21. Common signs and symptoms of a serious head injury include all of the following, EXCEPT:
A. constricted pupils.
B. combative behavior.
C. CSF leakage from the ears.
D. decreased sensory function.

22. Lacerations to the scalp:

A. bleed minimally because the scalp has few vessels.
B. uncommonly cause hypovolemic shock in children.
C. may be an indicator of deeper, more serious injuries.
D. are most commonly associated with skull fractures.

23. Common signs of a skull fracture include all of the following, EXCEPT:
A. mastoid process bruising.
B. ecchymosis around the eyes.
C. noted deformity to the skull.
D. superficial scalp lacerations.

24. Which of the following skull fractures would be the LEAST likely to present with palpable deformity or
other outward signs?
A. linear
B. basilar
C. open
D. compressed

25. The frontal and parietal bones of the skull are especially susceptible to:
A. basilar skull fractures.
B. compressed skull fractures.
C. linear skull fractures.
D. nondisplaced skull fractures.

26. When assessing a patient with a head injury, you note the presence of thin, bloody fluid draining from his
right ear. This indicates:
A. fractures to the internal structures of the ear following direct trauma.
B. a linear skull fracture and a significant increase in intracranial pressure.
C. significant pressure and bleeding in between the skull and dura mater.
D. rupture of the tympanic membrane following diffuse impact to the head.

27. Which of the following statements regarding a basilar skull fracture is correct?
A. Bloody CSF commonly leaks from the nose.
B. In most cases, mastoid bruising occurs.
C. The absence of raccoon eyes or Battle’s sign does not rule it out.
D. They are typically the result of local, low-energy trauma to the head.

28. Which of the following statements regarding secondary brain injury is correct?
A. It results from direct brain trauma following an impact to the head.
B. Because cerebral edema develops quickly, it is considered to be a primary brain injury.
C. Hypoxia and hypotension are the two most common causes of secondary brain injury.
D. Signs are often present immediately after an impact to the head.

29. Rapid deceleration of the head, such as when it impacts the windshield, causes:
A. compression injuries and contusions to the anterior, posterior, and lateral aspects of the brain.
B. primary impact to the posterior aspect of the brain, resulting in compression injuries, bruising, or torn blood
vessels.
C. stretching or tearing of the anterior aspect of the brain and compression injuries or bruising to the posterior
aspect of the brain.
D. compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior
portion of the brain.

30. The MOST common and serious complication of a significant head injury is:
A. a skull fracture.
B. cerebral edema.
C. a hypoxic seizure.
D. acute hypotension.

31. Moderate elevation in intracranial pressure with middle brain stem involvement is characterized by:
A. increased blood pressure, bradycardia, reactive pupils, and rapid respirations.
B. sluggishly reactive pupils, widened pulse pressure, bradycardia, and posturing.
C. ataxic respirations, unequal pupils, no response to pain, and an irregular pulse.
D. fixed and dilated pupils, decreased blood pressure, and irregular respirations.

32. An epidural hematoma is MOST accurately defined as:

A. bleeding between the skull and dura mater.
B. bleeding between the dura mater and brain.
C. venous lacerations that occur within the brain.
D. an injury caused by a damaged cerebral artery.

33. Which of the following head injuries would cause the patient’s condition to deteriorate MOST rapidly?
A. cerebral contusion
B. subdural hematoma
C. cerebral concussion
D. epidural hematoma

34. Bleeding within the brain tissue itself is called a(n):

A. epidural hematoma.
B. intracerebral hematoma.
C. subdural hematoma.
D. intracranial hematoma.

35. A temporary loss or alteration of part or all of the brain’s abilities to function without physical damage to
the brain MOST accurately describes a(n):
A. cerebral contusion.
B. cerebral concussion.
C. intracranial hemorrhage.
D. intracerebral hematoma.

36. A patient who cannot remember the events that preceded his or her head injury is experiencing:
A. retrograde amnesia.
B. anterograde amnesia.
C. perigrade amnesia.
D. posttraumatic amnesia.

37. In contrast to a cerebral concussion, a cerebral contusion:

A. does not cause pressure within the skull.
B. results from a laceration to the brain tissue.
C. involves physical injury to the brain tissue.
D. usually does not cause a loss of consciousness.

38. Distraction injuries of the spine are MOST commonly the result of:
A. falls.
B. diving.
C. hangings.
D. compression.
39. When caring for a patient with a possible head injury, it is MOST important to monitor the patient’s:
A. pupil size.
B. blood pressure.
C. pulse regularity.
D. level of consciousness.

40. Any unresponsive trauma patient should be assumed to have:

A. a history of diabetes mellitus.
B. an accompanying spinal injury.
C. a severe intracranial hemorrhage.
D. internal bleeding in the abdomen.

41. When opening the airway of a patient with a suspected spinal injury, you should use the:
A. tongue-jaw lift maneuver.
B. head tilt–neck lift maneuver.
C. head tilt–chin lift maneuver.
D. jaw-thrust maneuver.

42. During your primary assessment of a semiconscious 30-year-old female with closed head trauma, you note
that she has slow, shallow breathing and a slow, bounding pulse. As your partner maintains manual in-line
stabilization of her head, you should:
A. perform a focused secondary assessment of the patient’s head and neck.
B. instruct him to assist her ventilations while you perform a rapid assessment.
C. apply 100% oxygen via a nonrebreathing mask and obtain baseline vital signs.
D. immediately place her on a long backboard and prepare for rapid transport.

43. Once a cervical collar has been applied to a patient with a possible spinal injury, it should not be removed
unless:
A. the patient adamantly denies neck pain.
B. lateral immobilization has been applied.
C. it causes a problem managing the ABCs.
D. sensory and motor functions remain intact.

44. A female patient with a suspected spinal injury is breathing with a marked reduction in tidal volume. The
MOST appropriate airway management for her includes:
A. hyperventilating her at 30 breaths/min.
B. administering oxygen via a nonrebreathing mask.
C. ventilation assistance to maintain an oxygen saturation of 90%.
D. assisting ventilations at an age-appropriate rate.

45. You should be MOST suspicious that a patient has experienced a significant head injury if his or her pulse
is:
A. slow.
B. weak.
C. rapid.
D. irregular.

46. It would be MOST appropriate to perform a focused secondary assessment on a patient who:
A. fainted and fell to the ground from a standing position.
B. was restrained during a high-speed motor vehicle crash.
C. has blood draining from the ears following a head injury.
D. struck his or her head and is experiencing nausea or vomiting.
47. A 45-year-old male was working on his roof when he fell approximately 12′,landing on his feet. He is
conscious and alert and complains of an ache in his lower back. He is breathing adequately and has stable
vital signs. You should:
A. obtain a Glasgow Coma Score value and give him oxygen.
B. immobilize his spine and perform a focused secondary exam.
C. allow him to refuse transport if his vital signs remain stable.
D. perform a rapid head-to-toe exam and immobilize his spine.

48. When assessing a conscious patient with an MOI that suggests spinal injury, you should:
A. determine if the strength in all extremities is equal.
B. rule out a spinal injury if the patient denies neck pain.
C. defer spinal immobilization if the patient is ambulatory.
D. ask the patient to move his or her head to assess for pain.

49. The MOST reliable sign of a head injury is:

A. a pulse that is rapid and thready.
B. a decreased level of consciousness.
C. an abnormally low blood pressure.
D. decreased sensation in the extremities.

50. The Glasgow Coma Scale (GCS) is used to assess:

A. mental status, eye opening, and respiratory rate.
B. sensory response, pupil reaction, and heart rate.
C. verbal response, eye opening, and mental status.
D. eye opening, verbal response, and motor response.

51. Following a head injury, a 20-year-old female opens her eyes spontaneously, is confused, and obeys your
commands to move her extremities. You should assign her a GCS score of:
A. 12.
B. 13.
C. 14.
D. 15.

52. A patient with a head injury presents with abnormal flexion of his extremities. What numeric value should
you assign to him for motor response?
A. 2
B. 3
C. 4
D. 5

53. When a patient experiences a severe spinal injury, he or she:

A. will likely be paralyzed from the neck down.
B. may lose sensation below the level of the injury.
C. most commonly has a palpable spinal deformity.
D. often loses motor function on one side of the body.

54. The effectiveness of positive-pressure ventilations when treating a head-injured patient can ONLY be
determined by:
A. immediate reassessment following the intervention.
B. a neurosurgeon or emergency department physician.
C. reassessing the patient’s blood pressure after at least 10 minutes.
D. noting a decrease in the heart rate during ventilations.
55. An indicator of an expanding intracranial hematoma or rapidly progressing brain swelling is:
A. a rapid deterioration of neurologic signs.
B. a progressively lowering blood pressure.
C. an acute increase in the patient’s pulse rate.
D. acute unilateral paralysis following the injury.

56. The MOST important treatment for patients with a head injury, regardless of severity, is to:
A. immobilize the spine.
B. administer 100% oxygen.
C. establish an adequate airway.
D. transport to a trauma center.

57. During your primary assessment of a 19-year-old unconscious male who experienced severe head trauma,
you note that his respirations are rapid, irregular, and shallow. He has bloody secretions draining from his
mouth and nose. You should:
A. assist his ventilations with a bag-mask device.
B. suction his oropharynx for up to 15 seconds.
C. immobilize his spine and transport immediately.
D. pack his nostrils to stop the drainage of blood.

58. When controlling bleeding from a scalp laceration with a suspected underlying skull fracture, you should:
A. elevate the patient’s head and apply an ice pack.
B. apply manual pressure and avoid applying a bandage.
C. avoid excessive pressure when applying the bandage.
D. apply firm compression for no longer than 5 minutes.

59. Which of the following sets of vital signs depicts Cushing’s triad?
A. blood pressure, 190/110 mm Hg; pulse, 55 beats/min; respirations, 30 breaths/min
B. blood pressure, 90/50 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min
C. blood pressure, 200/100 mm Hg; pulse, 140 beats/min; respirations, 28 breaths/min
D. blood pressure, 80/40 mm Hg; pulse, 30 beats/min; respirations, 32 breaths/min

60. When immobilizing a trauma patient’s spine, the EMT manually stabilizing the head should not let go until:
A. an appropriately sized cervical collar has been applied.
B. the patient has been secured to the ambulance stretcher.
C. the head has been stabilized with lateral immobilization.
D. the patient has been completely secured to the backboard.

61. The ideal procedure for moving an injured patient from the ground to a backboard is:
A. the clothes drag.
B. the four-person log roll.
C. to use a scoop stretcher.
D. the direct patient carry.

62. When placing a patient onto a long backboard, the EMT at the patient’s _________ is in charge of all
patient movements.
A. head
B. chest
C. waist
D. lower extremities
63. When immobilizing a patient on a long backboard, you should:
A. have the patient exhale before fastening the torso straps.
B. secure the torso and then center the patient on the board.
C. follow the commands of the person at the patient’s torso.
D. ensure that you secure the torso before securing the head.

64. After your partner assumes manual in-line stabilization of the patient’s head, you should:
A. apply an appropriately sized rigid cervical collar.
B. assess distal neurovascular status in the extremities.
C. thoroughly palpate the patient’s head for deformities.
D. use four people to log roll the patient onto a backboard.

65. A short backboard or vest-style immobilization device is indicated for patients who:
A. are found supine and have stable vital signs.
B. are in a sitting position and are clinically stable.
C. require prompt extrication from an automobile.
D. are sitting in their car and are clinically unstable.

66. When immobilizing a seated patient with a short backboard or vest-style immobilization device, you should
apply a cervical collar:
A. after the torso has been adequately secured.
B. after moving the patient to a long backboard.
C. after assessing distal neurovascular functions.
D. before manually stabilizing the patient’s head.

67. Which of the following statements regarding cervical collars is correct?

A. Once a cervical collar is applied, you can cease manual head stabilization.
B. A cervical collar is used in addition to, not instead of, manual immobilization.
C. Cervical collars are contraindicated in patients with numbness to the extremities.
D. The patient’s head should be forced into a neutral position to apply a cervical collar.

68. If you do not have the appropriate size cervical collar, you should:
A. use rolled towels to immobilize the patient’s head.
B. place sandbags on either side of the patient’s head.
C. ask the patient to keep his or her head in a neutral position.
D. defer cervical immobilization and apply lateral head blocks.

69. A tight-fitting motorcycle helmet should be left in place unless:

A. it interferes with your assessment of the airway.
B. the patient must be placed onto a long backboard.
C. the patient complains of severe neck or back pain.
D. the helmet is equipped with a full face shield or visor.

70. When immobilizing a child on a long backboard, you should:

A. secure the head prior to securing the torso and legs.
B. defer cervical collar placement to avoid discomfort.
C. place the child’s head in a slightly extended position.
D. place padding under the child’s shoulders as needed.

CHAPTER 29: CHEST INJURIES

1. When a person is lying supine at the end of exhalation, the diaphragm:

A. contracts and flattens inferiorly.
B. may rise as high as the nipple line.
C. is less prone to penetrating trauma.
D. descends below the level of the navel.

2. A spinal cord injury at the level of C7 would MOST likely result in:
A. immediate cardiac arrest.
B. paralysis of the diaphragm.
C. paralysis of the intercostal muscles.
D. paralysis of all the respiratory muscles.

3. Very young children tend to breathe predominantly with their diaphragm because:
A. their chest wall and ribs are very pliable.
B. they require less tidal volume per breath.
C. their intercostal muscles are not fully developed.
D. there is no nerve innervation of the intercostal muscles.

4. Pleural fluid is contained between the:

A. visceral and parietal pleurae.
B. parietal pleura and the heart.
C. visceral pleura and the lung.
D. parietal pleura and the chest wall.

5. Which of the following organs or structures does NOT reside within the mediastinum?
A. lungs
B. trachea
C. vena cavae
D. esophagus

6. The thoracic cavity is separated from the abdominal cavity by the:

A. diaphragm.
B. anterior rib cage.
C. intercostal margin.
D. costovertebral angle.

7. Elevation of the rib cage during inhalation occurs when:

A. the diaphragm descends.
B. abdominal contents descend.
C. intrathoracic pressure decreases.
D. the intercostal muscles contract.

8. The phrenic nerves control the diaphragm and exit the spinal cord at:
A. C1 and C2.
B. C3 and C4.
C. C1, C2, and C3.
D. C3, C4, and C5.

9. The ________ nerves control the diaphragm.

A. vagus
B. costal
C. phrenic
D. intercostal
10. If a person’s tidal volume decreases, but his or her respiratory rate remains unchanged:
A. minute volume will increase.
B. minute volume will decrease.
C. minute volume will remain unchanged.
D. excess carbon dioxide will be eliminated.

11. If a patient with a chest injury is only able to inhale small amounts of air per breath, he or she:
A. often breathes at a slower rate because of lung damage caused by the injury.
B. will eliminate more carbon dioxide than if he or she were breathing deeply.
C. must increase his or her respiratory rate to maintain adequate minute volume.
D. will maintain adequate minute volume if his or her respiratory rate stays the same.

12. Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of:
A. a tension pneumothorax.
B. traumatic aortic rupture.
C. penetrating lung injuries.
D. a massive cardiac contusion.

13. Hemoptysis is defined as:

A. vomiting blood.
B. coughing up blood.
C. abnormal blood clotting.
D. blood in the pleural space.

14. Common signs and symptoms of a chest injury include all of the following, EXCEPT:
A. tachypnea.
B. hematemesis.
C. localized pain.
D. chest wall ecchymosis.

15. Irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation is called:
A. pleurisy.
B. dyspnea.
C. pneumonitis.
D. pneumothorax.

16. A patient who presents with profound cyanosis following a chest injury:
A. should be placed in Trendelenburg’s position.
B. is most likely experiencing severe blood loss.
C. has most likely experienced a ruptured aorta.
D. requires prompt ventilation and oxygenation.

17. Following blunt trauma to the chest, an 18-year-old female presents with respiratory distress, reduced tidal
volume, and cyanosis. Her blood pressure is 80/50 mm Hg and her pulse is 130 beats/min and thready. You
should:
A. apply 100% oxygen and immediately transport.
B. place her supine and elevate her lower extremities.
C. perform a rapid head-to-toe physical assessment.
D. provide some form of positive-pressure ventilation.

18. During your assessment of a patient with blunt chest trauma, you note paradoxical movement of the left
chest wall. As your partner is administering oxygen to the patient, you should:
A. request a paramedic to decompress the chest.
B. make note of it and continue your assessment.
C. stabilize the chest wall with a bulky dressing.
D. reassess the adequacy of the patient’s breathing.

19. In order to avoid exacerbating a patient’s injury, it is especially important to use extreme caution when
providing positive-pressure ventilation to patients with a:
A. flail chest.
B. pneumothorax.
C. cardiac tamponade.
D. myocardial contusion.

20. Pneumothorax is defined as:

A. accumulation of air between the lungs.
B. blood collection within the lung tissue.
C. accumulation of air in the pleural space.
D. blood collection within the pleural space.

21. An open pneumothorax occurs when:

A. a fractured rib perforates the tissue of the lung.
B. air enters the pleural space from outside the body.
C. extreme pleural pressure causes the lung to rupture.
D. air enters the pleural space from a perforated lung.

22. You have sealed the open chest wound of a 40-year-old male who was stabbed in the anterior chest. Your
reassessment reveals that he is experiencing increasing respiratory distress and tachycardia, and is
developing cyanosis. You should:
A. begin ventilatory assistance.
B. partially remove the dressing.
C. begin rapid transport at once.
D. call for a paramedic ambulance.

23. A spontaneous pneumothorax would MOST likely occur as the result of:
A. exertion of a person with a congenital lung defect.
B. excessive coughing in a patient with pneumonitis.
C. abnormally slow breathing in a patient with pleurisy.
D. blunt or penetrating trauma to the anterior chest wall.

24. While jogging, a 19-year-old male experienced an acute onset of shortness of breath and pleuritic chest pain.
He is conscious and alert with stable vital signs. Your assessment reveals that he has diminished breath
sounds over the left side of the chest. You should:
A. administer oxygen and transport to the hospital.
B. immediately perform a rapid head-to-toe exam.
C. recognize that he needs a needle decompression.
D. circumferentially tape a dressing around his chest.

25. You are transporting a stable patient with a possible pneumothorax. The patient is receiving 100% oxygen
and has an oxygen saturation of 95%. During your reassessment, you find that the patient is now confused,
hypotensive, and profusely diaphoretic. What is MOST likely causing this patient’s deterioration?
A. a total collapse of the affected lung
B. hidden bleeding in the thoracic cavity
C. compression of the aorta and vena cava
D. blood accumulation in the pleural space

26. Signs and symptoms of a tension pneumothorax include all of the following, EXCEPT:
A. profound cyanosis.
B. collapsed jugular veins.
C. bulging intercostal muscles.
D. unilaterally absent breath sounds.

27. You respond to a residence for a 40-year-old female who was assaulted by her husband; the scene has been
secured by law enforcement. Upon your arrival, you find the patient lying supine on the floor in the kitchen.
She is semiconscious with severely labored breathing. Further assessment reveals a large bruise to the left
anterior chest, jugular venous distention, and unilaterally absent breath sounds. As your partner is
supporting her ventilations, you should:
A. insert an oropharyngeal airway.
B. obtain a set of baseline vital signs.
C. perform a focused secondary exam.
D. immediately request ALS support.

28. The MOST critical treatment for a tension pneumothorax involves:

A. placing a bulky dressing over the affected side of the chest.
B. assisting the patient’s breathing with increased tidal volume.
C. surgically removing the portion of the lung that is damaged.
D. inserting a needle through the rib cage into the pleural space.

29. When assessing a patient with a hemothorax, you will MOST likely find:
A. jugular venous engorgement.
B. ipsilateral tracheal deviation.
C. distant or muffled heart tones.
D. signs and symptoms of shock.

30. Following a stab wound to the left anterior chest, a 25-year-old male presents with a decreased level of
consciousness and signs of shock. Which of the following additional assessment findings should increase
your index of suspicion for a cardiac tamponade?
A. engorged jugular veins
B. widening pulse pressure
C. diminished breath sounds
D. a rapid, irregular pulse

31. Subcutaneous emphysema is an indication that:

A. at least half of one lung has completely collapsed.
B. your patient is experiencing a pericardial tamponade.
C. air is escaping into the chest wall from a damaged lung.
D. blood is slowly accumulating within the tissue of the lung.

32. Patients with rib fractures will commonly:

A. breathe rapidly and shallowly.
B. take a series of deep breaths.
C. prefer to lie in a supine position.
D. develop a sucking chest wound.

33. A flail chest occurs when:

A. a segment of the chest wall is detached from the thoracic cage.
B. more than three ribs are fractured on the same side of the chest.
C. multiple ribs are fractured on both sides of the thoracic cage.
D. a segment of fractured ribs bulges during the inhalation phase.

34. A rapid, irregular pulse following blunt trauma to the chest is MOST suggestive of a:
A. ruptured aorta.
B. myocardial contusion.
C. pericardial tamponade.
D. tension pneumothorax.

35. A 37-year-old male was pinned between a flatbed truck and a loading dock. On exam, you find bruising to
the chest, distended neck veins, bilaterally diminished breath sounds, and bilateral scleral hemorrhaging.
You should:
A. aggressively manage his airway.
B. request a paramedic ambulance.
C. perform a secondary assessment.
D. suspect a severe hemopneumothorax.

36. A 28-year-old male was struck in the chest with a baseball bat during an altercation. He is conscious and
alert and complains of severe chest pain. Your assessment reveals a large area of ecchymosis over the
sternum and a rapid, irregular pulse. In addition to applying 100% oxygen, you should:
A. apply an automated external defibrillator (AED) and take his blood pressure.
B. prepare for immediate transport.
C. determine if he has cardiac problems.
D. apply bulky dressings to the sternum.

37. A 19-year-old male is unresponsive, apneic, and pulseless after being struck in the center of the chest with a
softball. Based on the mechanism of injury, what MOST likely occurred?
A. ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle
B. asystole secondary to massive intrathoracic hemorrhage due to traumatic rupture of the aorta
C. fracture of the sternum that caused a rupture of the myocardium and led to a cardiac dysrhythmia
D. collapse of both lungs due to fractured ribs that perforated the lung tissue and caused cardiac arrest

38. You arrive at the scene of a major motor vehicle crash. The patient, a 50-year-old female, was removed
from her vehicle prior to your arrival. Bystanders who removed her state that she was not wearing a seatbelt.
The patient is unconscious, tachycardic, and diaphoretic. Your assessment reveals bilaterally clear and equal
breath sounds, a midline trachea, and collapsed jugular veins. You should be MOST suspicious that this
patient has experienced a:
A. massive hemothorax.
B. tension pneumothorax.
C. pericardial tamponade.
D. laceration of the aorta.

CHAPTER 30: ABDOMINAL AND GENITOURINARY INJURIES

1. Bruising to the right upper quadrant of the abdomen following blunt trauma is MOST suggestive of injury to
the:
A. liver.
B. spleen.
C. kidney.
D. stomach.
2. All of the following are hollow abdominal organs, EXCEPT for the:
A. liver.
B. bladder.
C. ureters.
D. stomach.

3. Peritonitis, an intense inflammatory reaction of the abdominal cavity, usually occurs when:
A. solid abdominal organs bleed secondary to penetrating trauma.
B. the vessels that supply the abdominal organs become inflamed.
C. bacteria or viruses invade the walls of the gastrointestinal tract.
D. hollow abdominal organs are damaged and spill their contents.

4. The mesentery is:

A. the point of attachment between the small and large intestines.
B. a layer of thick skeletal muscles that protects the abdominal organs.
C. a complex network of blood vessels that supply blood to the liver.
D. a membranous fold that attaches the intestines to the walls of the body.

5. Which of the following statements regarding abdominal trauma is correct?

A. Most of the vital abdominal organs lie within the retroperitoneal space.
B. The absence of abdominal pain does not rule out intra-abdominal bleeding.
C. The liver is well protected and is rarely injured during a traumatic event.
D. Hollow abdominal organs are vascular and bleed profusely when injured.

6. Compression injuries to the abdomen that occur during a motor vehicle crash are typically the result of:
A. air bag deployment.
B. failure to wear seatbelts.
C. a poorly placed lap belt.
D. rapid vehicle deceleration.

7. Following blunt abdominal trauma, a 30-year-old male complains of referred pain to the left shoulder. This
finding is called the:
A. Kehr sign.
B. Cullen sign.
C. Grey Turner sign.
D. Brudzinski sign.

8. Contraction or tensing of the abdominal muscles in an effort to ease pain is called:

A. flexing.
B. referring.
C. guarding.
D. withdrawing.

9. Accumulation of blood in the abdominal cavity will MOST likely cause:

A. distention.
B. referred pain.
C. diffuse bruising.
D. nausea or vomiting.

10. When worn properly, a seatbelt should lie:

A. below the anterior superior iliac spines of the pelvis and against the hip joints.
B. across the abdominal wall at the level of the diaphragm and below the hip joints.
C. above the anterior posterior iliac spines of the pelvis and below the hip joints.
D. across the abdominal wall at the level of the umbilicus and against the hip joints.

11. Air bags, in conjunction with properly worn seatbelts, are MOST beneficial when a person is involved in a:
A. rollover crash.
B. lateral collision.
C. head-on crash.
D. rear-end collision.

12. While assessing a 21-year-old female who struck a tree head-on with her small passenger car, you note that
her air bag deployed. You should:
A. perform a head-to-toe assessment while she is in the car.
B. lift the air bag and look for deformity to the steering wheel.
C. carefully assess her upper chest for seatbelt-related injuries.
D. extricate her immediately and transport to a trauma center.

13. Because the depth of an open abdominal wound is often difficult to determine:
A. vital signs should be monitored frequently.
B. prompt transport to the hospital is essential.
C. the EMT must perform a thorough exam.
D. the abdomen must be vigorously palpated.

14. A 20-year-old male was accidentally shot in the right upper abdominal quadrant with an arrow during an
archery contest. Prior to your arrival, the patient removed the arrow. Your assessment reveals that he is
conscious and alert with stable vital signs. The entrance wound is bleeding minimally and appears to be
superficial. You should:
A. transport only if signs of shock begin to develop.
B. carefully probe the wound to determine its depth.
C. assume that the arrow injured an internal organ.
D. clean the wound and apply a dry, sterile dressing.

15. The presence of tachycardia following a significant abdominal injury:

A. is always accompanied by hypotension.
B. indicates a state of decompensated shock.
C. should be assumed to be a sign of shock.
D. is most commonly caused by severe pain.

16. Early bruising following abdominal trauma often manifests as:

A. localized pain.
B. red areas of skin.
C. gross distention.
D. dark purple marks.

17. During your assessment of a patient who experienced blunt trauma to the abdomen, you notice bruising
around the umbilicus. This is a sign of:
A. a ruptured spleen.
B. a severe liver laceration.
C. intra-abdominal bleeding.
D. rupture of a hollow organ.

18. When a hollow organ is punctured during a penetrating injury to the abdomen:
A. the abdomen will become instantly distended.
B. peritonitis may not develop for several hours.
C. it will bleed profusely and rapidly cause shock.
D. it commonly protrudes through the injury site.

19. Which of the following organs would MOST likely bleed profusely when injured?
A. bladder
B. liver
C. stomach
D. intestine

20. You are dispatched to a residence for a young female who was kicked in the abdomen by her boyfriend.
While en route to the scene, you should ask the dispatcher if:
A. the patient is conscious.
B. law enforcement is at the scene.
C. there are other patients involved.
D. the severity of the injury is known.

21. You are transporting a 42-year-old male who experienced blunt abdominal trauma. He is receiving oxygen
at 12 L/min via a nonrebreathing mask, and full spinal precautions have been applied. During your
reassessment, you note his level of consciousness has decreased and his respirations have become shallow.
You should:
A. perform a comprehensive secondary assessment to determine why his clinical status has changed.
B. insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a bag-mask device.
C. reassess his vital signs and then notify the receiving hospital of the change in his clinical status.
D. suction his oropharynx to ensure it is clear of secretions and then increase the oxygen flow rate to 15 L/min.

22. A 22-year-old male was punched in the abdomen several times. You find him lying on his left side with his
knees drawn up. He is conscious and alert and complains of increased pain and nausea when he tries to
straighten his legs. His blood pressure is 142/82 mm Hg, his pulse rate is 110 beats/min and strong, and his
respirations are 22 breaths/min and regular. In addition to administering high-flow oxygen, you should:
A. apply full spinal motion restriction precautions.
B. keep him on his side but gently straighten his legs.
C. place him supine but allow him to keep his knees bent.
D. transport him in the position in which you found him.

23. You are transporting a patient with blunt abdominal trauma. The patient is unstable and is experiencing
obvious signs and symptoms of shock. Your estimated time of arrival at the hospital is less than 10 minutes.
After treating the patient appropriately, you should:
A. closely monitor him and reassess him frequently.
B. perform a comprehensive secondary assessment.
C. begin documenting the call on the patient care form.
D. forgo the hospital radio report because of his condition.

24. Difficulty breathing and a sunken appearance of the anterior abdominal wall is MOST indicative of a
ruptured:
A. aorta.
B. spleen.
C. stomach.
D. diaphragm.
25. A 40-year-old male presents with severe abdominal pain following blunt trauma. He is diaphoretic,
intensely thirsty, and has a weak and rapid pulse. Appropriate treatment for this patient includes all of the
following, EXCEPT:
A. covering him with a warm blanket.
B. giving him small sips of plain water.
C. promptly transporting to the hospital.
D. administering supplemental oxygen.

26. Which of the following statements regarding abdominal eviscerations is correct?

A. Most eviscerations occur to the left upper quadrant.
B. The protruding organs should be kept warm and moist.
C. The organs should be replaced carefully to avoid heat loss.
D. Adherent material is preferred when covering an evisceration.

27. A football player was struck by another player in the right flank area just below the posterior rib cage. He
complains of severe pain and point tenderness to the area. Your assessment reveals that there is a small
amount of blood in his underwear. You should be MOST suspicious for:
A. external genitalia injury.
B. a lacerated liver or spleen.
C. blunt injury to the kidney.
D. a ruptured urinary bladder.

28. Which of the following organs is at MOST risk for injury as the result of a pelvic fracture?
A. pancreas
B. fallopian tubes
C. urinary bladder
D. liver or spleen

29. Placing a pregnant patient in a supine position during the third trimester of pregnancy:
A. may decrease the amount of blood that returns to the heart.
B. often causes hypotension secondary to cardiac compression.
C. results in spontaneous urinary incontinence if the bladder is full.
D. is recommended if the patient has severe abdominal discomfort.

30. A sign of kidney damage following blunt trauma is:

A. hematuria.
B. hemoptysis.
C. hematemesis.
D. hematochezia.

31. A 54-year-old male experienced an avulsion to his penis when his foreskin got caught in the zipper of his
pants. He was able to unzip his pants and remove the foreskin prior to your arrival. Your assessment reveals
that he is in severe pain and that the avulsion is bleeding moderately. The MOST appropriate treatment for
this patient includes:
A. applying direct pressure with a dry, sterile dressing.
B. covering the avulsion with moist, sterile dressings.
C. requesting a paramedic to administer pain medication.
D. administering 100% oxygen via a nonrebreathing mask.
32. A 66-year-old male presents with dark red rectal bleeding and abdominal pain. He is conscious and alert;
however, his skin is cool and clammy and his heart rate is elevated. Further assessment reveals that his
blood pressure is 112/60 mm Hg. Which of the following questions would be MOST pertinent to ask him?
A. What does your blood pressure normally run?
B. Do you take any over-the-counter medications?
C. Has blood soaked through your undergarments?
D. Have you experienced recent abdominal trauma?

33. When documenting a call involving a female patient who was sexually assaulted, the EMT should:
A. theorize as to why the sexual assault occurred.
B. include the results of his or her internal vaginal exam.
C. include a description of the suspected perpetrator.
D. avoid speculation and document only factual data.

34. Your presence is requested by law enforcement to assess a 33-year-old female who was sexually assaulted.
The patient is conscious and obviously upset. As you are talking to her, you note an impressive amount of
blood on her clothes in the groin area. Her blood pressure is 98/58 mm Hg, her pulse is 130 beats/min, and
her respirations are 24 breaths/min. You should:
A. visualize the vaginal area and pack the vagina with sterile dressings.
B. allow her to change her clothes and take a shower before you transport.
C. arrange for a rape crisis center representative to speak with the patient.
D. control any external bleeding, administer oxygen, and transport at once.

CHAPTER 31: ORTHOPAEDIC INJURIES

1. The musculoskeletal system refers to the:

A. bones and voluntary muscles of the body.
B. nervous system’s control over the muscles.
C. connective tissue that supports the skeleton.
D. involuntary muscles of the nervous system.

2. Skeletal muscle is also referred to as __________ muscle.

A. smooth
B. striated
C. connective
D. involuntary

3. Which of the following statements regarding striated muscle is correct?

A. Striated muscle is involuntary because you have no conscious control over it.
B. Most of the body’s striated muscle is found within the walls of the blood vessels.
C. Striated muscle tissue is attached directly to the bones by tough bands of cartilage.
D. It forms the major muscle mass of the body and usually crosses at least one joint.

4. Which of the following types of muscle is under direct voluntary control of the brain?
A. cardiac
B. skeletal
C. smooth
D. autonomic

5. Atrophy is a condition that occurs when:

A. increased use of skeletal muscle causes an increase in its strength.
B. the tendons that attach muscle to bone become stretched or injured.
C. muscle decreases in size and function because of disease or trauma.
D. carbon dioxide, lactic acid, and other wastes accumulate in the muscle.

6. Skeletal muscle is attached to the bone by tough, ropelike fibrous structures called:
A. fascia.
B. tendons.
C. cartilage.
D. ligaments.

7. Which of the following structures is regulated by smooth muscle?

A. heart
B. skeleton
C. blood vessels
D. diaphragm

8. What type of muscle contracts and relaxes to control the movement of the contents within its structures?
A. cardiac
B. skeletal
C. striated
D. smooth

9. Bone marrow produces:

A. platelets.
B. blood cells.
C. lymphocytes.
D. electrolytes.

10. The pectoral girdle consists of the:

A. scapulae and clavicles.
B. clavicles and rib cage.
C. sternum and scapulae.
D. acromion and clavicles.

11. Bones are connected to other bones by bands of tough fibrous tissues called:
A. bursa.
B. tendons.
C. cartilage.
D. ligaments.

12. In moving joints, the ends of the bones are covered with:
A. articular cartilage.
B. synovial tendons.
C. muscular fascia.
D. gliding cartilage.

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

A. total loss of function in a bone.
B. break in the continuity of the bone.
C. disruption in the midshaft of a bone.
D. abnormality in the structure of a bone.

14. The disruption of a joint in which the bone ends are no longer in contact is called a:
A. strain.
B. sprain.
C. fracture.
D. dislocation.

15. A subluxation occurs when:

A. ligaments are partially severed.
B. a fracture and a dislocation exist.
C. a joint is incompletely dislocated.
D. a bone develops a hairline fracture.

16. Which of the following joints allows no motion?

A. skull sutures
B. sacroiliac joint
C. shoulder joint
D. sternoclavicular joint

17. A ____________ is a musculoskeletal injury in which there is partial or temporary separation of the bone
ends as well as partial stretching or tearing of the supporting ligaments.
A. strain
B. sprain
C. fracture
D. dislocation

18. With regard to musculoskeletal injuries, the zone of injury is defined as the:
A. area of obvious deformity over the site of impact.
B. exact part of the bone or joint that was disrupted.
C. area of soft-tissue damage surrounding the injury.
D. part of the body that sustained secondary injury.

19. Which of the following scenarios is an example of a direct injury?

A. A passenger fractures her patella after it strikes the dashboard.
B. A skier dislocates his knee after a twisting injury to the ankle.
C. A person lands on his or her feet and fractures the lumbar spine.
D. A child dislocates his elbow after falling on his outstretched arm.

20. An open fracture is MOST accurately defined as a fracture in which:

A. bone ends protrude through the skin.
B. a large laceration overlies the fracture.
C. a bullet shatters the underlying bone.
D. the overlying skin is no longer intact.

21. Which of the following musculoskeletal injuries would MOST likely result in deformity?
A. severe strain
B. moderate sprain
C. hairline fracture
D. displaced fracture

22. When assessing a patient with a possible fracture of the leg, the EMT should:
A. assess proximal circulation.
B. compare it to the uninjured leg.
C. carefully move it to elicit crepitus.
D. ask the patient to move the injured leg.

23. A fracture caused by minimal force that is associated with diseases such as cancer and osteoporosis is called
a __________ fracture.
A. greenstick
B. pathologic
C. transverse
D. comminuted

24. A(n) __________ fracture occurs in the growth section of a child’s bone and may lead to bone growth
abnormalities.
A. greenstick
B. diaphyseal
C. epiphyseal
D. metaphyseal

25. The MOST reliable indicator of an underlying fracture is:

A. guarding.
B. severe swelling.
C. obvious bruising.
D. point tenderness.

26. Deformity caused by a fracture would MOST likely be masked by:

A. swelling.
B. guarding.
C. crepitus.
D. ecchymosis.

27. Crepitus and false motion are:

A. indicators of a severe sprain.
B. only seen with open fractures.
C. positive indicators of a fracture.
D. most common with dislocations.

28. If a dislocated shoulder has spontaneously reduced before your arrival, the only way to confirm the injury is
by noting:
A. distal circulation.
B. the patient history.
C. bruising to the shoulder.
D. the presence of deformity.

29. Common signs and symptoms of a sprain include all of the following, EXCEPT:
A. swelling.
B. deformity.
C. ecchymosis.
D. point tenderness.

30. Which of the following statements regarding compartment syndrome is correct?

A. Compartment syndrome typically develops within 6 to 12 hours after an injury.
B. Compartment syndrome occurs because of increased pressure within the bone cavity.
C. In most cases, compartment syndrome develops within a few minutes after an injury.
D. Most cases of compartment syndrome occur following a severe fracture of the pelvis.
31. Which of the following musculoskeletal injuries would pose the greatest threat to a patient’s life?
A. an amputated extremity
B. bilateral femur fractures
C. nondisplaced long bone fractures
D. pelvic fracture with hypotension

32. Of the following musculoskeletal injuries, which is considered to be the LEAST severe?
A. nondisplaced pelvic fracture
B. open fractures of a long bone
C. an amputation of an extremity
D. multiple closed long bone fractures

33. A 22-year-old female was ejected from her car after striking a tree head-on. As you approach her, you note
obvious closed deformities to both of her femurs. She is not moving and does not appear to be conscious.
You should:
A. apply manual stabilization to both of her femurs.
B. administer oxygen and perform a rapid assessment.
C. assess for a carotid pulse and assist her ventilations.
D. stabilize her head and perform a primary assessment.

34. Assessing a person’s neurovascular status following a musculoskeletal injury includes all of the following,
EXCEPT:
A. assessing motor function.
B. assessing sensory function.
C. evaluating proximal pulses.
D. determining capillary refill.

35. During your rapid secondary assessment of a 19-year-old female with multiple trauma, you note bilateral
humeral deformities and a deformity to the left midshaft femur. Her skin is diaphoretic and her pulse is
rapid and weak. Your partner has appropriately managed her airway and is maintaining manual stabilization
of her head. The MOST appropriate treatment for this patient includes:
A. applying and inflating the pneumatic antishock garment (PASG) and transporting.
B. immobilizing her to a backboard and rapidly transporting.
C. applying a traction splint to immobilize her femur.
D. carefully splinting each of her deformed extremities.

36. A 54-year-old male accidentally shot himself in the leg while cleaning his gun. Your assessment reveals a
small entrance wound to the medial aspect of his right leg. The exit wound is on the opposite side of the leg
and is actively bleeding. The patient complains of numbness and tingling in his right foot. You should:
A. assess distal pulses as well as sensory and motor functions.
B. manually stabilize the leg above and below the site of injury.
C. gently manipulate the injured leg until the numbness dissipates.
D. control the bleeding and cover the wound with a sterile dressing.
37. Applying ice to and elevating an injured extremity are performed in order to:
A. prevent further injury.
B. reduce pain and swelling.
C. enhance tissue circulation.
D. maintain extremity perfusion.

38. In general, musculoskeletal injuries should be splinted before moving the patient unless:
A. the patient is in severe pain.
B. the patient is clinically unstable.
C. deformity and swelling are present.
D. transport time is less than 15 minutes.

39. The primary purpose for splinting a musculoskeletal injury is to:

A. prevent further injury.
B. maximize distal circulation.
C. make the patient comfortable.
D. facilitate ambulance transport.

40. The act of pulling on a body structure in the direction of its normal alignment is called:
A. traction.
B. reduction.
C. stabilization.
D. immobilization.

41. A 21-year-old male was thrown over the handlebars of his motorcycle when he rear-ended a car that was
stopped at a red light. He was wearing a helmet, which he removed prior to your arrival. He is conscious,
but restless, and has closed deformities to both of his femurs. His skin is pale, his heart rate is rapid and
weak, and his respirations are rapid and shallow. In addition to applying high-flow oxygen and protecting
his spine, you should:
A. bind his legs together on the backboard, keep him warm, and transport without delay.
B. apply traction splints to both of his legs, keep him warm, and transport without delay.
C. splint each of his deformed femurs with long board splints and transport immediately.
D. apply the PASG to stabilize his femurs and transport at once.

42. In which of the following situations should the EMT splint an injured limb in the position of deformity?
A. when distal circulation and neurological functions are absent
B. if transport time to the hospital is greater than 20 to 30 minutes
C. if resistance is encountered or the patient experiences severe pain
D. if a traction splint will be used to immobilize the injured extremity

43. You have applied a zippered air splint to a patient’s left arm. During transport, the patient complains of
increased numbness and tingling in his left hand. You reassess distal circulation and note that it remains
present. Your MOST appropriate action should be to:
A. elevate the injured arm and reassess distal sensory function.
B. inflate the splint with more air until the patient is comfortable.
C. assess the amount of air in the splint and let air out as necessary.
D. remove the air splint and reimmobilize with padded board splints.

44. Traction splints are used primarily to immobilize and secure fractures of the:
A. hip.
B. pelvis.
C. femur.
D. humerus.

45. A 76-year-old male experienced sudden pain to his left thigh when he was standing in line at the grocery
store. Your assessment reveals ecchymosis and deformity to the distal aspect of his left femur, just above
the knee. Distal circulation and sensory and motor functions are intact. The MOST appropriate method of
splinting this injury involves:
A. applying a traction splint to realign the deformity.
B. applying and fully inflating the pneumatic antishock garment (PASG).
C. applying padded board splints to both sides of the leg.
D. binding the legs together and elevating them 6″ to 8″.

46. During your rapid secondary assessment of a 30-year-old male who fell 25′, you note crepitus when
palpating his pelvis. Your partner advises you that the patient’s blood pressure is 80/50 mm Hg and his heart
rate is 120 beats/min and weak. After completing your assessment, you should:
A. defer spinal immobilization and transport to a trauma center.
B. perform a focused physical exam with emphasis on the pelvis.
C. stabilize the pelvis with a pelvic binder and protect the spine.
D. log roll the patient onto a long backboard and transport at once.

47. The PASG is absolutely contraindicated in patients who have:

A. pelvic fractures.
B. pulmonary edema.
C. bilateral femur fractures.
D. any trauma below the pelvis.

48. The MOST significant hazard associated with splinting is:

A. aggravation of the injury or worsened pain.
B. reduction in circulation distal to the injury site.
C. compression of nerves, tissues, and vasculature.
D. delaying transport of a critically injured patient.

49. The MOST commonly fractured bone(s) in the body is the:

A. clavicle.
B. scapula.
C. radius and ulna.
D. midshaft femur.

50. When caring for a patient with a possible fracture of the scapula, the EMT should:
A. carefully assess the patient for breathing problems.
B. apply rigid board splints across the chest and back.
C. assume that minimal force was applied to the back.
D. recognize that scapular fractures are life threatening.

51. Following direct trauma to the left upper back, a 44-year-old male presents with diaphoresis and
restlessness. His blood pressure is 100/50 mm Hg, his pulse rate is 120 beats/min and weak, and his
respirations are 24 breaths/min and labored. Your assessment reveals abrasions and contusions over the left
scapula. You should:
A. hyperventilate him with a bag-mask device and monitor his oxygen saturation.
B. apply high-flow oxygen, perform a detailed secondary assessment, and transport.
C. focus your assessment on his scapulae and clavicles and apply high-flow oxygen.
D. apply high-flow oxygen, consider spinal precautions, and transport without delay.

52. A 17-year-old football player collided with another player and has pain to his left clavicular area. He is
holding his arm against his chest and refuses to move it. Your assessment reveals obvious deformity to the
midshaft clavicle. After assessing distal pulse, sensory, and motor functions, you should:
A. perform a rapid secondary assessment.
B. straighten his arm and apply a board splint.
C. immobilize the injury with a sling and swathe.
D. place a pillow under his arm and apply a sling.
53. Which of the following statements regarding shoulder dislocations is MOST correct?
A. Posterior dislocations are most common.
B. They are caused by forced arm adduction.
C. Most shoulder dislocations occur anteriorly.
D. They involve the acromion process and humerus.

54. You receive a call to a local gymnasium for a basketball player with a dislocated shoulder. Upon arrival,
you find the patient, a 17-year-old male, sitting on the ground. He is holding his left arm in a fixed position
away from his body. There is an obvious anterior bulge to the area of injury. You should:
A. assess distal pulse, motor, and sensory functions.
B. gently attempt to move his arm toward his body.
C. place a pillow under his arm and apply a swathe.
D. flex his arm at the elbow and then apply a sling.

55. A supracondylar or intercondylar fracture is also known as a fracture of the:

A. radial head.
B. distal humerus.
C. proximal radius.
D. olecranon process.

56. A 31-year-old male fell and landed on his left elbow. Your assessment reveals that the elbow is grossly
deformed, his forearm is cool and pale, and the distal pulse on the side of the injury is barely palpable. His
vital signs are stable and he denies any other injuries. Your transport time to the closest appropriate hospital
is approximately 15 minutes. You should:
A. splint the elbow in the position found and transport.
B. gently manipulate the elbow to improve circulation.
C. gently straighten the elbow and apply an air splint.
D. apply a heat pack to the elbow to reduce swelling.

57. During your assessment of a 29-year-old female with significant deformity to her left elbow, you are unable
to palpate a radial pulse. Your transport time to the hospital is approximately 40 minutes. You should:
A. splint the elbow in the position of deformity and transport immediately.
B. apply gentle manual traction in line with the limb and reassess for a pulse.
C. carefully straighten the injured arm and secure it with padded board splints.
D. make two or three attempts to restore distal circulation by manipulating the elbow.

58. A Colles fracture involves a fracture of the:

A. distal ulna.
B. distal radius.
C. proximal radius.
D. radius and ulna.

59. When splinting an injury of the wrist, the hand should be placed:
A. into a fist.
B. in a straight position.
C. in an extended position.
D. in a functional position.

60. Which of the following fractures has the greatest potential for internal blood loss and shock?
A. hip
B. femur
C. pelvis
D. humerus

61. A 45-year-old female was the unrestrained passenger of a small car that rear-ended another vehicle at a
moderate rate of speed. She is conscious and alert, but complains of pain to both of her knees. There is
visible damage to the dashboard on the passenger’s side of the vehicle. In addition to fractures or
dislocations of the knees, you should be MOST suspicious for:
A. anterior hip dislocation.
B. posterior hip dislocation.
C. a thoracic spine fracture.
D. fracture of the tibia or fibula.

62. A “hip” fracture is actually a fracture of the:

A. pelvic girdle.
B. femoral shaft.
C. pubic symphysis.
D. proximal femur.

63. A 77-year-old woman slipped and fell on a throw rug and landed on her left hip. She denies striking her
head or losing consciousness. Assessment of her left leg reveals that it is shortened and externally rotated.
Distal pulses, sensory, and motor functions are intact. You should:
A. manually stabilize her left leg, apply a traction splint, and then secure her to a long backboard or scoop.
B. carefully slide a long backboard underneath her, keep her in a supine position, and apply a splint to her leg.
C. place her onto a scoop stretcher, pad around her left hip with pillows, and secure her to the scoop with
straps.
D. bind both of her legs together with triangular bandages and carefully secure her onto the ambulance
stretcher.

64. Femoral shaft fractures can result in up to _____ mL of internal blood loss.
A. 1,000
B. 1,500
C. 2,000
D. 4,000

65. The MOST common and significant complication associated with fractures or dislocations of the knee is:
A. neurovascular compromise.
B. internal bleeding and shock.
C. ligament and cartilage damage.
D. total depletion of synovial fluid.

66. A person who experiences a calcaneus fracture after jumping and landing on his or her feet would MOST
likely experience an accompanying fracture of the:
A. thoracic spine.
B. lumbar spine.
C. coccygeal spine.
D. symphysis pubis.

67. When splinting a possible fracture of the foot, it is MOST important for the EMT to:
A. use a pillow as a splint.
B. leave the toes exposed.
C. apply a pneumatic splint.
D. observe for tissue swelling.
 CHAPTER 32: ENVIRONMENTAL INJURIES

1. A dysbarism injury refers to the signs and symptoms related to changes in:
A. rapid ascent.
B. rapid descent.
C. decompression.
D. barometric pressure.

2. When a warm hand is immersed in water that is 70°F (21°C), heat is transferred from the hand to the water
through a process called:
A. radiation.
B. conduction.
C. convection.
D. evaporation.

3. The transfer of heat to circulating air, such as when cool air moves across the body’s surface, is called:
A. radiation.
B. conduction.
C. convection.
D. evaporation.

4. The body’s natural cooling mechanism, in which sweat is converted to a gas, is called:
A. radiation.
B. convection.
C. conduction.
D. evaporation.

5. Heat loss from the body through respiration occurs when:

A. warm air is exhaled into the atmosphere.
B. the core body temperature is greater than 98°F (37°C).
C. cool air is inhaled and displaces warm air.
D. air temperature is greater than body temperature.

6. Shivering is a mechanism in which the body generates heat by:

A. increasing the metabolic rate.
B. decreasing the use of oxygen.
C. decreasing the metabolic rate.
D. retaining excess carbon dioxide.

7. Covering a patient’s _________ will significantly minimize radiation heat loss.

A. head
B. chest
C. abdomen
D. extremities

8. Hypothermia occurs when the core body temperature falls below:

A. 98°F (37°C).
B. 95°F (35°C).
C. 90°F (32°C).
D. 88°F (31°C).
9. The body’s natural protective mechanisms against heat loss are:
A. shivering and vasodilation.
B. vasodilation and respiration.
C. respiration and vasoconstriction.
D. vasoconstriction and shivering.

10. Compared to adults, infants and children are at higher risk for hypothermia for all of the following reasons,
EXCEPT:
A. a decreased ability to shiver.
B. a relatively small surface area.
C. a smaller amount of body fat.
D. a smaller overall muscle mass.

11. Which of the following conditions would be the LEAST likely to increase a person’s risk of hypothermia?
A. hypoperfusion
B. severe infection
C. hyperglycemia
D. spinal cord injury

12. To assess a patient’s general temperature, pull back on your glove and place the back of your hand on his or
her skin at the:
A. neck.
B. chest.
C. abdomen.
D. forehead.

13. To obtain the MOST accurate reading of a patient’s core body temperature, you should place a special
hypothermia thermometer:
A. into the patient’s rectum.
B. under the patient’s tongue.
C. behind the patient’s knee.
D. under the patient’s armpit.

14. A patient with a core body temperature of 95°F (35°C) will MOST likely experience:
A. a slow pulse.
B. rapid breathing.
C. muscle stiffness.
D. loss of consciousness.

15. Which of the following would be the LEAST likely to occur in a patient with a core body temperature of
between 89°F (32°C) and 92°F (33°C)?
A. bradypnea
B. confusion
C. stiff muscles
D. tachycardia

16. A person’s ability to shiver is lost when his or her body temperature falls below:
A. 90°F (32°C).
B. 92°F (33°C).
C. 94°F (34°C).
D. 95°F (35°C).
17. All of the following terms are used to describe a cold body part that is not frozen, EXCEPT:
A. frostnip.
B. frostbite.
C. chilblains.
D. trench foot.

18. Patients with generalized hypothermia are at an increased risk of a local cold injury because:
A. blood is shunted away from the extremities to the body’s core.
B. peripheral vasodilation brings warm blood to the skin’s surface.
C. the major muscles of the body become rigid during hypothermia.
D. the patient is usually unable to escape the cold ambient temperature.

19. A frostbitten foot can be identified by the presence of:

A. gross deformity.
B. soft, smooth skin.
C. mottling and blisters.
D. blanching of the skin.

20. A 30-year-old male was rescued after being lost in the woods for approximately 18 hours. The outside
temperature is 30°F (−1°C). He is immediately placed in the warmed ambulance, where you perform a
primary assessment. He is unconscious, pale, and apneic. You should:
A. apply an AED and assess his cardiac rhythm.
B. assess for a carotid pulse for up to 45 seconds.
C. open his airway and give two rescue breaths.
D. apply chemical heat packs to his groin and axillae.

21. Hypothermia can worsen internal bleeding secondary to:

A. cardiac arrhythmias.
B. a decreased heart rate.
C. severe muscular rigidity.
D. blood clotting abnormalities.

22. Rough handling of a hypothermic patient with a pulse may cause:

A. profound bradycardia.
B. ventricular fibrillation.
C. ventricular tachycardia.
D. pulseless electrical activity.

23. Your assessment of a 23-year-old female reveals a core body temperature of 93.4°F (34°C). She is
conscious, answers your questions appropriately, is shivering, and complains of nausea. Her skin is cold and
pale, her muscles appear rigid, and her respirations are rapid. In addition to monitoring her ABCs,
administering oxygen, and turning up the heat in the back of the ambulance, you should:
A. apply the AED in case she develops cardiopulmonary arrest, cover her with layers of blankets, and transport
carefully.
B. place heat packs to her groin, axillae, and behind her neck; cover her with warm blankets; and avoid rough
handling.
C. cover her with warm blankets and let her move about on the stretcher in order to generate body heat and
increase her temperature.
D. sit her up and give her small sips of warm water to drink, place heat packs to her axillae and groin, and
cover her with blankets.
24. You are transporting a 28-year-old man with a frostbitten foot. The patient’s vital signs are stable and he
denies any other injuries or symptoms. The weather is treacherous and your transport time to the hospital is
approximately 45 minutes. During transport, you should:
A. rewarm his foot in 100°F to 105°F (38°C to 40°C) water.
B. administer oxygen via a nonrebreathing mask.
C. cover his foot with chemical heat compresses.
D. protect the affected part from further injury.

25. The two MOST efficient ways for the body to eliminate excess heat are:
A. respiration and bradycardia.
B. perspiration and tachycardia.
C. sweating and dilation of skin blood vessels.
D. hyperventilation and tachycardia.

26. Which of the following MOST accurately describes hyperthermia?

A. The core body temperature exceeds 99.5°F (37°C).
B. The body is exposed to more heat than it can lose.
C. Heat evaporates a significant amount of body water.
D. The body eliminates more heat than it can generate.

27. High air temperature reduces the body’s ability to lose heat by:
A. radiation.
B. convection.
C. conduction.
D. evaporation.

28. Geriatric patients, newborns, and infants are especially prone to hyperthermia because they:
A. have relatively smaller heads.
B. have less body fat.
C. exhibit poor thermoregulation.
D. have smaller body surface areas.

29. When the body loses sweat, it also loses:

A. plasma.
B. nutrients.
C. erythrocytes.
D. electrolytes.

30. In order for sweating to be an effective cooling mechanism:

A. several layers of clothing must be worn.
B. it must be able to evaporate from the body.
C. the relative humidity must be above 90%.
D. the body must produce at least 1 L per hour.

31. High humidity reduces the body’s ability to lose heat through:
A. radiation.
B. convection.
C. conduction.
D. evaporation.

32. Common signs and symptoms of heat exhaustion include all of the following, EXCEPT:
A. nausea.
B. headache.
C. tachycardia.
D. hot, dry skin.

33. Heatstroke occurs when:

A. a person’s core body temperature rises above 103°F (39°C).
B. the body’s heat-eliminating mechanisms are overwhelmed.
C. a person becomes dehydrated secondary to excess water loss.
D. the ambient temperature exceeds 90°F (32°C) and the humidity is high.

34. Signs of late heatstroke include:

A. hot, moist skin.
B. nausea and vomiting.
C. a weak, rapid pulse.
D. a change in behavior.

35. Which of the following medications increases a person’s risk of a heat-related emergency?
A. Motrin
B. Tylenol
C. Aspirin
D. diuretics

36. You receive a call to a residence for a sick patient. Upon your arrival, you find the patient, a 53-year-old
diabetic male, lying down on his front porch. His wife tells you that he had been mowing the lawn in the
heat for the past 3 hours. The patient is confused and has hot, moist skin. His pulse is weak and thready, and
his blood pressure is 90/50 mm Hg. In addition to administering 100% oxygen, you should:
A. perform a rapid assessment and look for signs of trauma.
B. place him in a sitting position and have him drink 1 L of water.
C. load him into the ambulance and begin rapid cooling interventions.
D. administer one tube of oral glucose and reassess his mental status.

37. You are dispatched to a local high school track and field event for a 16-year-old male who fainted. The
outside temperature is approximately 95°F (35°C) with high humidity. Upon your arrival, the patient is
conscious, alert, and complains of nausea and a headache. His skin is cool, clammy, and pale. You should:
A. give him a liquid salt solution to drink.
B. administer 100% supplemental oxygen.
C. apply chemical ice packs to his axillae.
D. move him into the cooled ambulance.

38. Geriatric patients are at a higher risk for heatstroke because:

A. circulation to the skin is reduced.
B. most geriatric patients are obese.
C. their ability to sweat is enhanced.
D. their ability to shiver is reduced.

39. Drowning is MOST accurately defined as:

A. temporary survival after submersion in water.
B. death from suffocation after submersion in water.
C. water in the lungs following submersion in water.
D. death beyond 24 hours after submersion in water.
40. Which of the following statements regarding drowning is correct?
A. Hypoxia in the drowning victim initially occurs due to water in the lungs.
B. Artificial ventilations can easily be performed in patients with a laryngospasm.
C. Large amounts of water enter the lungs in a small number of drowning victims.
D. Laryngospasm following submersion in water makes rescue breathing difficult.

41. A 20-year-old male was pulled from cold water by his friends. The length of his submersion is not known
and was not witnessed. You perform a primary assessment and determine that the patient is apneic and has a
slow, weak pulse. You should:
A. suction his airway for 30 seconds, provide rescue breathing, keep him warm, and transport at once.
B. ventilate with a bag-mask device, apply a cervical collar, remove his wet clothing, and transport rapidly.
C. provide rescue breathing, remove wet clothing, immobilize his spine, keep him warm, and transport
carefully.
D. apply 100% oxygen via a nonrebreathing mask, immobilize his spine, keep him warm, and transport rapidly.

42. The EMT must assume that any unwitnessed water-related incident is accompanied by:
A. an air embolism.
B. alcohol intoxication.
C. possible spinal injury.
D. cold water immersion.

43. You and your partner are standing by at a large social event at a river resort when a frantic woman tells you
that she found a young male floating face-down in the water. Nobody claims to have witnessed the event.
After you and your partner enter the water and reach the patient, you should:
A. move him as a unit to a supine position.
B. begin ventilations with a barrier device.
C. immediately secure him to a longboard.
D. perform a jaw-thrust maneuver to open his airway.

44. The diving reflex may allow a person to survive extended periods of submersion in cold water secondary to:
A. bradycardia and a slowing of the metabolic rate.
B. laryngospasm that protects the lungs from water.
C. tachycardia and a lowering of the blood pressure.
D. increases in the metabolic rate and oxygen demand.

45. Most of the serious injuries associated with scuba diving are caused by:
A. water temperature lower than 70°F (21°C).
B. too rapid of a descent.
C. alcohol consumption.
D. too rapid of an ascent.

46. An air embolism associated with diving occurs when:

A. the diver hyperventilates prior to entering the water.
B. the diver holds his or her breath during a rapid ascent.
C. the alveoli completely collapse due to high pressure.
D. high water pressure forces air into the mediastinum.

47. Signs and symptoms of an air embolism include all of the following, EXCEPT:
A. dysphasia.
B. pale skin.
C. dizziness.
D. joint pain.
48. The MOST prominent symptom of decompression sickness is:
A. tightness in the chest.
B. difficulty with vision.
C. dizziness and nausea.
D. abdominal or joint pain.

49. You respond to a local lake where a diver complains of difficulty breathing that occurred immediately after
rapidly ascending from a depth of approximately 30′. On assessment, you note that he has cyanosis around
his lips and has pink froth coming from his nose and mouth. You should:
A. suction his mouth and nose, apply high-flow oxygen, position him on his left side with his head down, and
contact medical control regarding transport to a recompression facility.
B. place him in a semi-sitting position, suction his mouth and nose, apply a continuous positive airway pressure
(CPAP) device, and transport to the closest emergency department.
C. suction his mouth and nose, keep him supine and elevate his legs to prevent air bubbles from entering his
brain, administer high-flow oxygen, and transport to a hyperbaric chamber.
D. position him supine with his head elevated 30°, suction his mouth and nose, hyperventilate him with a bag-
mask device, and contact medical control for further guidance.

50. Breath-holding syncope is caused by a decreased stimulus to breathe and occurs when:
A. a swimmer breathes shallowly before entering the water.
B. a diver holds his or her breath during a staged ascent.
C. a swimmer hyperventilates prior to entering the water.
D. a diver holds his or her breath for a long period of time.

51. Burns associated with lightning strikes are typically:

A. superficial.
B. third-degree.
C. full-thickness.
D. partial-thickness.

52. Which of the following statements regarding lightning strikes is correct?

A. Lighting often results in a brief period of asystole that resolves spontaneously.
B. The tissue damage pathway caused by lightning usually occurs through the skin.
C. Victims who are struck by lightning often experience severe full-thickness burns.
D. Cervical spine fractures are the most common cause of lightning-related deaths.

53. You and your partner respond to a park where several people were reportedly struck by lightning. When you
arrive, you find three patients. The first patient is lying supine on the ground; he is unresponsive and does
not appear to be breathing. The second patient is ambulatory, appears confused, and is holding his arm
against his chest. The third patient is sitting on the ground holding the sides of his head. After calling for
backup, you should:
A. immediately begin CPR on the unresponsive patient, but cease resuscitation efforts if there is no response
after 5 minutes of treatment.
B. focus your initial treatment efforts on the patients who are conscious because the unresponsive patient is
likely in irreversible cardiac arrest.
C. assess the unresponsive patient’s pulse, begin CPR starting with chest compressions if he is pulseless, and
attach the AED as soon as possible.
D. recognize that the patients who are conscious are at high risk for developing cardiac arrest and quickly
assess them for potentially life-threatening injuries.

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

A. renal system.
B. nervous system.
C. respiratory system.
D. cardiovascular system.

55. In contrast to the brown recluse spider, the black widow spider:
A. is very small and has a violin-shaped marking on its back.
B. is large and has a red-orange hourglass mark on its abdomen.
C. has a bite that is typically painless until a blister develops.
D. has a bite that usually produces local pain but no systemic signs or symptoms.

56. The venom of a brown recluse spider is cytotoxic, meaning that it:
A. suppresses the respiratory drive.
B. destroys the body’s red blood cells.
C. weakens the structure of the bones.
D. causes severe local tissue damage.

57. You are assessing a 33-year-old male who complains of severe abdominal pain, weakness, and nausea. He
tells you that he was gathering wood to build a fire when he felt a sudden, sharp pain on the back of his
hand. Your assessment reveals that the patient’s abdomen is rigid and painful to palpation. You should
suspect:
A. a black widow spider bite.
B. envenomation from a pit viper.
C. a brown recluse spider bite.
D. Rocky Mountain spotted fever.

58. All of the following snakes are pit vipers, EXCEPT for the:
A. copperhead.
B. rattlesnake.
C. coral snake.
D. cottonmouth.

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

A. local swelling and ecchymosis
B. general weakness and diaphoresis
C. syncope and bleeding at distal sites
D. signs and symptoms of hypoperfusion

60. While drinking beer with his friends near a creek, a 31-year-old male was bitten on the leg by an
unidentified snake. The patient is conscious and alert and in no apparent distress. Your assessment of his leg
reveals two small puncture marks with minimal pain and swelling. In addition to administering oxygen and
providing reassurance, further care for this patient should include:
A. applying ice to the wound and transporting quickly.
B. transporting only with close, continuous monitoring.
C. elevating the lower extremities and giving antivenin.
D. supine positioning, splinting the leg, and transporting.

61. You are dispatched to a residence for a young female who is sick. The patient complains of a rash to her
lower extremities and truncal area. Your assessment reveals a small, painful blister on her inner thigh. As
your partner is taking the patient’s vital signs, she states that she and her family returned from a camping
trip two days ago. On the basis of this patient’s presentation, you should suspect:
A. Lyme disease.
B. an allergic reaction.
C. exposure to poison ivy.
D. Rocky Mountain spotted fever.

62. A 48-year-old male was stung on the leg by a jellyfish while swimming in the ocean. He is conscious and
alert, but complains of intense pain at the wound site. Specific treatment for this patient includes:
A. irrigating the wound with vinegar and immersing his leg in hot water.
B. pulling the nematocysts out with tweezers and bandaging the wound.
C. immersing his leg in fresh cold water and scraping away the stingers.
D. applying a chemical ice pack to the wound and encouraging movement.

CHAPTER 33: OBSTETRICS AND NEONATAL CARE

1. Which of the following processes occurs during ovulation?

A. Certain female hormone levels decrease significantly in quantity.
B. The endometrium sheds its lining and is expelled from the vagina.
C. The inner lining of the uterus thickens in preparation for implantation.
D. Numerous follicles mature and release eggs into the fallopian tubes.

2. From what internal female organ is the fetus expelled during delivery?
A. vagina
B. uterus
C. cervix
D. perineum

3. The vagina and the neck of the uterus comprise the:

A. womb.
B. cervix.
C. fundus.
D. birth canal.

4. The term “bloody show” is defined as:

A. the small amount of pink-tinged mucus that is discharged from the vagina after expulsion of the mucous
plug.
B. mild vaginal bleeding that occurs within the first 30 minutes after the onset of the second stage of the labor
process.
C. the normal amount of vaginal bleeding that occurs within the first 24 hours following delivery of the baby
and placenta.
D. any volume of blood that is expelled from the vagina after the amniotic sac has ruptured and contractions
have begun.

5. Which of the following statements regarding the placenta is correct?

A. The placenta allows oxygen, carbon dioxide, and other products to transfer between the mother and fetus but
does not allow blood to mix between the mother and fetus.
B. The placental barrier consists of two layers of cells and allows the mother’s blood that contains high
concentrations of oxygen to directly mix with the blood of the fetus.
C. The placenta, also referred to as the afterbirth, provides oxygen and nutrients to the fetus and is expelled
from the vagina about 30 minutes before the baby is born.
D. The placenta allows for the transfer of oxygen and carbon dioxide between the mother and fetus but
prevents most medications from passing between the mother and fetus.
6. The umbilical cord:
A. separates from the placenta shortly after birth.
B. carries blood away from the baby via the artery.
C. carries oxygen to the baby via the umbilical vein.
D. contains two veins and one large umbilical artery.

7. The amniotic fluid serves to:

A. transfer oxygen to the fetus.
B. insulate and protect the fetus.
C. remove viruses from the fetus.
D. assist in fetal development.

8. Most medical models base a pregnant woman’s due date:

A. two weeks after her last menstrual cycle.
B. on the last day of her last menstrual cycle.
C. two weeks before her last menstrual cycle.
D. on the first day of her last menstrual cycle.

9. By the 20th week of pregnancy, the uterus is typically at or above the level of the mother’s:
A. belly button.
B. pubic bone.
C. xiphoid process.
D. superior diaphragm.

10. Which of the following is a normal physiologic change that occurs in the mother’s respiratory system during
pregnancy?
A. decreased respiratory rate and increased minute volume
B. increased respiratory rate and decreased respiratory reserve
C. increased respiratory reserve and decreased oxygen demand
D. increased respiratory depth and decreased respiratory rate

11. Pregnant women are advised to take iron supplements, such as prenatal vitamins, because:
A. iron makes the blood clot faster, which protects the mother from excessive bleeding during delivery.
B. the blood naturally thins during pregnancy, which predisposes the mother to severe bleeding.
C. white blood cells decrease during pregnancy, which increases the mother’s risk of an infection.
D. pregnancy causes a decreased number of red blood cells, which predisposes the mother to anemia.

12. A mother who is pregnant with her first baby is typically in the first stage of labor for approximately:
A. 4 hours.
B. 8 hours.
C. 10 hours.
D. 16 hours.

13. The onset of labor begins with:

A. thinning of the uterus.
B. full dilation of the cervix.
C. increased fetal movement.
D. contractions of the uterus.

14. The term primigravida refers to a woman who:

A. has never been pregnant.
B. has had only one live birth.
C. is pregnant for the first time.
D. has had more than one live baby.

15. Which of the following occurs during true labor?

A. Uterine contractions decrease in intensity.
B. The uterus becomes very soft and movable.
C. Uterine contractions become more regular.
D. Uterine contractions last about 10 seconds.

16. Braxton-Hicks contractions are characterized by:

A. regular contractions of progressively increasing intensity.
B. alleviation of pain with movement or changing positions.
C. pink or red bloody show in conjunction with the contractions.
D. a rupture of the amniotic sac just before the contractions begin.

17. After the fetus has descended into the pelvis at the end of the third trimester, many mothers experience:
A. midback pain.
B. a bloated feeling.
C. an urge to push.
D. easier breathing.

18. The third stage of labor begins when the:

A. placenta is fully delivered.
B. cervix is completely dilated.
C. umbilical cord has been clamped.
D. baby is expelled from the vagina.

19. Preeclampsia MOST commonly occurs after the ____ week of gestation.
A. 12th
B. 20th
C. 24th
D. 30th

20. Signs and symptoms of preeclampsia include:

A. headache and edema.
B. marked hypoglycemia.
C. dyspnea and bradycardia.
D. dysuria and constipation.

21. Eclampsia is MOST accurately defined as:

A. high levels of protein in the patient’s urine.
B. hypertension in the 20th week of pregnancy.
C. seizures that result from severe hypertension.
D. a blood pressure greater than 140/90 mm Hg.

22. Supine hypotensive syndrome occurs when:

A. a supine position kinks the ascending aorta.
B. the pregnant uterus compresses the inferior vena cava.
C. the superior vena cava is compressed by the uterus.
D. blood pressure decreases as a result of hypovolemia.
23. A 33-year-old woman who is 36 weeks pregnant is experiencing scant vaginal bleeding. During transport,
you note that she suddenly becomes diaphoretic, tachycardic, and hypotensive. In addition to administering
100% oxygen, you should:
A. place her in a left lateral recumbent position.
B. position her supine and elevate her legs 12″.
C. carefully place sterile gauze into her vagina.
D. assist her ventilations with a bag-mask device.

24. The leading cause of maternal death during the first trimester of pregnancy is:
A. massive brain damage secondary to a prolonged seizure.
B. unrecognized or untreated supine hypotensive syndrome.
C. internal bleeding caused by a ruptured ectopic pregnancy.
D. blunt trauma to the abdomen during a motor vehicle crash.

25. A history of pelvic inflammatory disease or tubal ligations increases a woman’s risk for:
A. preeclampsia.
B. placenta previa.
C. gestational diabetes.
D. an ectopic pregnancy.

26. Abruptio placenta occurs when:

A. the placenta prematurely separates from the uterine wall.
B. a tear in the placenta causes severe internal hemorrhage.
C. the placenta affixes itself to the outer layer of the uterus.
D. the placenta develops over and covers the cervical opening.

27. Placenta previa is MOST accurately defined as:

A. delivery of a portion of the placenta before the baby.
B. premature placental separation from the uterine wall.
C. abnormal development and functioning of the placenta.
D. development of the placenta over the cervical opening.

28. Which of the following statements regarding gestational diabetes is correct?

A. Gestational diabetes results in permanent diabetes mellitus after delivery.
B. The onset of gestational diabetes typically manifests with hypoglycemia.
C. In some cases, women with gestational diabetes require insulin injections.
D. Diet and exercise are typically ineffective in controlling gestational diabetes.

29. A pregnant trauma patient may lose a significant amount of blood before showing signs of shock because:
A. pregnant patients can dramatically increase their heart rate.
B. pregnancy causes vasodilation and a lower blood pressure.
C. pregnant patients have an overall increase in blood volume.
D. blood is shunted to the uterus and fetus during major trauma.

30. If a pregnant patient requires spinal immobilization, you should secure her to the backboard and then:
A. tilt the board 30° to the right to prevent hypotension.
B. elevate the right side of the board with rolled towels or blankets.
C. raise the foot of the board 12″ in order to maintain blood pressure.
D. elevate the head of the board 6″ to prevent breathing impairment.

31. The presence of thick meconium in the amniotic fluid indicates:

A. an expected finding in full-term infants.
B. that the baby’s airway may be obstructed.
C. that the fetus is at least 4 weeks premature.
D. that full newborn resuscitation will be needed.

32. Which of the following questions is of LEAST pertinence when determining whether a mother will deliver
her baby within the next few minutes?
A. “When are you due?”
B. “Is this your first baby?”
C. “Have you had a sonogram?”
D. “Do you feel the urge to push?”

33. Which of the following is an indication of imminent birth?

A. rupture of the amniotic sac
B. crowning of the baby’s head
C. irregular contractions lasting 10 minutes
D. expulsion of the mucus plug from the vagina

34. You are assessing a 25-year-old woman who is 39 weeks pregnant. She is experiencing regular contractions
that are approximately 3 minutes apart and states that her amniotic sac broke 2 hours ago. After taking the
standard precautions, you should:
A. apply 100% oxygen.
B. place her on her left side.
C. assess her for crowning.
D. transport her immediately.

35. When preparing a pregnant patient for delivery, you should position her:
A. in a supine position with her legs spread.
B. on her left side with the right leg elevated.
C. in a sitting position with her hips elevated 12″.
D. on a firm surface with her hips elevated 2″ to 4″.

36. During delivery, it is MOST important to position your partner at the mother’s head because:
A. the mother may become nauseated and vomit.
B. the mother needs to be apprised of the situation.
C. she may need emotional support during the delivery.
D. mothers often need assisted ventilation during delivery.

37. A precipitous labor and delivery is MOST common in women who:

A. have gestational diabetes.
B. are younger than 30 years of age.
C. have delivered a baby before.
D. are pregnant for the first time.

38. When determining the frequency of contractions, you should time the contractions from the:
A. end of one to the start of the next.
B. start of one to the end of the next.
C. end of one to the end of the next.
D. start of one to the start of the next.

39. When the mother is experiencing a contraction, you should instruct her to:
A. hold her breath.
B. push for 30 seconds.
C. take quick short breaths.
D. rest and breathe deeply.

40. During delivery of the baby’s head, you should suction the mouth before the nose because:
A. suctioning the nose first may cause the baby to gasp and aspirate fluid.
B. it is easier to suction larger volumes of fluid from the baby’s oropharynx.
C. babies are primarily mouth breathers and do not breathe through their nose.
D. the mucosa of the nose is fragile and is easily damaged by vigorous suctioning.

41. During your visual inspection of a 19-year-old woman in labor, you see the baby’s head crowning at the
vaginal opening. What should you do?
A. Apply gentle pressure to the baby’s head as it delivers.
B. Tell the mother not to push and transport her immediately.
C. Place your fingers in the vagina to assess for a nuchal cord.
D. Maintain firm pressure to the head until it completely delivers.

42. Upon delivery of the baby’s head, you note that its face is encased in the unruptured amniotic sac. You
should:
A. give the mother 100% oxygen and transport at once.
B. puncture the sac and suction the baby’s mouth and nose.
C. leave the amniotic sac intact until arrival at the hospital.
D. note the color of the amniotic fluid before breaking the sac.

43. A nuchal cord is defined as an umbilical cord that:

A. has separated from the placenta.
B. is wrapped around the baby’s neck.
C. is lacerated due to a traumatic delivery.
D. has abnormally developed blood vessels.

44. Upon delivery of an infant’s head, you note that the umbilical cord is wrapped around its neck. You should:
A. immediately clamp and cut the umbilical cord.
B. give 100% oxygen to the mother and transport at once.
C. provide free-flow oxygen to the infant and transport.
D. attempt to slip the cord gently over the infant’s head.

45. After a baby is born, it is important to:

A. ensure that it is thoroughly dried and warmed.
B. position it so that its head is higher than its body.
C. cool the infant to stimulate effective breathing.
D. immediately clamp and cut the umbilical cord.

46. Following delivery of a full-term baby, you have properly cared for the baby and have clamped and cut the
umbilical cord. During transport, you note that the mother is experiencing moderate vaginal bleeding. You
should:
A. elevate her legs 6″ to 8″ and cover her with a blanket.
B. firmly massage the uterine fundus with a circular motion.
C. carefully insert a sterile trauma dressing into her vagina.
D. place her legs together and position her on her left side.

47. Which of the following is NOT generally considered an obstetrical emergency?

A. failure of the placenta to deliver after 30 minutes
B. significant bleeding after delivery of the placenta
C. return of contractions following delivery of the baby
D. more than 500 mL of blood loss before placental delivery

48. A newborn infant will usually begin breathing spontaneously within _______ seconds following birth.
A. 3 to 5
B. 5 to 10
C. 15 to 30
D. 30 to 60

49. Common interventions used to stimulate spontaneous respirations in the newborn include all of the
following, EXCEPT:
A. suctioning of the upper airway.
B. thorough drying with a towel.
C. positive-pressure ventilations.
D. some form of tactile stimulation.

50. If a newborn’s heart rate is less than 60 beats/min following delivery, you should:
A. flick the soles of its feet.
B. begin chest compressions.
C. re-suction the mouth only.
D. provide ventilations for 30 seconds.

51. Vigorous suctioning of a newborn’s airway is indicated if:

A. there is meconium in the amniotic fluid.
B. positive-pressure ventilations are indicated.
C. the newborn presents with labored breathing.
D. his or her heart rate is less than 60 beats/min.

52. You have just delivered a premature baby. Your assessment reveals that he is breathing adequately;
however, his heart rate is 90 beats/min. You should:
A. keep him warm and provide ventilatory assistance.
B. begin chest compressions and reassess in 30 seconds.
C. clamp and cut the umbilical cord and keep him warm.
D. assess his skin color and give free-flow oxygen as needed.

53. Which of the following is NOT a component of the Apgar score?

A. pulse
B. activity
C. grimace
D. body size

54. If a baby is born at 7:52, the second Apgar score should be calculated at:
A. 7:53.
B. 7:57.
C. 7:59.
D. 8:00.

55. You have just delivered a baby boy. His body is pink, but his hands and feet are blue. His heart rate is
approximately 110 beats/min and his respirations are rapid and irregular. He has a weak cry when
stimulated and resists attempts to straighten his legs. His Apgar score is:
A. 6
B. 7
C. 8
D. 9

56. You have just delivered a full-term infant. His respirations are rapid and irregular, and he has a strong cry.
What should you do next?
A. Allow the mother to hold her baby.
B. Clamp and cut the umbilical cord.
C. Assess the brachial or umbilical pulse.
D. Begin assisting the newborn’s breathing.

57. Which of the following statements regarding a breech presentation is MOST correct?
A. A breech presentation occurs when the buttocks are the presenting part.
B. There is minimal risk of trauma to the infant with a breech presentation.
C. It is impossible to deliver a breech presentation in the prehospital setting.
D. Breech deliveries occur rapidly, so the EMT should deliver at the scene.

58. Your 22-year-old patient is in active labor. Upon visual inspection, you note that the infant’s leg is
protruding from the vagina. Appropriate management of this situation includes:
A. placing the mother supine with her head down and pelvis elevated.
B. gently pulling on the infant’s leg in an attempt to facilitate delivery.
C. placing the mother in a recumbent position and rapidly transporting.
D. carefully attempting to push the infant’s leg off of the umbilical cord.

59. The ONLY indications for placing your gloved fingers in the vagina during delivery are:
A. breech presentation and prolapsed umbilical cord.
B. limb presentation and severe vaginal hemorrhage.
C. vertex presentation and delivery of the placenta.
D. nuchal cord and presentation of an arm or leg.

60. While examining a woman in labor, you see the umbilical cord protruding from the vagina. You should:
A. carefully push the cord back into the vagina.
B. push the infant’s head away from the cord.
C. cover the umbilical cord with a dry dressing.
D. gently pull on the cord to facilitate delivery.

61. Spina bifida is a developmental defect in which:

A. an excessive amount of cerebrospinal fluid damages the spinal cord.
B. nerve fibers that arise from the spinal cord do not function properly.
C. the spinal column is severely deformed, resulting in permanent paralysis.
D. a portion of the spinal cord or meninges protrudes outside of the vertebrae.

62. An abortion occurs when the fetus and placenta deliver before:
A. 20 weeks.
B. 24 weeks.
C. 26 weeks.
D. 28 weeks.

63. Which of the following statements regarding twins is correct?

A. Twins are typically larger than single infants.
B. Identical twins are typically of different gender.
C. Most twins are born within 45 minutes of each other.
D. Fraternal twins have two cords coming from one placenta.
64. Fetal complications associated with drug- or alcohol-addicted mothers include all of the following,
EXCEPT:
A. low birth weight.
B. profound tachycardia.
C. premature delivery.
D. respiratory depression.

65. An infant is considered to be premature if it:

A. is born before 38 weeks’ gestation or weighs less than 6 lb.
B. weighs less than 5.5 lb or is born before 37 weeks’ gestation.
C. is born before 40 weeks’ gestation or weighs less than 7 lb.
D. weighs less than 5 lb or is born before 36 weeks’ gestation.

66. In contrast to a full-term infant, a premature infant:

A. has an even proportionately larger head.
B. is often covered with excess vernix material.
C. is one who is born before 38 weeks’ gestation.
D. retains heat better because of excess body hair.

67. Following delivery of a pulseless and apneic infant who has a foul odor, skin sloughing, and diffuse
blistering, you should:
A. begin full resuscitation and transport.
B. report the case to the medical examiner.
C. provide emotional support to the mother.
D. dry the infant off to stimulate breathing.

68. General treatment guidelines when caring for a woman with traumatic vaginal bleeding include:
A. carefully removing impaled objects.
B. transporting to an appropriate facility.
C. packing the vagina with sterile dressings.
D. cleaning external wounds with sterile water.

CHAPTER 34: PEDIATRIC EMERGENCIES

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

A. neonatal period.
B. toddler period.
C. start of infancy.
D. premature phase.

2. Which of the following statements regarding a 3-month-old infant is correct?

A. The infant is unable to turn his or her head and focus.
B. The infant should be aroused easily from a sleeping state.
C. At this age, the infant typically sleeps for up to 8 hours a day.
D. A 3-month-old infant can distinguish a parent from a stranger.

3. A child may begin to show signs of separation anxiety as early as:

A. 6 months.
B. 12 months.
C. 18 months.
D. 24 months.
4. Unless he or she is critically ill or injured, you should generally begin your assessment of a toddler:
A. at the feet.
B. at the head.
C. in the ambulance.
D. en route to the hospital.

5. Which of the following statements regarding preschool-age children is correct?

A. They realize that injuries are not a form of punishment.
B. Preschoolers are usually not fearful of pain or separation.
C. The preschool age begins after the child turns 2 years old.
D. They can usually identify painful areas when questioned.

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

A. refrain from taking a blood pressure.
B. talk to the child, not just the caregiver.
C. use a toe-to-head assessment approach.
D. rely solely on the parent for information.

7. When assessing or treating an adolescent patient, it is important to remember that:

A. they usually do not wish to be observed during a procedure.
B. it is generally not necessary to explain procedures in advance.
C. they often request medication to help in the relief of severe pain.
D. they cannot understand complex concepts and treatment options.

8. Which of the following statements regarding a pediatric patient’s anatomy is correct?

A. The tracheal rings of a child are more rigid than an adult’s.
B. A child’s tongue is proportionately smaller than an adult’s.
C. Children have a larger, rounder occiput compared to adults.
D. The child’s epiglottis is less floppy and smaller than an adult’s.

9. The normal respiratory rate for a newborn should not exceed ______ breaths/min.
A. 50
B. 60
C. 70
D. 80

10. Compared to an adult, the diaphragm dictates the amount of air that a child inspires because the:
A. intercostal muscles are not well developed.
B. rib cage is rigid and provides little flexibility.
C. abdominal organs force the diaphragm upward.
D. upper airway is smaller and easily collapsible.

11. Pale skin in a child indicates that the:

A. child is in severe decompensated shock.
B. oxygen content in the blood is decreased.
C. blood vessels near the skin are constricted.
D. child’s core body temperature is elevated.

12. Signs of vasoconstriction in the infant or child include:

A. warm, dry skin.
B. weak distal pulses.
C. a rapid heart rate.
D. brisk capillary refill.

13. Which of the following statements regarding spinal injuries in pediatric patients is correct?
A. Because of a child’s proportionately large head, they are more prone to spinal cord injuries than adults.
B. The majority of cervical spine injuries in children are partial transections of the spinal cord, resulting in
partial paralysis.
C. Most cervical spine fractures in infants and children occur between the first and second cervical vertebrae.
D. If the cervical spine is injured, it is most likely to be an injury to the ligaments because of rapid movement
of the head.

14. Compared to adults, the liver and spleen of pediatric patients are more prone to injury and bleeding because
they are:
A. proportionately larger and situated more anteriorly.
B. more vascular despite the fact that they are proportionately smaller.
C. spaced further apart, which causes them to shift following trauma.
D. lower in the abdominal cavity, where the muscles are not as strong.

15. The suture of the anterior fontanelle is typically closed by _____ months of age, and the suture of the
posterior fontanelle is typically closed by _____ months of age.
A. 2, 4
B. 6, 12
C. 12, 4
D. 18, 6

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

A. determine if the child’s vital signs are within the age-appropriate limits.
B. allow you to rapidly and visually form a general impression of the child.
C. facilitate a rapid head-to-toe assessment of the child by visualization only.
D. gather critical data by performing a rapid hands-on assessment of the child.

17. The components of the PAT are:

A. appearance, work of breathing, and skin circulation.
B. mental status, heart rate, and systolic blood pressure.
C. skin condition, respiratory rate, and level of alertness.
D. activity, respiratory quality, and level of consciousness.

18. After using the PAT to form your general impression of a sick or injured child, you should:
A. evaluate the child’s baseline vital signs.
B. obtain a SAMPLE history from the parents.
C. perform a hands-on assessment of the ABCs.
D. assess the child’s heart rate and skin condition.

19. A normal level of consciousness in an infant or child is characterized by:

A. normal interactiveness, awareness to time, and pink skin color.
B. awareness to place, pink and dry skin, and consistent eye contact.
C. crying or combativeness, good muscle tone, and awareness to time.
D. age-appropriate behavior, good muscle tone, and good eye contact.
20. You are dispatched to a residence for a child with respiratory distress. The patient, an 18-month-old female,
is tachypneic, has sternal retractions, and is clinging to her mother. Her skin is pink and dry, and her heart
rate is 120 beats/min. The MOST appropriate treatment for this child includes:
A. requesting a paramedic ambulance to insert an advanced airway device.
B. separating the child from her mother and providing ventilatory assistance.
C. administering blow-by oxygen and transporting the child with her mother.
D. allowing the child to remain with her mother and applying a nasal cannula.

21. Early signs of respiratory distress in the pediatric patient include all of the following, EXCEPT:
A. cyanosis.
B. tachypnea.
C. retractions.
D. abnormal airway noise.

22. Before assessing the respiratory adequacy of an semiconscious infant or child, you must:
A. routinely suction the mouth to remove oral secretions.
B. ensure that the airway is patent and clear of obstructions.
C. insert a nasopharyngeal or oropharyngeal airway adjunct.
D. ensure that his or her head is in a hyperextended position.

23. You are dispatched to a local elementary school for an injured child. As you approach the child, you note
that he is lying at the base of the monkey bars. He is unresponsive and there are no signs of breathing. You
should:
A. begin immediate rescue breathing.
B. stabilize his head and check for a pulse.
C. perform a head tilt–chin lift maneuver.
D. open his airway and look in his mouth.

24. Before positioning an infant or child’s airway, you should:

A. put padding behind his or her head.
B. thoroughly suction his or her airway.
C. rule out an injury to the spinal cord.
D. place him or her on a firm surface.

25. To ensure that the airway of an infant or small child is correctly positioned, you may have to:
A. place bulky padding behind his or her occiput.
B. place a towel or folded sheet behind the shoulders.
C. slightly flex the neck to prevent tracheal kinking.
D. hyperextend the neck to ensure adequate alignment.

26. When assessing an infant’s ventilation status, you should:

A. observe the chest for rise and fall.
B. rule out hypoxia if cyanosis is absent.
C. palpate the abdomen for rise and fall.
D. give oxygen if the SpO2 is less than 90%.

27. All of the following are normal findings in an infant or child, EXCEPT:
A. quiet breathing.
B. fear or anxiety.
C. belly breathing.
D. head bobbing.
28. Drawing in of the muscles between the ribs or of the sternum during inspiration is called:
A. tenting.
B. retracting.
C. hyperpnea.
D. accessory muscle use.

29. A high-pitched inspiratory sound that indicates a partial upper airway obstruction is called:
A. stridor.
B. rhonchi.
C. grunting.
D. wheezing.

30. When assessing the heart rate of a 6-month-old infant, you should palpate the brachial pulse or ________
pulse.
A. radial
B. carotid
C. femoral
D. popliteal

31. After determining that an infant or child has strong central pulses, you should:
A. assume the child is hypertensive.
B. not rule out compensated shock.
C. conclude that the child is stable.
D. assess his or her respiratory effort.

32. After squeezing the end of a child’s finger or toe for a few seconds, blood should return to the area within:
A. 2 seconds.
B. 3 seconds.
C. 4 seconds.
D. 5 seconds.

33. Capillary refill time is MOST reliable as an indicator of end-organ perfusion in children younger than:
A. 4 years.
B. 6 years.
C. 8 years.
D. 10 years.

34. Immediate transport is indicated for a child when he or she:

A. is experiencing mild to moderate pain.
B. falls from a height greater than 5′.
C. has a possible closed fracture of the radius.
D. has a history suggestive of a serious illness.

35. You respond to a skate park where a 10-year-old male fell from his skateboard and struck his head on the
ground; he was not wearing a helmet. He is responsive to painful stimuli only and has a large hematoma to
the back of his head. After your partner stabilizes his head and opens his airway, you assess his breathing
and determine that it is slow and irregular. His pulse is slow and bounding. You should:
A. apply high-flow oxygen via a nonrebreathing mask, perform an in-depth secondary assessment, apply full
spinal precautions, and transport.
B. insert an oral airway, hyperventilate him with a bag-mask device, apply full spinal precautions, and
transport to the closest trauma center.
C. apply high-flow oxygen via a nonrebreathing mask, obtain baseline vital signs, apply full spinal precautions,
and perform a secondary assessment.
D. assist his ventilations, be prepared to suction his mouth if he vomits, apply full spinal precautions, and
prepare for immediate transport to a trauma center.

36. If the situation allows, a child should be transported in a car seat if he or she weighs less than _____ lb.
A. 40
B. 50
C. 60
D. 70

37. Which of the following inquiries should you make in private when obtaining a SAMPLE history from an
adolescent patient?
A. sexual activity
B. past medical history
C. change in bladder habits
D. duration of symptoms

38. The secondary assessment of a sick or injured child:

A. is a rapid head-to-toe exam to detect life threats.
B. should be performed, regardless of the circumstances.
C. may not be possible if the child’s condition is critical.
D. is most appropriate when your transport time is short.

39. Blood pressure is usually not assessed in children younger than _____ years.
A. 3
B. 4
C. 5
D. 6

40. Which of the following represents a low normal systolic blood pressure for a 6-year-old child?
A. 82 mm Hg
B. 88 mm Hg
C. 90 mm Hg
D. 98 mm Hg

41. Early signs of respiratory distress in the child include:

A. cyanosis.
B. bradycardia.
C. restlessness.
D. decreased LOC.

42. An infant or child with respiratory distress will attempt to keep his or her alveoli expanded at the end of
inhalation by:
A. grunting.
B. wheezing.
C. assuming a tripod position.
D. retracting the intercostal muscles.

43. The MOST ominous sign of impending cardiopulmonary arrest in infants and children is:
A. pallor.
B. retractions.
C. nasal flaring.
D. bradycardia.

44. A viral infection that may cause obstruction of the upper airway in a child is called:
A. croup.
B. asthma.
C. bronchitis.
D. epiglottitis.

45. Infection should be considered a possible cause of an airway obstruction in an infant or child, especially if
he or she presents with:
A. extreme restlessness.
B. drooling or congestion.
C. skin that is cool and dry.
D. acute respiratory distress.

46. Signs of an upper airway obstruction in an infant or child include all of the following, EXCEPT:
A. wheezing.
B. a weak cough.
C. a cough that resembles the bark of a seal.
D. stridorous breathing.

47. A 6-year-old male presents with acute respiratory distress. His mother states that she saw him put a small
toy into his mouth shortly before the episode began. The child is conscious, obviously frightened, and is
coughing forcefully. You should:
A. carefully look into his mouth and remove the object if you see it.
B. encourage him to cough, give oxygen as tolerated, and transport.
C. deliver a series of five back blows and then reassess his condition.
D. place the child in a supine position and perform abdominal thrusts.

48. Signs of a severe airway obstruction in an infant or child include:

A. pink, dry skin.
B. crying and anxiety.
C. an ineffective cough.
D. mild respiratory distress.

49. A child who has no recent history of illness suddenly appears cyanotic and cannot speak after playing with a
small toy. You should:
A. perform abdominal thrusts.
B. visualize the child’s airway.
C. perform a blind finger sweep.
D. give oxygen and transport at once.

50. An 8-year-old female with a history of asthma continues to experience severe respiratory distress despite
being given multiple doses of her prescribed albuterol by her mother. She is conscious, but clearly restless.
Her heart rate is 130 beats/min and her respiratory rate is 30 breaths/min. She is receiving high-flow oxygen
via a nonrebreathing mask. You should:
A. be prepared to assist her ventilations, transport at once, and request an ALS intercept en route to the
hospital.
B. continue high-flow oxygen therapy, contact medical control, and request permission to administer more
albuterol.
C. begin immediate ventilation assistance and ensure that you squeeze the bag forcefully in order to open her
bronchioles.
D. begin chest compressions if she becomes unresponsive and her heart rate falls below 80 beats/min.

51. The MOST efficient way to identify the appropriately sized equipment for a pediatric patient is to:
A. estimate the child’s weight based on age.
B. use a length-based resuscitation tape measure.
C. estimate the child’s weight based on appearance.
D. ask a relative if he or she knows the child’s weight.

52. An oropharyngeal airway should not be used in children who have ingested a caustic or petroleum-based
product because it may:
A. depress the gag reflex.
B. cause the child to vomit.
C. result in airway swelling.
D. result in a soft-tissue injury.

53. When inserting an oropharyngeal airway in an infant or child, you should:

A. place padding under the child’s head.
B. ensure that his or her neck is hyperextended.
C. insert it until the flange rests on the teeth.
D. depress the tongue with a tongue depressor.

54. Which of the following statements regarding the use of nasopharyngeal airways in children is correct?
A. They are rarely used in infants younger than 1 year.
B. It is the recommended adjunct for children with head trauma.
C. They are usually not well tolerated in children with a gag reflex.
D. Blanching of the nares after insertion indicates correct placement.

55. If a nasopharyngeal airway is too long, it may:

A. result in tachycardia.
B. push the tongue anteriorly.
C. stimulate the vagus nerve.
D. become obstructed by mucus.

56. Use of a nonrebreathing mask or nasal cannula in a child is appropriate ONLY if:
A. an oral airway has been inserted.
B. his or her tidal volume is adequate.
C. his or her respirations are shallow.
D. he or she is breathing inadequately.

57. Which of the following children would benefit the LEAST from a nonrebreathing mask?
A. a conscious 4-year-old male with adequate tidal volume
B. a responsive 6-year-old male who responds appropriately
C. an unresponsive 5-year-old male with shallow respirations
D. a semiconscious 7-year-old female with normal ventilation

58. When administering oxygen to a frightened child, it would be MOST appropriate to:
A. place oxygen tubing through a hole in a paper cup.
B. tightly secure the oxygen mask straps to the face.
C. have a parent restrain the child as you give oxygen.
D. use a nasal cannula instead of a nonrebreathing mask.
59. When ventilating a pediatric patient with a bag-mask device, the EMT should:
A. block the pop-off valve if needed to achieve adequate chest rise.
B. squeeze the bag 40 times/min when ventilating an infant.
C. ensure that he or she uses a neonatal device for children younger than 12 months.
D. ventilate the child with sharp, quick breaths at the appropriate rate.

60. The MOST accurate method for determining if you are delivering adequate tidal volume to a child during
bag-mask ventilations is to:
A. monitor the child’s heart rate.
B. observe the child’s skin color.
C. monitor the pulse oximeter reading.
D. observe the chest for adequate rise.

61. Cardiac arrest in the pediatric population is MOST commonly the result of:
A. a complete airway obstruction.
B. respiratory or circulatory failure.
C. a congenital cardiovascular defect.
D. lethal cardiac rhythm disturbances.

62. In contrast to adults, deterioration to cardiac arrest in infants and children is usually associated with:
A. irritability of the left ventricle.
B. a sudden ventricular arrhythmia.
C. severe hypoxia and bradycardia.
D. acute hypoxia and tachycardia.

63. A common cause of shock in an infant is:

A. a cardiac arrhythmia.
B. dehydration from vomiting and diarrhea.
C. excessive tachycardia.
D. cardiovascular disease.

64. Blood loss in a child exceeding _____ of his or her total blood volume significantly increases the risk of
shock.
A. 5%
B. 15%
C. 25%
D. 35%

65. Which of the following is the LEAST reliable assessment parameter to evaluate when determining the
presence of shock in infants and children?
A. heart rate
B. blood pressure
C. skin condition
D. capillary refill

66. Common causes of seizures in children include all of the following, EXCEPT:
A. infection.
B. hyperglycemia.
C. electrolyte imbalances.
D. poisonings or ingestion.
67. Febrile seizures are MOST common in children between:
A. 3 months and 4 years.
B. 6 months and 6 years.
C. 8 months and 8 years.
D. 18 months and 10 years.

68. In most children, febrile seizures are characterized by:

A. a blank stare, a duration of between 15 and 30 minutes, and a prolonged postictal phase.
B. unresponsiveness, complete body relaxation, a fever greater than 105°F, and a short postictal phase.
C. generalized tonic-clonic activity, a duration of less than 15 minutes, and a short or absent postictal phase.
D. isolated tonic-clonic activity, a duration of greater than 15 minutes, and a short postictal phase.

69. Febrile seizures in a child:

A. typically last less than 30 minutes.
B. occur after a week of a febrile illness.
C. are usually caused by viral meningitis.
D. may indicate a serious underlying illness.

70. A 2-year-old female has experienced a seizure. When you arrive at the scene, the child is conscious, crying,
and clinging to her mother. Her skin is hot and moist. The mother tells you that the seizure lasted
approximately 5 minutes. She further tells you that her daughter has no history of seizures, but has had a
recent ear infection. You should:
A. allow the mother to drive her daughter to the hospital.
B. attempt cooling measures, offer oxygen, and transport.
C. place the child in cold water to attempt to reduce her fever.
D. suspect that the child has meningitis and transport at once.

71. Which of the following groups of people is associated with the lowest risk of meningitis?
A. newborns
B. females
C. geriatrics
D. children with shunts

72. Signs and symptoms of meningitis in the infant or child include all of the following, EXCEPT:
A. sunken fontanelles.
B. headache and fever.
C. a stiff or painful neck.
D. an altered mental status.

73. Children with N meningitides would MOST likely present with:

A. cherry-red spots or a purplish rash.
B. a low-grade fever and tachycardia.
C. hypothermia and an irregular pulse.
D. a generalized rash with intense itching.

74. The signs and symptoms of poisoning in children:

A. vary widely, depending on the child’s age and weight.
B. are more obvious than in the adult population.
C. usually present within the first 10 minutes of ingestion.
D. are most severe if the child ingested a poisonous substance.
75. When questioning the parent of a child who ingested a poisonous substance, which of the following
questions would be of LEAST pertinence?
A. What time did the ingestion occur?
B. Have you noticed any signs or symptoms?
C. Why did your child ingest the poison?
D. Do you know what substance was ingested?

76. A 4-year-old female ingested an unknown quantity of liquid drain cleaner. Your assessment reveals that she
is conscious and alert, is breathing adequately, and has skin burns around her mouth. You should:
A. place her supine and elevate her legs.
B. monitor her airway and give oxygen.
C. determine why the ingestion occurred.
D. give 12.5 to 25 g of activated charcoal.

77. Which of the following is the MOST appropriate dose of activated charcoal for a 20-kg child?
A. 12.5 g
B. 20 g
C. 25 g
D. 50 g

78. The MOST common cause of dehydration in pediatric patients is:

A. high fever.
B. internal blood loss.
C. vomiting and diarrhea.
D. refusal to drink fluids.

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

A. excessive tearing.
B. moist oral mucosa.
C. bulging fontanelles.
D. absent urine output.

80. Signs of severe dehydration in an infant include all of the following, EXCEPT:
A. profound tachycardia.
B. slowed level of activity.
C. delayed capillary refill.
D. dry mucous membranes.

81. A 6-month-old male presents with 2 days of vomiting and diarrhea. He is conscious, but his level of activity
is decreased. The infant’s mother tells you that he has not had a soiled diaper in over 12 hours. The infant’s
heart rate is 140 beats/min and his anterior fontanelle appears to be slightly sunken. You should suspect:
A. mild dehydration.
B. moderate dehydration.
C. severe dehydration.
D. hypovolemic shock.

82. The EMT should be MOST concerned when a child presents with fever and:
A. chills.
B. a rash.
C. ear pain.
D. a headache.
83. Hyperthermia differs from fever in that it is an increase in body temperature:
A. of more than 2°F to 3°F per hour.
B. secondary to a severe bacterial infection.
C. caused by inflammation of the spinal cord.
D. caused by the inability of the body to cool itself.

84. Submersion injuries in the adolescent age group are MOST commonly associated with:
A. alcohol.
B. child abuse.
C. hyperthermia.
D. swimming pools.

85. Which of the following statements regarding pediatric trauma is correct?

A. Children are less likely than adults to be struck by a car.
B. A child’s head is less frequently injured than an adult’s.
C. Children are more likely to experience diving-related injuries.
D. Inexperience and poor judgment are rare causes of pediatric trauma.

86. When a child is struck by a car, the area of greatest injury depends MOSTLY on the:
A. speed at which the car was traveling when impact occurred.
B. size of the child and the height of the bumper upon impact.
C. age of the child and the size of the car that struck him or her.
D. height of the child and the speed at which the car was traveling.

87. Which of the following is MORE common in children than in adults following a head injury?
A. spinal cord injury
B. loss of consciousness
C. seizures and hypoxia
D. nausea and vomiting

88. When immobilizing an injured child in a pediatric immobilization device, you should:
A. secure the head before the torso.
B. slide the device under the child.
C. pad underneath the child’s head.
D. secure the torso before the head.

89. Padding underneath the torso when immobilizing an injured child is generally not necessary if he or she is:
A. older than 8 to 10 years.
B. complaining of severe back pain.
C. immobilized on a long backboard.
D. experiencing cardiopulmonary arrest.

90. The pediatric patient should be removed from his or her car seat and secured to an appropriate spinal
immobilization device if:
A. the car seat is visibly damaged.
B. he or she has no visible injuries.
C. his or her vital signs are stable.
D. he or she even has a minor injury.

91. When a child experiences a blunt chest injury:

A. the flexible rib cage protects the vital thoracic organs.
B. the flexible ribs can be compressed without breaking.
C. the sudden force against the ribs causes them to fracture.
D. there is usually obvious injury to the external chest wall.

92. When a child experiences a blunt injury to the abdomen:

A. he or she can compensate for blood loss better than adults.
B. his or her blood pressure falls with as little as 5% blood loss.
C. your assessment will most often reveal bruising to the abdomen.
D. delayed capillary refill indicates a state of decompensated shock.

93. Burns in children are commonly caused by all of the following, EXCEPT:
A. hot items on a stovetop.
B. scalding water in a bathtub.
C. exposure to caustic chemicals.
D. entrapment in a structural fire.

94. Critical burns in children include:

A. any superficial or partial-thickness burn that involves the legs or arms.
B. partial-thickness burns covering more than 20% of the body surface.
C. second-degree burns covering more than 10% of the body surface.
D. superficial burns covering more than 10% to 15% of the body surface.

95. Greenstick fractures occur in infants and children because:

A. the growth plate is commonly injured.
B. their bones are more brittle than an adult’s.
C. their bones bend more easily than an adult’s.
D. twisting injuries are more common in children.

96. Effective methods for providing pain relief to a child with an extremity injury include:
A. separating the child from his or her parents.
B. positioning, ice packs, and emotional support.
C. avoiding the placement of a splint, if possible.
D. heat compresses and lowering the injured extremity.

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

A. evidence of alcohol consumption or drug use at the scene
B. burns to the hands or feet that involve a glove distribution
C. consistency in the method of injury reported by the caregiver
D. an unexplained delay in seeking medical care after the injury

98. Bruising to the _________ is LEAST suggestive of child abuse.

A. shins
B. back
C. face
D. buttocks

99. Death caused by shaken baby syndrome is usually the result of:
A. bleeding in the brain.
B. multiple open fractures.
C. intra-abdominal hemorrhage.
D. fracture of the cervical spine.
100. With regard to the legal implications of child abuse:
A. child abuse must be reported only if it can be proven.
B. EMTs must report all suspected cases of child abuse.
C. you should document your perceptions on the run form.
D. a supervisor can forbid you from reporting possible abuse.

101. When caring for a female child who has possibly been sexually abused, you should:
A. encourage the child to urinate and take a shower.
B. have a female EMT remain with her if possible.
C. carefully examine the genitalia for signs of injury.
D. immediately report your suspicions to the parents.

102. Which of the following statements regarding sudden infant death syndrome (SIDS) is correct?
A. Certain cases of SIDS are predictable and therefore preventable.
B. SIDS is most commonly the result of an overwhelming infection.
C. Most cases of SIDS occur in infants younger than 6 months.
D. The cause of death following SIDS can be established by autopsy.

103. Which of the following is NOT a known risk factor of SIDS?

A. mother younger than 20 years
B. low birth weight
C. putting a baby to sleep on his or her back
D. mother smoked during pregnancy

104. Causes of infant death that may be mistaken for SIDS include all of the following, EXCEPT:
A. child abuse.
B. meningitis.
C. severe infection.
D. hyperglycemia.

105. During the attempted resuscitation of an infant with suspected SIDS:

A. discourage the family from observing.
B. allow the family to observe if they wish.
C. a law enforcement officer must be present.
D. give detailed updates to the infant’s parents.

CHAPTER 35: GERIATRIC EMERGENCIES

1. To minimize distractions and confusion when assessing an older patient, you should:
A. dismiss the family members from the room or area.
B. have only one EMT speak to the patient at a time.
C. elevate your voice and speak directly to the patient.
D. perform a physical exam and then talk to the patient.

2. General communication techniques with the elderly include:

A. using medical terms to ensure patient understanding.
B. explaining procedures while you are performing them.
C. frequently asking the patient if he or she understands.
D. having at least two EMTs talk to the patient at a time.

3. When explaining the need for a particular procedure to an elderly patient, you should:
A. use plain language and simple terms.
B. use the appropriate medical terminology.
C. be complex so the patient fully understands.
D. realize that he or she will not understand you.

4. Talking about an elderly patient in front of him or her to other members of the family:
A. often causes the patient to become paranoid and untrusting of your help.
B. may cause the patient to think that he or she has no say in making decisions.
C. will anger the patient and result in his or her refusal to accept care or transport.
D. is usually beneficial because the patient’s cognitive skills are typically impaired.

5. Which of the following statements regarding communications with the elderly is correct?
A. The majority of elderly patients are hearing or visually impaired.
B. Attempt to calm the elderly patient by using his or her first name.
C. Explain the justification for a procedure after it has been completed.
D. Older patients have difficulty understanding when they are stressed.

6. Sedentary behavior while healing from a hip fracture would MOST likely predispose the older patient to:
A. pneumonia.
B. osteoporosis.
C. heart failure.
D. ischemic stroke.

7. The leading cause of death in the geriatric patient is:

A. hypertension.
B. altered mental status.
C. arthritis.
D. heart disease.

8. When caring for a geriatric patient with a traumatic injury, it is important to consider that:
A. geriatric patients usually present with little to no pain.
B. decreased bone density often results in incomplete fractures.
C. the injury may have been preceded by a medical condition.
D. geriatric patients typically present with classic signs of shock.

9. Because of the complexity of the older patient and the vagueness of his or her complaint, you should:
A. limit your physical examination to the area of pain or injury.
B. rely exclusively on family members for the medical history.
C. attempt to differentiate between chronic and acute problems.
D. perform a rapid assessment on all geriatric patients you treat.

10. When transporting a stable older patient to the hospital, the MOST effective way to reduce his or her
anxiety is to:
A. allow at least two family members to accompany the patient.
B. transport him or her to a hospital that he or she is familiar with.
C. avoid the use of a long backboard, even if trauma is suspected.
D. perform frequent detailed assessments to gain the patient’s trust.

11. An elderly patient may understate or minimize the symptoms of his or her illness because:
A. the nervous system has deteriorated.
B. of decreased perception of pain.
C. of conditions such as dementia.
D. he or she fears hospitalization.
12. Which of the following statements regarding a decreased level of consciousness in the elderly patient is
correct?
A. A decreased level of consciousness is not a normal part of the aging process.
B. Most elderly patients have some deterioration in their level of consciousness.
C. A decreased level of consciousness is most often the result of chronic dementia.
D. The AVPU scale is an ineffective tool when assessing an elderly patient’s level of consciousness.

13. You are dispatched to a skilled nursing care facility for an 80-year-old female with abnormal behavior. The
patient is clearly confused and asks you if you are her husband. As your partner administers oxygen to the
patient, you should:
A. determine the patient’s baseline mental status.
B. inquire about a history of Alzheimer disease.
C. obtain a complete list of the patient’s medications.
D. ask an attendant for the patient’s medical records.

14. A 69-year-old female was involved in a motor vehicle crash. She is semiconscious with a blood pressure of
80/50 mm Hg and a heart rate of 74 beats/min that is weak. Her daughter, who was uninjured in the crash,
tells you that her mother has a history of hypertension and takes beta-blockers. Considering the fact that this
patient is probably in shock, what is the MOST likely explanation for the absence of tachycardia?
A. deterioration of the cardiac conduction system
B. intrathoracic bleeding and cardiac compression
C. the effects of her antihypertensive medication
D. failure of the parasympathetic nervous system

15. The purpose of the GEMS diamond is to:

A. help EMS personnel remember what is different about elderly patients.
B. provide the EMT with a standard format for assessing elderly patients.
C. replace the typical ABC approach to patient care when caring for the elderly.
D. provide clues about an elderly patient’s problem by observing his or her home.

16. Upon entering the residence of a geriatric patient with a medical or trauma complaint, the EMT should:
A. immediately seek out a family member or other caregiver.
B. observe for conditions that may make the residence unsafe.
C. begin his or her assessment after gathering any medication bottles.
D. talk to the patient after performing his or her primary assessment.

17. Which of the following observations or statements represents the “E” in the GEMS diamond?
A. Elderly patients present atypically and deserve your respect.
B. The patient’s residence is cold due to a malfunctioning heater.
C. A patient is assisted with his or her activities of daily living.
D. The patient’s medications have not been filled in 2 months.

18. Findings during the social assessment of an older patient include all of the following, EXCEPT:
A. interaction with others.
B. daily activity assistance.
C. outdated medications.
D. delays in obtaining meals.

19. Which of the following statements regarding the aging process is correct?
A. Aging is a linear process; the rate at which a person loses functions does not increase with age.
B. Because he or she is younger and healthier, a 35-year-old person ages slower than a 75-year-old person.
C. Human growth and development peaks in the late 40s or early 50s, at which point the aging process sets in.
D. The older a person gets, the slower the decline in the function of vital organs, such as the kidneys and liver.

20. During the natural process of aging, the number of functional cilia in the respiratory system decreases,
resulting in:
A. a decreased ability to cough.
B. baseline respiratory distress.
C. an increased risk of COPD.
D. air-trapping within the alveoli.

21. A productive cough, fever, and chills in an 80-year-old patient with a compromised immune system should
make you MOST suspicious for:
A. heart failure.
B. bronchitis.
C. emphysema.
D. pneumonia.

22. An older patient with significant dehydration would MOST likely present with:
A. an increase in blood pressure upon standing.
B. dizziness or fainting upon standing.
C. weakness to one side of the body.
D. a drop in heart rate upon standing.

23. Which of the following patients is at highest risk for a pulmonary embolism?
A. 59-year-old male who is recovering from pneumonia
B. 66-year-old active female with a history of hypertension
C. 71-year-old male with recent surgery to a lower extremity
D. 78-year-old female who takes blood thinning medications

24. In contrast to younger patients, older patients are more prone to a decrease in blood pressure upon standing
because:
A. their red blood cells are destroyed at a faster than normal rate.
B. the aging process results in an overall increase in blood volume.
C. the baroreceptors have become less sensitive to blood pressure.
D. any change in position causes blood to be shunted to the brain.

25. A “silent” heart attack occurs when:

A. sweating is the only presentation.
B. the usual chest pain is not present.
C. a sudden dysrhythmia causes death.
D. the patient minimizes the chest pain.

26. The EMT should suspect left-sided heart failure in the geriatric patient who presents with:
A. fever and a cough that produces green sputum.
B. tachypnea and paroxysmal nocturnal dyspnea.
C. jugular venous distention and peripheral edema.
D. swelling of the lower extremities and weakness.

27. When assessing a 78-year-old female who complains of shortness of breath, the EMT should:
A. give oxygen only if the patient has labored breathing.
B. conclude that the patient is experiencing a heart attack.
C. ask her how many pillows she uses when she sleeps.
D. place the patient supine to see if the problem worsens.
28. When assessing a geriatric patient who has possibly experienced an acute ischemic stroke, it is MOST
important to:
A. determine the onset of the patient’s symptoms.
B. ascertain about a history of atrial fibrillation.
C. administer 324 mg of aspirin as soon as possible.
D. determine if the patient has risk factors for a stroke.

29. A 10% to 20% reduction in brain weight and volume would MOST likely increase an older person’s risk
for:
A. stroke.
B. delirium.
C. dementia.
D. head trauma.

30. Clouding of the lenses of the eyes is called:

A. retinitis.
B. cataracts.
C. glaucoma.
D. conjunctivitis.

31. When caring for an elderly patient who is hearing-impaired, you should:
A. speak directly into his or her ear with an elevated tone.
B. remember that most hearing-impaired patients can read lips.
C. request that he or she communicates with you by writing on paper.
D. recall that elderly patients have difficulty hearing high-frequency sounds.

32. The slow onset of progressive disorientation, shortened attention span, and loss of cognitive function is
known as:
A. delirium.
B. delusion.
C. paranoia.
D. dementia.

33. In contrast to delirium, dementia:

A. is usually considered irreversible.
B. is the result of an acute condition.
C. is reversible with certain treatment.
D. often develops over a period of days.

34. 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:
A. because of her age and medical history, you should suspect Alzheimer disease.
B. the patient is experiencing delirious behavior, which suggests a new health problem.
C. her mental status is likely the result of hypoglycemia and you should give her sugar.
D. dementia typically presents as an acute onset of deterioration of cognitive function.

35. Causes of delirium in the older patient include all of the following, EXCEPT:
A. acute hypovolemia.
B. Alzheimer disease.
C. low blood sugar level.
D. decreased cerebral perfusion.

36. Syncope in the older patient is:

A. caused by an interruption of blood flow to the brain.
B. generally of no concern unless the patient was injured.
C. most commonly caused by a silent myocardial infarction.
D. rarely life threatening but should be evaluated by a physician.

37. Motor nerve neuropathy is characterized by:

A. numbness, tingling, and severe muscle pain.
B. loss of bladder control and sensitivity to touch.
C. loss of balance, muscle weakness, and spasms.
D. constipation, low blood pressure, and bradycardia.

38. Common causes of syncope in older patients include all of the following, EXCEPT:
A. venous pooling.
B. vasoconstriction.
C. acute hypotension.
D. blood volume loss.

39. An abdominal aortic aneurysm:

A. is usually not repairable, even if discovered early.
B. causes dull pain that often radiates to the shoulders.
C. is often the result of hypertension and atherosclerosis.
D. can sometimes be palpated as a mass in the groin area.

40. A 73-year-old female experienced a syncopal episode while watching TV. She is now conscious, but is
diaphoretic, tachycardic, and hypotensive. Your assessment reveals abdominal tenderness and a pulsating
mass to the left of her umbilicus. You should be MOST suspicious for:
A. an aortic aneurysm.
B. acute appendicitis.
C. a strangulated bowel.
D. myocardial infarction.

41. 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 level is
450 mg/dL. 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:
A. diabetic ketoacidosis.
B. hyperglycemia with moderate dehydration.
C. hyperosmolar hyperglycemic nonketotic coma (HHNC).
D. acute renal failure with associated hyperglycemia.

42. The stooped posture of some older people, which gives them a humpback appearance, is called:
A. kyphosis.
B. arthritis.
C. scoliosis.
D. miosis.

43. Osteoporosis is MOST accurately defined as:

A. increased flexibility of bone mass.
B. decreased bone marrow production.
C. a decrease in bone mass and density.
D. an abnormality near the growth plate.

44. The chief component of connective tissues and bones that deteriorates as people age is called:
A. fibrin.
B. elastin.
C. sebum.
D. collagen.

45. Blood levels of medications may rise in the elderly, sometimes to toxic levels. This is MOST likely due to:
A. pancreatic failure.
B. renal insufficiency.
C. intentional overdose.
D. splenic dysfunction.

46. When an elderly patient presents you with multiple over-the-counter medications that he or she is taking, it
is MOST important to:
A. recall that the patient is at risk for negative medication interactions.
B. ask the patient to explain what each of the medications is used for.
C. look up all of the medications before providing care to the patient.
D. contact each of the physicians whose names are on the medications.

47. The use of multiple prescription drugs by a single patient, causing the potential for negative effects such as
overdosing or drug interaction, is called:
A. potentiation.
B. polypharmacy.
C. drug tolerance.
D. drug dependency.

48. Common causes of depression in the elderly include all of the following, EXCEPT:
A. chronic medical conditions.
B. prescription medication use.
C. an acute onset of dementia.
D. alcohol abuse and dependence.

49. Which of the following statements regarding suicide in the older patient is correct?
A. Older patients tend to use more lethal means than younger patients.
B. Older females have a higher rate of suicide than any other group.
C. Depression and hopeless feelings are often not predisposing factors.
D. Most suicidal patients readily seek care and do not deny the problem.

50. Which of the following is the MOST common mechanism of injury in older patients?
A. falls
B. burns
C. abuse
D. suicide

51. When performing your secondary assessment on an older patient who has been injured, it is important to:
A. routinely perform a focused exam to minimize time at the scene.
B. perform an in-depth physical exam prior to initiating any treatment.
C. recall that it will take a less severe mechanism of injury to cause significant injuries.
D. focus your assessment just on the area(s) of pain or obvious injury.

52. Upon arriving at the residence of an elderly female who apparently fainted, you find the patient lying supine
on her living room floor. She is not moving and her eyes are closed. A neighbor tells you that she found the
patient this way, but did not move her. When you gently tap the patient, she does not respond. You should:
A. suction her airway, apply a cervical collar, administer high-flow oxygen via a nonrebreathing mask, and
perform a rapid assessment.
B. open her airway with the head tilt–chin lift maneuver, insert an oral or nasal airway, and assess her blood
glucose level to rule out hypoglycemia.
C. direct your partner to manually stabilize her head while you quickly visualize her chest for signs of
breathing.
D. begin assisting her ventilations with a bag-mask device while your partner auscultates her lung sounds to
ensure adequate positive-pressure ventilation.

53. When immobilizing a patient with a kyphotic spine to a long backboard, the EMT would MOST likely have
to:
A. force the head into a neutral alignment.
B. place blankets behind the patient’s head.
C. secure the patient’s head before the torso.
D. use a scoop stretcher instead of a log roll.

54. You are dispatched to a residence for an 80-year-old female who fell. When you arrive, you find the patient
conscious, lying in a recumbent position on the floor in her living room. In addition to providing the
appropriate treatment, you should ask the patient if:
A. she became dizzy or fainted before falling.
B. she attempted to catch herself before falling.
C. a family member regularly checks up on her.
D. she takes medications for Alzheimer disease.

55. An older woman with osteoporosis presents with pain and deformity to her left hip after she shifted her
weight onto her other foot. She has MOST likely experienced a(n):
A. pathologic fracture.
B. idiopathic fracture.
C. compression fracture.
D. comminuted fracture.

56. Fractures of the pelvis in older patients often occur as the result of a combination of:
A. osteoporosis and low-energy trauma.
B. increased bone density and car crashes.
C. arthritic joints and high-energy trauma.
D. acetabular separation and severe falls.

57. With age, the spine stiffens as a result of shrinkage of the intervertebral disc spaces, and the vertebrae
become brittle. This increases the risk of:
A. severe kyphosis.
B. distracting injuries.
C. spinal cord tearing.
D. compression fractures.

58. You receive a call for a sick person. When you arrive, you find the patient, a 75-year-old male, lying
unresponsive in his bed. His respirations are slow and irregular and his pulse is slow and weak. His daughter
tells you that he fell the day before, but refused to allow her to call 9-1-1. His past medical history is
 significant for hypothyroidism, deep vein thrombosis, heavy alcohol use, and liver cirrhosis. His
medications include blood thinners and vitamins. You should be MOST suspicious that this patient is
experiencing:
A. acute hyperglycemia.
B. a subdural hematoma.
C. acute ischemic stroke.
D. diabetic ketoacidosis.

59. Patients who have experienced even minor-appearing head injuries should be suspected of having a brain
injury, especially if they:
A. have minor abrasions to the head area.
B. are taking blood-thinning medications.
C. do not have deformities to the skull.
D. have a history of Alzheimer disease.

60. 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):
A. statute of care.
B. power of attorney.
C. physician directive.
D. advance directive.

61. In contrast to a living will, a “do not resuscitate” (DNR) order becomes valid when:
A. the patient has a terminal illness.
B. the patient develops cardiac arrest.
C. the patient is in a health care setting.
D. it is signed by three or more physicians.

62. When faced with a situation in which an older patient with a terminal illness is in cardiac arrest, but written
documentation regarding the patient’s wishes cannot be located, the EMT should:
A. try to locate the documentation.
B. attempt to resuscitate the patient.
C. allow the patient to die in peace.
D. contact medical control for advice.

63. Which of the following is NOT a reason why the exact extent and prevalence of elder abuse is unknown?
A. It has been largely hidden from society.
B. The definitions of abuse and neglect vary.
C. Human resource agencies fail to investigate.
D. Victims of elder abuse are hesitant to report it.

64. Poor maintenance of home, poor personal care, and dietary neglect are all possible indicators of
____________ elder abuse.
A. physical
B. financial
C. emotional
D. psychological

65. Many older victims of physical abuse may make false statements or lie about the origin of their injuries
because:
A. they are protective of the abuser.
B. they do not want to be bothersome.
C. most elderly patients have dementia.
D. they fear retribution from the abuser.

66. When assessing an older patient who has multiple bruises in various stages of healing, the EMT should do
all of the following, EXCEPT:
A. factually document all findings.
B. accuse a caregiver of physical abuse.
C. ask the patient how the bruises occurred.
D. review the patient’s activities of daily living.

67. When documenting a case of suspected elder abuse, it is MOST important for the EMT to:
A. theorize as to why the patient was abused.
B. document his or her perceptions of the event.
C. list the names of all of the suspected abusers.
D. avoid documenting any unsupported opinions.

CHAPTER 36: PATIENTS WITH SPECIAL CHALLENGES

1. Which of the following statements regarding patients with developmental disabilities is correct?
A. Speaking with the patient’s family is the least effective way to determine how much the patient understands.
B. Patients with developmental disabilities are susceptible to the same disease processes as other patients.
C. A developmental disability differs from mental retardation in that it is the result of a congenital abnormality.
D. Most patients with developmental disabilities have normal cognitive function, but abnormal physical
features.

2. Autism is MOST accurately defined as a:

A. psychiatric condition related to an imbalance of serotonin in the brain.
B. mental disability caused by insufficient cognitive development of the brain.
C. congenital condition caused by factors such as malnutrition or birth complications.
D. pervasive developmental disorder characterized by impairment of social interaction.

3. Patients with autism:

A. have extreme difficulty with complex tasks that require many steps.
B. prefer to maintain eye contact with whomever is talking with them.
C. often speak with speech patterns that alternate in tone and speed.
D. use and understand nonverbal means of communicating messages.

4. Which of the following statements regarding autism is correct?

A. Autism affects females four times greater than males.
B. The majority of patients with autism do not speak at all.
C. Most cases of autism are diagnosed by 3 years of age.
D. Impairment of motor activity is a classic sign of autism.

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

A. an extra pair of chromosomes.
B. a separation of chromosome 21.
C. a triplication of chromosome 21.
D. a sperm that contains 24 chromosomes.

6. Characteristic anatomic features of Down syndrome include:

A. a proportionately small tongue.
B. a round head with a flat occiput.
C. bulging eyes and a large face.
D. long hands with wide fingers.

7. Two thirds of children born with Down syndrome have:

A. diabetes mellitus.
B. intracranial bleeding.
C. unilateral paralysis.
D. congenital heart disease.

8. Airway management can be challenging in patients with Down syndrome because their:
A. teeth are misaligned and they have a large tongue.
B. occiput is round, which causes flexion of the neck.
C. tongue is relatively small and falls back in the throat.
D. mandible is large, which inhibits a mask-to-face seal.

9. You respond to a residence for a 9-year-old female with Down syndrome who is sick. When you arrive at
the scene and assess the patient, you determine that she is unresponsive and has gurgling respirations. You
should:
A. insert an oropharyngeal airway and begin assisting her ventilations with a bag-mask device.
B. open her airway with the jaw-thrust maneuver and assess the rate and depth of her breathing.
C. immediately apply high-flow oxygen via a nonrebreathing mask and then assess her pulse rate.
D. open her airway with a manual maneuver, suction her oropharynx, and insert a simple airway adjunct.

10. When interacting with a developmentally disabled patient, the best approach is to:
A. speak primarily with the patient’s family to establish the degree of disability.
B. approach the patient as a team to reassure him or her that you are there to help.
C. ask your team members to wait until you can establish a rapport with the patient.
D. position yourself slightly above the patient’s level to reduce his or her anxiety.

11. When assessing or providing care to a patient with a developmental disability, you should:
A. explain procedures while in the process of performing them.
B. be observant for signs of fear or reluctance from the patient.
C. move swiftly and deliberately to quickly accomplish the task.
D. frequently reassure him or her that everything will be okay.

12. An important aspect in the assessment of a patient who experienced a previous brain injury involves:
A. presuming that he or she has cognitive impairment until proven otherwise.
B. contacting the patient’s physician to determine the extent of the brain injury.
C. recalling that most patients with a brain injury have other organ dysfunction.
D. speaking with the patient and family to establish what is considered normal for the patient.

13. A service dog is easily identified by its:

A. size.
B. breed.
C. color.
D. harness.

14. When caring for a patient who is visually impaired, it is important to:
A. allow a service dog to remain with the patient at all times, even if the patient is critically ill.
B. stand to the side of the patient when speaking if his or her peripheral vision is impaired.
C. leave items such as canes and walkers at the residence if the patient will be carried on a gurney.
D. tell him or her what is happening, identify noises, and describe the situation and surroundings.
15. Which of the following conditions would MOST likely cause a patient to slur words, speak very slowly, or
speak in a monotone?
A. advanced age
B. cerebral palsy
C. Parkinson disease
D. visual impairment

16. In contrast to conductive hearing loss, sensorineural hearing loss is caused by:
A. barotrauma.
B. nerve damage.
C. earwax accumulation.
D. eardrum perforation.

17. 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?
A. attempting to use body language to determine the problem
B. using a piece of paper and writing utensil to ask questions
C. using a high-pitched voice while speaking directly into the ear
D. contacting dispatch and requesting a sign language interpreter

18. General techniques for communicating with hearing-impaired patients include:

A. exaggerating your lip movements to ensure the patient understands.
B. speaking directly into the patient’s ear with an increased voice pitch.
C. removing any hearing aids and using pen and paper to ask questions.
D. positioning yourself approximately 18″ directly in front of the patient.

19. Because hearing-impaired patients typically have more difficulty hearing high-frequency sounds, it is
important for you to:
A. try basic sign language first.
B. speak in a monotone voice.
C. lower the pitch of your voice.
D. increase the pitch of your voice.

20. When enlisting the help of an interpreter who signs, it is important for you to ask the interpreter to:
A. report exactly what the patient signs and not to add any commentary.
B. voice what he or she is signing while communicating with the patient.
C. document the answers to the questions that the patient has responded to.
D. avoid any kind of lip movement while he or she is signing with the patient.

21. By placing one hand on top of your head and the other hand over your abdomen, you are asking a hearing-
impaired patient if he or she:
A. is hurt.
B. is sick.
C. needs help.
D. is nauseated.

22. Which of the following statements regarding hearing aids is correct?

A. Over time, hearing aids can restore normal hearing.
B. In-the-canal hearing aids fit in the outer part of the ear.
C. Hearing aids cannot restore hearing to normal levels.
D. A whistling sound indicates correct hearing aid placement.
23. 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:
A. recognize that the batteries in his hearing aids are probably depleted.
B. remove his hearing aids, turn up the volume, and replace them in his ears.
C. try repositioning the hearing aid or remove it and turn down the volume.
D. remove both of his hearing aids and use pencil and paper to communicate.

24. Cerebral palsy is characterized by poorly controlled ________ movement.

A. eye
B. neck
C. body
D. extremity

25. Cerebral palsy is a condition that results from damage or injury to the:
A. brain.
B. spinal cord.
C. voluntary muscles.
D. peripheral nervous system.

26. Which of the following statements regarding cerebral palsy is correct?

A. Conditions such as brain injury at birth, postpartum infections, and fetal hypoxia can cause cerebral palsy.
B. Most cases of cerebral palsy develop within the first 10 years of life and are typically caused by meningitis.
C. Approximately 25% of patients with cerebral palsy possess some varying degrees of developmental delay.
D. A key clinical feature of cerebral palsy is paralysis of the respiratory muscles, which confines the patient to
a ventilator.

27. A significant number of patients with cerebral palsy also have:

A. paralysis.
B. brain tumors.
C. type 2 diabetes.
D. a seizure disorder.

28. When caring for patients with cerebral palsy, it is important to remember that:
A. they are unable to walk and are totally dependent upon you.
B. their limbs are often underdeveloped and are prone to injury.
C. hearing aids are usually ineffective for patients with hearing loss.
D. most patients have the ability to walk, but have an unsteady gait.

29. Spina bifida is MOST accurately defined as:

A. congenital inflammation of the spinal cord, usually in the neck.
B. a birth defect caused by incomplete closure of the spinal column.
C. a birth defect in which the child is born without spinal vertebrae.
D. chronic pressure on the brain caused by excess cerebrospinal fluid.

30. Common associated conditions in patients with spina bifida include all of the following, EXCEPT:
A. hydrocephalus.
B. spastic limb movement.
C. extreme latex allergy.
D. loss of bladder control.

31. A tube from the brain to the abdomen that drains excessive cerebrospinal fluid is called a:
A. shunt.
B. G-tube.
C. CS tube.
D. cerebral bypass.

32. Which of the following does NOT usually contribute to or cause obesity?
A. rapid metabolism
B. high caloric intake
C. low metabolic rate
D. genetic predisposition

33. A person is said to be obese when he or she is ________ over his or her ideal weight.
A. 5% to 10%
B. 10% to 15%
C. 20% to 30%
D. 40% to 50%

34. When caring for a morbidly obese patient, you should:

A. leave him or her in a supine position, as this often facilitates breathing.
B. ask the patient if he or she knows what led to his or her obesity problem.
C. call for ALS backup because obese patients are at high risk for heart attack.
D. establish his or her chief complaint and then communicate your plan to help.

35. 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:
A. avoid placing him in a supine position if possible and administer oxygen.
B. notify the receiving facility and advise them of the patient’s weight and status.
C. perform a secondary assessment, focusing on his respiratory system and back.
D. ask a member of your team to locate the best route to move him to the ambulance.

36. Because a tracheostomy tube bypasses the nose and mouth:

A. secretions can build up in and around the tube.
B. the risk of a local infection is significantly high.
C. bleeding or air leakage may occur around the tube.
D. severe swelling of the trachea and bronchi can occur.

37. 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?
A. Look for blood or other secretions in the tube.
B. Attempt to pass a suction catheter into the tube.
C. Check the mechanical ventilator for malfunction.
D. Listen to breath sounds to assess for a pneumothorax.

38. General care for a patient with a tracheostomy tube includes all of the following, EXCEPT:
A. ensuring adequate oxygenation and ventilation at all times.
B. removing the tube if the area around it appears to be infected.
C. suctioning the tube as needed to clear a thick mucous plug.
D. maintaining the patient in a position of comfort when possible.

39. If suctioning of the tracheostomy tube is necessary, the EMT should:

A. attach a bag-mask device to the tracheostomy tube and hyperventilate the patient for 2 minutes.
B. instill 20 mL of saline into the tracheostomy tube and suction for no longer than 20 seconds.
C. attempt to use the patient’s suction device first because it is probably already sized correctly.
D. insert the suction catheter to a depth of no more than 15-cm and set the suction unit to 140 mm Hg.

40. A 13-year-old child is on a home ventilator. The parents called because the ventilator is malfunctioning and
the child has increasing respiratory distress. You should:
A. attempt to troubleshoot the ventilator problem.
B. disconnect the ventilator and use a bag-mask device.
C. place a call to the home health agency treating this patient.
D. reset the ventilator by unplugging it for 30 to 60 seconds.

41. You receive a call to a residence for an apneic 2-month-old male. When you arrive at the scene, the infant’s
mother tells you that her son was born prematurely and that his apnea monitor has alarmed 4 times in the
past 30 minutes. Your assessment of the infant reveals that he is conscious and active. His skin is pink and
dry, and he is breathing at an adequate rate and with adequate tidal depth. His oxygen saturation reads 98%
on room air. You should:
A. request an ALS ambulance to transport the infant to the hospital.
B. advise the mother to observe her son and call 9-1-1 again if necessary.
C. administer high-flow oxygen and observe for a drop in oxygen saturation.
D. transport the infant to the hospital and bring the apnea monitor with you.

42. In contrast to an automated implanted cardioverter/defibrillator, an internal cardiac pacemaker:

A. regulates the patient’s heart rate if it falls below a preset value.
B. delivers a shock to the heart if the rate becomes exceedingly fast.
C. is implanted under the skin in the left upper abdominal quadrant.
D. will only activate if it detects rhythms such as ventricular fibrillation.

43. Under what circumstances is a left ventricular assist device used?

A. to permanently replace the function of one or both of the ventricles
B. as a bridge to heart transplantation while a donor heart is being located
C. to reduce ventricular pumping force in patients with aortic aneurysms
D. to ensure that the ventricles contract at an adequate and consistent rate

44. The tip of a central venous catheter rests in the:

A. vena cava.
B. left atrium.
C. right ventricle.
D. pulmonary vein.

45. Common complications associated with central venous catheters include all of the following, EXCEPT:
A. a local infection.
B. clotting of the line.
C. bleeding around the line.
D. rupture of a central vein.

46. Which of the following statements regarding gastrostomy (gastric) tubes is correct?
A. Gastrostomy tubes are placed directly into the small intestine.
B. Most gastrostomy tubes are temporary and are not sutured in place.
C. Patients with a gastrostomy tube may still be at risk for aspiration.
D. Gastrostomy tubes are used for patients who cannot digest food.
47. For which of the following conditions would you MOST likely encounter a ventricular peritoneum shunt?
A. heart failure
B. hydrocephalus
C. cerebral palsy
D. subdural hematoma

48. The purpose of a ventricular peritoneum shunt is to:

A. divert excess cerebrospinal fluid to the ventricles of the brain.
B. monitor pressure within the skull in patients with a head injury.
C. remove fluid from the abdomen of patients with right heart failure.
D. prevent excess cerebrospinal fluid from accumulating in the brain.

49. Vagal nerve stimulators may be an alternative treatment to medication for patients with:
A. chronic seizure disorders.
B. inherently slow heart rates.
C. certain psychiatric conditions.
D. chronic muscle pain and fatigue.

50. 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):
A. colostomy.
B. gastrostomy.
C. gastric stoma.
D. intestinal shunt.

51. Which of the following statements regarding interaction with the caregiver of a child or adult with special
health care needs is correct?
A. In most cases, it is more appropriate for the EMT to contact medical control prior to speaking with the
patient’s primary caregiver.
B. Before performing an assessment of the patient’s ABCs, the EMT should ask the caregiver about the
patient’s medical condition.
C. 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.
D. Communication with the patient’s caregiver or family members is important because they are the most
familiar with the patient’s condition.

52. EMS personnel would MOST likely be called to the residence of a patient receiving home health care when
the home care provider:
A. needs simple assistance in providing patient care.
B. must confirm that a specific intervention is required.
C. has recognized a change in the patient’s health status.
D. has a question that is specific to the patient’s condition.

53. According to the Emergency Medical Treatment and Active Labor Act (EMTALA):
A. all health care facilities are legally obligated to provide assessment and care only if the patient is critically ill
or injured.
B. all health care facilities must provide a medical assessment and required treatment, regardless of the
patient’s ability to pay.
C. 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.
D. a patient maintains the legal right to recant his or her consent to emergency treatment, even after signing in
to the emergency department.

CHAPTER 37: TRANSPORT OPERATIONS

1. A type _____ ambulance features a conventional, truck cab-chassis with a modular ambulance body that can
be transferred to a newer chassis as needed.
A. I
B. II
C. III
D. IV

2. The six-pointed Star of Life® emblem identifies vehicles that:

A. are staffed by a minimum of one certified advanced EMT (AEMT).
B. meet federal specifications as licensed or certified ambulances.
C. are equipped with supplies to manage a mass-casualty situation.
D. have complied with state regulations for ambulance certification.

3. Phases of an ambulance call include all of the following activities, EXCEPT:

A. emergency care provided at the scene.
B. transport of the patient to the hospital.
C. checking equipment on the ambulance.
D. transferring the patient to the ambulance.

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

A. as directed by the EMS system’s medical director.
B. according to the urgency and frequency of their use.
C. based on recommendations of the health department.
D. in locked or secured cabinets in order to prevent theft.

5. Other than personal safety equipment, which of the following should be the MOST readily accessible item
in the back of an ambulance?
A. emergency childbirth kit
B. stethoscope and penlight
C. pneumatic antishock garment (PASG) and traction splint
D. bleeding control supplies

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

A. oral glucose
B. vacuum splint
C. snake bite kit
D. bronchodilator

7. Minimum airway and ventilation equipment that should be carried on every ambulance include all of the
following, EXCEPT:
A. various sizes of oral and nasal airways.
B. Combitubes or laryngeal mask airways.
C. mounted and portable suctioning units.
D. adult and pediatric bag-mask devices.

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

A. inside the jump kit.
B. near the side or rear door.
C. in the driver’s compartment.
D. on the ambulance stretcher.

9. Portable and mounted suction units must be powerful enough to generate a vacuum of at least ____ mm Hg
when the tubing is clamped.
A. 100
B. 200
C. 300
D. 400

10. A portable oxygen cylinder should have a capacity of a minimum of ____ of oxygen.
A. 250 L
B. 500 L
C. 750 L
D. 1,000 L

11. Regardless of where portable and mounted oxygen cylinders are stored in the ambulance, they must:
A. undergo hydrostatic testing on a weekly basis.
B. hold a minimum capacity of 1,500 L of oxygen.
C. be easily identifiable by their bright green color.
D. be capable of delivering oxygen at 1 to 15 L/min.

12. A disposable oxygen humidifier should be considered for ambulance services that often transport patients on
runs longer than:
A. 1 hour.
B. 2 hours.
C. 3 hours.
D. 4 hours.

13. Which of the following items would MOST likely require special protocols in order to be carried on the
ambulance?
A. PASG
B. pediatric nonrebreathing masks
C. automated external defibrillator (AED)
D. devices for restraining a patient

14. The purpose of a jump kit is to:

A. facilitate defibrillation within 5 to 10 minutes after making patient contact.
B. manage a critically injured patient until he or she is loaded into the ambulance.
C. carry advanced life support equipment approved by the EMS medical director.
D. contain anything that you might need during the first 5 minutes of patient care.

15. Common safety equipment carried on the ambulance includes all of the following, EXCEPT:
A. face shields.
B. hazardous materials gear.
C. safety goggles.
D. turnout gear.

16. When working at the scene of a motor vehicle crash at night, you should NOT use:
A. road flares.
B. reflective vests.
C. portable floodlights.
D. intermittent flashing devices.

17. Minimum staffing in the patient compartment of a basic life support (BLS) ambulance includes:
A. at least one EMT.
B. at least two EMTs.
C. an EMT and a paramedic.
D. an EMT and an AEMT.

18. For every emergency request, the dispatcher should routinely gather and record all of the following
information, EXCEPT the:
A. nature of the call.
B. caller’s phone number.
C. location of the patient(s).
D. patient’s medical history.

19. Common activities that occur while you and your partner are en route to the scene of an emergency call
include all of the following, EXCEPT:
A. assigning tasks to each member of the response team.
B. obtaining additional information from the dispatcher.
C. apprising the medical director of the nature of the call.
D. fastening your seatbelts before the ambulance departs.

20. Immediately upon arriving at the scene of an emergency call involving a traumatic injury, you should notify
the dispatcher of your arrival and then:
A. quickly gain access to the patient.
B. observe the scene for safety hazards.
C. determine if additional units are needed.
D. carefully assess the mechanism of injury.

21. When parking your ambulance at the scene of a motor vehicle crash, you should position the ambulance:
A. 50′ past the scene on the opposite side of the road.
B. 100′ past the scene on the same side of the road.
C. 50′ before the scene on the same side of the road.
D. alongside the scene to rapidly access the patient(s).

22. 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:
A. park downhill from the scene.
B. ask the driver to exit the vehicle.
C. position the ambulance upwind.
D. quickly gain access to the patient.

23. The main objective of traffic control at the scene of a motor vehicle crash is to:
A. warn oncoming traffic and prevent another crash.
B. facilitate a route for the media to access the scene.
C. prevent curious onlookers from observing the scene.
D. get oncoming traffic past the scene as soon as possible.

24. When transporting a patient to the hospital, you should:

A. generally exceed the posted speed limit by 10 to 20 mph.
B. place the patient on a long backboard, even if no trauma is involved.
C. secure the patient to the ambulance stretcher with at least two straps.
D. be safe and get the patient to the hospital in the shortest practical time.

25. When transporting a patient who is secured to a backboard, it is important to:

A. place deceleration straps over the patient’s shoulders.
B. routinely elevate the head of the backboard 12″.
C. use at least eight straps to secure the patient to the board.
D. place a folded towel or blanket under his or her head.

26. During the transport phase of an ambulance call, it is MOST important to:
A. reassess the patient only if he or she deteriorates.
B. reassess unstable patients at least every 15 minutes.
C. converse with the patient and provide reassurance.
D. complete the run form before arrival at the hospital.

27. Delivering a patient to the hospital involves all of the following activities, EXCEPT:
A. completing a detailed written report.
B. informing the dispatcher of your arrival.
C. restocking any disposable items you used.
D. giving a verbal report to the triage clerk.

28. As soon as you leave the hospital and are en route back to your station, you should inform the dispatcher:
A. whether you are back in service.
B. that you are prepared for another call.
C. of the name of the accepting physician.
D. about the patient’s clinical condition.

29. 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:
A. proceed to the call, functioning only as an emergency medical responder.
B. advise the dispatcher that you are out of service and to send another unit.
C. have your partner quickly clean the ambulance as you proceed to the call.
D. quickly proceed to the call and clean and restock the ambulance afterwards.

30. The process of removing dirt, dust, blood, or other visible contaminants from a surface or equipment is
called:
A. cleaning.
B. disinfection.
C. sterilization.
D. high-level disinfection.

31. Upon returning to your station following a run, you should disinfect the ambulance as needed. Disinfection
is MOST accurately defined as:
A. using heat as a means of removing all microbial contaminants.
B. killing pathogenic agents with a chemical made for that purpose.
C. removing dirt, dust, blood, or other grossly visible contaminants.
D. destroying pathogenic agents by using potent disinfection means.

32. Characteristics of a safe ambulance operator include:

A. the ability to operate an ambulance at a high rate of speed.
B. a positive attitude about the ability to tolerate other drivers.
C. realizing that lights and siren will be effective traffic tools.
D. an offensive attitude about driving during an emergency call.

33. When driving an ambulance on a multilane highway in emergency mode, you should:
A. pass other drivers on the right side.
B. remain in the extreme left-hand lane.
C. remain in the extreme right-hand lane.
D. drive in the center lane of the highway.

34. After assessing your patient, you determine that his condition is stable. You provide the appropriate
treatment and then load him into the ambulance. While en route to the hospital, you should:
A. turn your emergency lights off and obey all traffic laws.
B. keep your emergency lights on but avoid using the siren.
C. use your lights and siren but drive slowly and defensively.
D. drive slowly and remain in the far left-hand lane, if possible.

35. General guidelines for safe ambulance driving include all of the following, EXCEPT:
A. avoiding one-way streets whenever possible.
B. assuming that other drivers will not see you.
C. regularly using the siren as much as possible.
D. avoiding routes with heavy traffic congestion.

36. Upon arriving at the scene of a major motor vehicle crash at night, you find that the safest place to park your
ambulance is in a direction that is facing oncoming traffic. You should:
A. turn your headlights off.
B. quickly access the patient.
C. place a flare near the crash.
D. turn all warning lights off.

37. Aggressive ambulance driving may have a negative effect on other motorists because:
A. they may become enraged and attempt to run you off the road.
B. they move to the right or drive as close to the curb as possible.
C. it may not allow for their reaction time to respond to your vehicle.
D. they often freeze when they see the lights in the rearview mirror.

38. You are en route to an emergency call when you approach a slow-moving vehicle on a two-way road. You
can see oncoming traffic in the other lane. The driver has his windows up and does not realize that you are
behind him. You should:
A. use your public address (PA) system to alert the driver.
B. quickly pass the vehicle on the left side.
C. pass the driver on the right-hand shoulder.
D. remain at a safe distance until it is safe to pass.

39. Maintaining a cushion of safety when operating an ambulance means:

A. remaining in the far right-hand lane when transporting a critical patient and refraining from passing other
motorists on the left side.
B. driving at the posted speed limit, regardless of the patient’s condition, and routinely using your lights and
siren when driving on a freeway.
C. 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.
D. keeping a safe distance between your ambulance and the vehicles in front of you and remaining aware of
vehicles potentially hiding in your mirror’s blind spots.

40. When being tailgated by another vehicle while responding to an emergency call, you should:
A. slow down and allow the driver to pass you.
B. increase your speed to create more distance.
C. slam on the brakes to frighten the tailgater.
D. stop the ambulance and confront the driver.

41. If you properly assess and stabilize a patient at the scene, driving to the hospital with excessive speed:
A. is allowable according to state law.
B. will decrease the driver’s reaction time.
C. is often necessary if the patient is critical.
D. increases the patient’s chance for survival.

42. The use of lights and siren on an ambulance:

A. signifies a request for other drivers to yield the right of way.
B. legally gives the emergency vehicle operator the right of way.
C. allows other drivers to hear and see you from a great distance.
D. is required any time a patient is being transported to the hospital.

43. Hydroplaning of the ambulance on wet roads would MOST likely occur at speeds of greater than _____
mph.
A. 10
B. 15
C. 20
D. 30

44. If hydroplaning of the ambulance occurs, the driver should:

A. slowly move the steering wheel back and forth.
B. gradually slow down without jamming on the brakes.
C. slowly pump the brakes until he or she regains vehicle control.
D. quickly jerk the steering wheel.

45. While using lights and siren, most state laws permit an ambulance to:
A. disregard all traffic control signals.
B. drive as fast as the department allows.
C. carefully exceed the posted speed limit.
D. proceed through red lights without stopping.

46. 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:
A. pass the bus only after all the children have exited.
B. back up and take an alternate route to the scene.
C. slowly and carefully pass the bus on the left side.
D. stop and wait until the warning lights stop flashing.

47. Which of the following statements regarding the use of the warning lights and siren on the ambulance is
correct?
A. If it is necessary to use the siren, you should tell the patient beforehand.
B. If the patient is stable, you may use the warning lights without the siren.
C. Warning lights and siren should be avoided, even if the patient is unstable.
D. It is generally acceptable to increase your speed if lights and siren are in use.

48. You are dispatched to a residence for a patient with chest pain; however, you are unfamiliar with the address
and cannot find the location in your map book. A nearby police officer radios you and tells you that he
knows how to get to the scene. You should:
A. ask the dispatcher to call the residence and obtain driving directions.
B. turn off your lights and carefully follow the police officer to the scene.
C. follow the police officer in emergency mode until you get near the scene.
D. keep your lights on and ask the police officer to guide you to the scene.

49. The MOST common and usually the most serious ambulance crashes occur at:
A. stop signs.
B. stop lights.
C. intersections.
D. railroad crossings.

50. Your unit and a fire department vehicle are responding to the scene of a patient in cardiac arrest. As you
approach an intersection that is highly congested, you should:
A. turn off your lights and siren and proceed with safety.
B. advise the fire department vehicle to follow you closely.
C. use a different siren tone than the fire department vehicle.
D. ask the fire department vehicle to remain 1,000′ behind you.

51. In general, medivac helicopters should be utilized when:

A. ground transport would leave your service area without an ambulance for greater than 30 minutes.
B. ground transport to the hospital exceeds 30 to 45 minutes, even if the patient’s present condition is stable.
C. a patient has been in cardiac arrest for more than 15 minutes and has not responded to CPR and
defibrillation.
D. a patient has a time-dependent injury or illness and traffic conditions would cause a significant delay in
definitive care.

52. It is 10:30 pm and you have requested air medical transport for a critically injured patient. When you arrive
at the designated landing zone, you should:
A. mark the proposed landing area with road flares.
B. survey the area for power lines or other hazards.
C. provide the flight crew with a patient status update.
D. mark the landing site using personnel with flashlights.

53. When approaching a helicopter, whether the rotor blades are moving or not, you should:
A. never duck under the body or the tail boom because the pilot cannot see you in these areas.
B. remember that the main rotor blade is flexible and can dip as low as 5′ to 6′ from the ground.
C. carefully approach the aircraft from the rear unless a crew member instructs you to do otherwise.
D. approach the aircraft from the side because this will make it easier for you to access the aircraft doors.

54. When a helicopter must land on a grade (uneven ground), you should:
A. approach the aircraft from the uphill side.
B. approach the aircraft from the downhill side.
C. attempt to approach the aircraft from behind.
D. move the patient to the aircraft as soon as it lands.

55. Typically medivac helicopters fly between:

A. 100 and 120 mph.
B. 120 and 140 mph.
C. 130 and 150 mph.
D. 150 and 200 mph.

CHAPTER 38: VEHICLE EXTRICATION AND SPECIAL RESCUE

1. Extrication is MOST accurately defined as:

A. using heavy equipment to access a patient.
B. dismantling an automobile to remove a victim.
C. removal from a dangerous situation or position.
D. immobilizing a patient before moving him or her.

2. Your primary concern when arriving at the scene of a motor vehicle crash is:
A. gaining access to the patient(s).
B. requesting additional resources.
C. immediately beginning triage.
D. surveying the area for hazards.

3. The scene size-up at a motor vehicle crash or other incident:

A. is an ongoing process until the incident is terminated.
B. should be performed by the most experienced EMT.
C. is a quick visual assessment of the scene prior to entry.
D. determines who is allowed to safely enter the hot zone.

4. Situational awareness is MOST accurately defined as:

A. an ongoing process of information gathering and scene evaluation to determine appropriate strategies and
tactics.
B. the ability to recognize any possible issues once you arrive at the scene and act proactively to avoid a
negative impact.
C. predicting the presence of certain hazards at the scene after receiving initial information from the dispatcher.
D. performing an initial scan of the scene in order to identify hazards that will pose an immediate threat to you
and your crew.

5. 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:
A. begin triage to determine injury severity.
B. call medical control for further direction.
C. immediately request additional resources.
D. request law enforcement for traffic control.

6. In order to evaluate hazards present at the scene and determine the number of patients, you should:
A. request the fire department at all scenes.
B. perform a 360° walk-around of the scene.
C. use the information provided by dispatch.
D. interview bystanders present at the scene.

7. 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:
A. only if the patient has experienced a major injury.
B. after rescue personnel have cut the battery cables.
C. after receiving approval from the extrication officer.
D. only after you believe the vehicle has been stabilized.
8. _____________ is defined as the ability to reach the patient.
A. Access
B. Rescue
C. Extrication
D. Disentanglement

9. Which of the following is a typical function of the rescue team?

A. initial triage and patient prioritization
B. shutting off power to downed electrical lines
C. providing safe entry and access to patients
D. providing emergency care during extrication

10. Common duties and responsibilities of EMS personnel at the scene of a motor vehicle crash include all of
the following, EXCEPT:
A. keeping bystanders at a safe distance.
B. assigning all patients a triage category.
C. preparing all patients for transportation.
D. continual assessment of critical patients.

11. A unique consideration when dealing with a hybrid vehicle is that:

A. you must locate the ignition switch and cut it to prevent a fire.
B. cutting the battery cables often results in an explosion or fire.
C. rescue teams should disconnect the positive battery cable first.
D. the battery has higher amperes than a traditional vehicle battery.

12. 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:
A. ensure that she is in a safe area, away from the scene.
B. allow her to observe the extrication and keep her calm.
C. ask her follow-up questions about the crash.
D. allow her to talk to her husband during the extrication.

13. When determining the exact location and position of the patient(s) in a wrecked vehicle, you and your team
should routinely consider all of the following, EXCEPT:
A. the position of the crashed vehicle.
B. hazards that pose a risk to rescuers.
C. the make and model of the vehicle.
D. the possibility of vehicle instability.

14. Which of the following statements regarding the rapid extrication technique is correct?
A. The only indication for performing a rapid extrication is if the patient is not entrapped and is in cardiac
arrest.
B. Rapid extrication involves the use of heavy equipment to disentangle a patient from his or her crashed
vehicle.
C. It involves rapidly removing a patient from his or her vehicle after immobilizing him or her with a short
backboard.
D. The rapid extrication technique is indicated if the scene is unsafe and the patient is not entrapped in his or
her vehicle.

15. Which of the following is the BEST example of gaining simple access to a patient?
A. using a pry bar to open a damaged door
B. entering a vehicle through an open window
C. breaking glass to gain access to the patient
D. removing the roof to access a critical patient

16. You are attempting to gain access to a patient who was injured when his truck struck another vehicle from
behind. The patient is conscious and alert, but is screaming in pain. You try to open the door, but it is
locked. You should:
A. break the window and unlock the door.
B. ask the patient if he can unlock the door.
C. request the rescue team to extricate him.
D. use a pry bar to attempt to open the door.

17. In contrast to simple access, complex access:

A. involves forcible entry into a vehicle.
B. is a skill commonly taught to EMTs.
C. does not involve the breaking of glass.
D. often involves simply unlocking a door.

18. Once entrance and access to the patient have been provided, you should:
A. allow extrication to commence.
B. perform a primary assessment.
C. administer high-flow oxygen.
D. begin treating his or her injuries.

19. A 50-year-old female is entrapped in her passenger car after it struck a tree. As the rescue team is preparing
to extricate her, you quickly assess her and determine that she is breathing shallowly and that her radial
pulse is absent. You should:
A. maintain spinal stabilization as she is extricated.
B. secure her with a short backboard or vest device.
C. stabilize her condition before extrication begins.
D. begin CPR as the rescue team begins extrication.

20. A 19-year-old female has just been extricated from her severely damaged car. She is on a long backboard
and has been moved to a place of safety. As your partner maintains manual stabilization of her head, you
perform a rapid assessment. The patient is unconscious, has slow and shallow respirations, and has
bilaterally closed femur deformities. You should:
A. stabilize her legs with the pneumatic antishock garment (PASG).
B. apply 100% oxygen via a nonrebreathing mask.
C. obtain baseline vital signs and transport at once.
D. direct your partner to begin ventilatory assistance.

21. Disentanglement involves:

A. removing a patient from a dangerous position.
B. the use of simple access tools such as a pry bar.
C. extrication techniques that EMTs are trained in.
D. gaining access to a patient in a crashed vehicle.

22. A 33-year-old restrained driver of a motor vehicle crash is awake and alert, complaining only of neck pain.
The vehicle is stable and no hazards are present. When removing this patient from his vehicle, you should:
A. use the rapid extrication technique.
B. immobilize him with a vest-style device.
C. maintain slight traction to his neck area.
D. adequately secure him to a long backboard.

23. As you and your team are removing an unconscious patient from her wrecked car, you note that she has
closed deformities to both of her legs and a deformity to her left humerus. You should:
A. realign the deformed extremities before continuing.
B. splint the deformities before moving her any further.
C. support the injured extremities and continue removal.
D. assess distal neurovascular functions in her extremities.

24. When removing a critically injured patient from his or her vehicle, you should:
A. remove him or her using a short backboard.
B. move him or her in one fast, continuous step.
C. protect the cervical spine during the entire process.
D. release c-spine control to facilitate rapid removal.

25. Which of the following situations would require the use of a specialized rescue team?
A. a patient trapped in a cave or a confined space
B. a patient in a badly damaged car, not entrapped
C. an obese patient who must be moved to the ambulance
D. a patient found floating facedown in a swimming pool

26. If a technical rescue team is required at the scene, but is not present when you arrive, you should:
A. don personal protective equipment and begin the rescue process.
B. check with the incident commander to ensure that the team is en route.
C. remain with your ambulance until the rescue team arrives at the scene.
D. have fire personnel initiate the rescue process if they are at the scene.

27. A hiker was injured when he fell approximately 20′ from a cliff. When you arrive at the scene, a member of
the technical rescue group escorts you to the patient, who is positioned on a steep incline. The MOST
appropriate method of immobilizing and moving the patient to the ambulance is to:
A. immobilize his spine with a long backboard and place him in a basket stretcher.
B. immobilize him to a long backboard and use the four-person carry to move him.
C. apply a vest-style immobilization device and move him using a stair chair device.
D. immobilize him with a short backboard and place him on the ambulance stretcher.

28. The EMT’s role at the scene of a search and rescue attempt is to:
A. accompany search team members and provide care.
B. reassure the family members of the missing person.
C. report to a location where the patient will be carried.
D. stand by at the command post until the person is located.

29. Trench collapses usually involve large areas of falling dirt that weigh approximately _______ per cubic
foot.
A. 50 lb
B. 100 lb
C. 150 lb
D. 200 lb

30. Which of the following statements regarding trench rescue is correct?

A. Rescue vehicles should park at least 250′ from the scene.
B. Ground vibration is a primary cause of secondary collapse.
C. A trench deeper than 10′ should be shored prior to entry.
D. Most deaths involving cave-ins are caused by head injury.

31. You are standing by at the scene of a hostage situation when the incident commander advises you that one
of his personnel has been shot. The patient is lying supine in an open area and is not moving. As the SWAT
team escorts you to the patient, you should:
A. limit your primary assessment to airway and breathing only.
B. treat only critical injuries before moving him to a safe place.
C. grab him by the clothes and immediately move him to safety.
D. perform a rapid assessment and move him to a place of safety.

32. Upon arriving at the scene of a law enforcement tactical situation, you should ensure your own safety and
then:
A. begin immediate triage of any injured personnel.
B. report to the incident commander for instructions.
C. locate all injured personnel and begin treatment.
D. apprise medical control of the tactical situation.

33. The reasons for rescue failure can be referred to by the mnemonic FAILURE. According to this mnemonic,
the “U” stands for:
A. underutilizing personnel at the scene.
B. unprepared to effectively manage the scene.
C. underestimating the logistics of the incident.
D. undertrained to correctly utilize equipment.

34. Your unit has been dispatched to stand by at the scene of a structure fire. There are no injuries of which you
are aware. Upon arriving at the scene, you should:
A. contact medical control and apprise him or her of the situation.
B. park your ambulance behind the incident commander’s vehicle.
C. set up a staging area where fire fighters can be treated if necessary.
D. ask the incident commander where the ambulance should be staged.

35. You and your partner are standing by at the scene of a residential fire when you hear the incident
commander state “We have located a victim” over the radio. You should:
A. notify the hospital that you will be transporting a burn patient to their facility.
B. remain with the ambulance and wait for fire personnel to bring the victim to you.
C. immediately locate the incident commander and ask where the victim is located.
D. locate the victim and provide initial care while your partner stays with the ambulance.

CHAPTER 39: INCIDENT MANAGEMENT

1. The function of the National Incident Management System (NIMS) is to:

A. prepare for, prevent, respond to, and recover from domestic incidents.
B. facilitate a standard method of incident command for natural disasters.
C. prepare for the potential of a nuclear attack against the United States.
D. educate city and county governments regarding foreign terrorist attacks.

2. Interoperability, an important feature of the NIMS, refers to the ability of:

A. the federal government to intervene during any large- or small-scale incident involving terrorism.
B. EMS systems and fire departments in the same jurisdiction to effectively work as a team.
C. county and state law enforcement agencies to acquire information and pass it along to EMS personnel.
D. agencies of different types or from different jurisdictions to communicate with each other.
3. The purpose of the incident command system (ICS) is to:
A. reduce overall mortality and morbidity from large-scale mass-casualty incidents and to restore key
infrastructure.
B. ensure responder and public safety, achieve incident management goals, and ensure the effective use of
resources.
C. quickly and efficiently respond to natural disasters and terrorist incidents, regardless of the complexity of
the incident.
D. protect the public from the effects of large- and small-scale disasters and to minimize the financial impact
from such incidents.

4. The term used when individual units or different organizations make independent and often inefficient
decisions regarding an incident is called:
A. freelancing.
B. undermining.
C. logistical chaos.
D. single command.

5. A supervisor who has more than seven people reporting to him or her:
A. is more beneficial to the overall effort than a supervisor with fewer personnel because his or her team can
accomplish more tasks.
B. should regularly report to the incident commander (IC) to inform him or her of the functions that his or her
team is performing.
C. has exceeded an effective span of control and should divide tasks and delegate the supervision of some tasks
to another person.
D. should assign a specific task to each person reporting to him or her and regularly follow up to ensure that the
tasks were carried out.

6. During a motor vehicle collision involving multiple patients, the IC would MOST likely:
A. maintain responsibility for all of the command functions.
B. designate a safety officer, but retain other command functions.
C. delegate all of the command functions to the appropriate personnel.
D. relinquish command when a senior EMS provider arrives at the scene.

7. Which of the following statements regarding the unified command system is correct?
A. The unified command system is one in which one person is in charge, even if multiple agencies respond to a
disaster or mass-casualty incident.
B. Ideally, the unified command system is used for short-duration, limited incidents that require the services of
a single agency from one jurisdiction.
C. In a unified command system, there are separate ICs for fire, police, EMS, and any other agencies that
respond to the incident.
D. Under the unified command system, plans are drawn up in advance by all cooperating agencies that assume
a shared responsibility for decision making.

8. If an incident increases in scope and complexity, the IC should consider:

A. ceasing all operations until a revised plan is established.
B. maintaining responsibility for all of the command functions.
C. relinquishing command to someone with more experience.
D. requesting a second IC to assist him or her.

9. Command functions under the ICS include all of the following, EXCEPT:
A. triage officer.
B. safety officer.
C. liaison officer.
D. public information officer

10. At a very large incident, the __________ section is responsible for managing the tactical operations usually
handled by the IC on routine EMS calls.
A. logistics
B. operations
C. planning
D. finance

11. The development of an incident action plan is the responsibility of the:

A. planning section.
B. logistics section.
C. operations section.
D. finance section.

12. A critical function of the safety officer is to:

A. determine the most efficient approach to extricate a victim.
B. stop an emergency operation whenever a rescuer is in danger.
C. monitor emergency responders for signs of stress and anxiety.
D. brief responders during the demobilization phase of an incident.

13. Historically, the weak point at most major incidents has been:
A. accountability.
B. lack of personnel.
C. incident briefing.
D. communication.

14. In preparing for a disaster, EMS systems should have enough supplies for at least a ______ period of self-
sufficiency.
A. 24-hour
B. 48-hour
C. 72-hour
D. 96-hour

15. As the first-arriving senior EMT at the scene of an incident, you should perform a scene size-up and then:
A. establish command.
B. begin the triage process.
C. call for additional resources.
D. quickly identify the walking wounded.

16. Which of the following statements regarding communications at a disaster or mass-casualty incident is
correct?
A. Each command group should utilize a separate radio frequency.
B. Ten-codes or signals should be used when communicating via radio.
C. When possible, all communication should occur via two-way radio.
D. If possible, use face-to-face communications to minimize radio traffic.

17. Which of the following duties or responsibilities does NOT fall within the realm of the medical branch of
the ICS?
A. triage
B. transport
C. treatment
D. extrication

18. As a triage supervisor, you:

A. must prepare patients for transport before they leave the triage area.
B. must not begin treatment until all patients have been triaged.
C. are responsible for providing initial treatment to all patients.
D. should communicate with area hospitals regarding their capabilities.

19. Which of the following is NOT a responsibility of the treatment supervisor?

A. primary assessment
B. secondary triage
C. patient packaging
D. communication with the medical branch director

20. When victims involved in a mass-casualty incident are moved to the treatment area:
A. definitive care is provided and preparations for transport will be made.
B. secondary triage is performed and the appropriate treatment is rendered.
C. they will be rapidly assessed and prioritized according to their injuries.
D. all uninjured patients are placed in a holding area and closely observed.

21. The ____________ supervisor is responsible for notifying area hospitals and determining their availability
and capabilities.
A. triage
B. medical
C. treatment
D. transportation

22. The __________ area is where incoming ambulances meet and await further instructions at the scene of a
mass-casualty incident.
A. triage
B. support
C. staging
D. transportation

23. When a rehabilitation area is established at the scene of a mass-casualty incident, it should:
A. be in a location that prevents visualization of the scene itself.
B. be mandated that responders participate in a defusing session.
C. provide rehabilitative services to both responders and patients.
D. be staffed by the treatment supervisor and at least one physician.

24. Which of the following MOST accurately describes a mass-casualty incident?

A. an incident that involves more than five critically injured or ill patients
B. an incident where patients have been exposed to hazardous materials
C. an incident in which at least half of the patients are critically injured
D. an incident that greatly taxes or depletes a system’s available resources

25. Which of the following is probably NOT a mass-casualty incident?

A. a motor vehicle crash with two critically injured patients and two ambulances
B. a loss of power to a hospital or nursing home with ventilator-dependent patients
C. an apartment fire with one patient and the possibility of others trapped in the building
D. a rollover crash of a school bus with eight children who have injuries of various severity
26. You and your partner are the first to arrive at the scene of a motor vehicle accident. As you approach the
scene, you can see multiple patients, some walking and others who are still in their vehicles. You should:
A. establish an incident command post until you are relieved of your duties.
B. declare a mass-casualty incident and request additional resources.
C. begin rapidly triaging all patients before requesting additional help.
D. immediately move all ambulatory patients to a designated area.

27. Which of the following questions is of LEAST pertinence when the EMT is determining whether or not to
declare a mass-casualty incident and activate the ICS?
A. What will happen if there are more than two patients that require emergency care?
B. How long will it take for additional resources to arrive at the scene once requested?
C. How many paramedics are able to respond to the scene and provide advanced care?
D. How many seriously injured patients can be effectively cared for in my ambulance?

28. You have a critically injured patient in the back of your ambulance, ready to be transported. There are other
injured patients at the scene and it will be approximately 10 minutes before other ambulances will arrive.
Law enforcement personnel are at the scene. You should:
A. transport the critically injured patient to a trauma center.
B. direct a police officer to monitor the patients as you transport.
C. remain at the scene until at least one other ambulance arrives.
D. assign the least injured patient the task of caring for the others.

29. In order to accomplish the goal of primary triage, it is important to:

A. take no more than 2 minutes to determine the patient’s status.
B. keep the triage assessment brief and the patient categories basic.
C. begin life-saving care immediately upon detecting critical injuries.
D. perform a rapid assessment on all patients who appear to be unstable.

30. After primary triage, the triage supervisor should communicate all of the following information to the
medical branch officer, EXCEPT:
A. the total number of patients that have been triaged.
B. the recommended transport destination for each patient.
C. recommendations for movement to the treatment area.
D. the number of patients that are in each triage category.

31. Injuries or conditions that would be classified as first priority (red tag; immediate) include all of the
following, EXCEPT:
A. severe medical problems.
B. fractures of multiple long bones.
C. any airway or breathing difficulty.
D. uncontrolled or severe hemorrhage.

32. Which of the following patients should be assigned an immediate (red tag) category?
A. 22-year-old male with blunt abdominal trauma, tachycardia, pallor, and diaphoresis
B. 29-year-old female with a back injury and numbness and tingling in her extremities
C. 31-year-old male with an open fracture of the forearm and minimal external bleeding
D. 36-year-old female with an open brain injury, agonal breathing, and a slow pulse rate

33. You are triaging four patients who were involved in a head-on motor vehicle crash. Which of the following
patients should be assigned the highest (red) triage category?
A. a 50-year-old male with an open head injury and no pulse
B. a 49-year-old female with diabetes and difficulty breathing
C. a 36-year-old female with back pain and numb extremities
D. a 29-year-old male with bilaterally closed femur deformities

34. A patient who has experienced a back injury, with or without spinal cord damage, would be triaged with a
__________ tag during a mass-casualty incident.
A. red
B. green
C. black
D. yellow

35. Burn patients without airway compromise and patients with multiple bone or joint injuries should be marked
with a __________ triage at a mass-casualty incident.
A. red
B. yellow
C. green
D. black

36. A patient in respiratory arrest at the scene of a mass-casualty incident would typically be classified as a
fourth priority (black tag; expectant) patient, unless:
A. he or she has signs of an injury to the cervical spine.
B. he or she has external signs of severe thoracic trauma.
C. there are at least three other patients in respiratory arrest.
D. there are enough resources to provide care for him or her.

37. You and your partner arrive at the scene where a truck has crashed into a small building, injuring eight
people. You immediately request additional ambulances and begin the triage process. The first patient that
you triage is a young female who is unconscious and apneic. She has an open head injury and her pulse is
weak and thready. You should:
A. assess the severity of her open head injury.
B. place a red tag on her and continue triaging.
C. begin ventilating her with a bag-mask device.
D. assign her a low priority and continue triaging.

38. A tour bus has overturned, resulting in numerous patients. When you arrive, you are immediately assigned
to assist in the triage process. Patient 1 is a middle-aged male with respiratory distress, chest pain, and a
closed deformity to his right forearm. Patient 2 is a young female who is conscious and alert, but has
bilateral femur fractures and numerous abrasions to her arms and face. Patient 3 is an older woman who
complains of abdominal pain and has a history of cardiovascular disease. Patient 4 is unresponsive, is not
breathing, has a weak carotid pulse, and has a grossly deformed skull. What triage categories should you
assign to these patients?
A. Patient 1, immediate (red); Patient 2, minimal (green); Patient 3, delayed (yellow); Patient 4, expectant
(black)
B. Patient 1, delayed (yellow); Patient 2, immediate (red); Patient 3, delayed (yellow); Patient 4, immediate
(red)
C. Patient 1, immediate (red); Patient 2, delayed (yellow); Patient 3, immediate (red); Patient 4, expectant
(black)
D. Patient 1, delayed (yellow); Patient 2, delayed (yellow); Patient 3, minimal (green); Patient 4, immediate
(red)

39. The FIRST step in the START triage system is to:

A. focus on the patients who are unconscious.
B. scan the area for patients with severe bleeding.
C. move all walking patients to a designated area.
D. get a quick head count of all the patients involved.

40. According to the START triage system, what should you do if you encounter an unresponsive patient who is
not breathing?
A. Open the airway and reassess breathing status.
B. Assign the patient in the “immediate” category.
C. Ventilate the patient for 2 minutes and reassess.
D. Triage the patient as “expectant” and move on.

41. According to the START triage system, which of the following patients should be triaged as an immediate
priority (red tag)?
A. conscious with a respiratory rate of 24 breaths/min
B. unresponsive with a respiratory rate of 34 breaths/min
C. apneic, despite manually opening the airway
D. conscious, in severe pain, with radial pulses present

42. According to the START triage system, what should you do if a patient is found to have a respiratory rate of
24 breaths/min?
A. Administer high-flow oxygen.
B. Triage the patient as delayed.
C. Assess for bilateral radial pulses.
D. Assess his or her neurologic status.

43. You are triaging patients at the scene of a multiple vehicle crash when you encounter a young male who is
unresponsive and is not breathing. After you open his airway, he begins to breathe at a rapid rate. According
to the START triage system, you should:
A. assist his ventilations with a bag-mask device and perform a rapid scan of his entire body.
B. move him to the treatment area so he can receive a more comprehensive assessment of his status.
C. move to the other patients, but reassess him in 5 minutes to determine if he is still breathing.
D. tag him as immediate (red), place him in the recovery position, and move to the next patient.

44. The JumpSTART triage system is intended to be used for children younger than _____ years or who appear
to weigh less than _____.
A. 5, 50 lb
B. 6, 70 lb
C. 7, 90 lb
D. 8, 100 lb

45. According to the JumpSTART triage system, infants or children not developed enough to walk or follow
commands, including children with special needs:
A. are treated immediately in the primary triage area and then transported.
B. are initially triaged on the basis of whether or not they have distal pulses.
C. should be taken to the treatment area for immediate secondary triage.
D. are the first to be transported, regardless of the severity of their injuries.

46. According to the JumpSTART triage system, if a pediatric patient is not breathing, you should:
A. immediately check for a pulse.
B. triage him or her as expectant.
C. give five rescue breaths and reassess.
D. open the airway and reassess breathing.
47. According to the JumpSTART triage system, if a pediatric patient has a respiratory rate of 40 breaths/min,
you should:
A. look for posturing.
B. assess for a distal pulse.
C. assess neurologic status.
D. assign an immediate category.

48. While triaging patients at the scene of a building collapse, you encounter a young child who is conscious,
alert, and breathing; has bilateral radial pulses; and has points to his severely angulated leg, which is not
bleeding. According to the JumpSTART triage system, you should:
A. quickly bind his legs together to stabilize the fracture, and continue triaging.
B. assign him a delayed (yellow) category and continue triaging the other patients.
C. evacuate him to a designated area and assign him a minimal (green) category.
D. apply high-flow oxygen, obtain baseline vital signs, and continue triaging.

49. Which of the following statements regarding transport of patients from a mass-casualty incident or disaster
site is correct?
A. Delayed-priority patients should be transported five at a time.
B. Immediate-priority patients should be transported two at a time.
C. Walking wounded patients should be taken to the closest hospitals.
D. Patients who are in cardiac arrest should clearly be transported first.

50. Unlike a mass-casualty incident, a natural disaster:

A. often requires personnel to remain on scene for several days.
B. exists when there are more than 100 critically injured patients.
C. is typically short-lived and does not require as much manpower.
D. usually does not require the ICS process.

51. Upon arriving at the scene of a possible hazardous materials (HazMat) incident involving several patients,
you should:
A. retrieve all critical patients.
B. rope off the entire perimeter.
C. carefully assess the situation.
D. divert traffic away from the scene.

52. General principles for approaching a potential HazMat incident include:

A. parking the ambulance in a location that is upwind and downhill.
B. taking standard precautions before entering any HazMat scene.
C. asking for wind direction from dispatch and entering downwind.
D. maintaining a safe distance and viewing the scene with binoculars.

53. Which of your senses can be safely used to identify a HazMat incident?
A. sight and sound
B. sound and smell
C. smell and sight
D. sight and touch

54. Which of the following statements regarding storage containers and hazardous materials is correct?
A. Red phosphorus from a drug laboratory is found in a blue container that is clearly labeled.
B. In most cases, there is no correlation between the color of the container and the possible contents.
C. Steel utility drums are used to contain acids, bases, and other corrosive chemicals and substances.
D. The Emergency Response Guidebook tells you the type and color of container used to store hazardous
materials.

55. A carboy is a container that would MOST likely be used to store and transport:
A. explosives.
B. corrosives.
C. flammable liquids.
D. combustible materials.

56. Placards and labels on a storage container are intended to:

A. advise responders of the appropriate neutralizing measures.
B. broadly classify chemicals as being explosive or non-explosive.
C. provide specific information about the chemical being carried.
D. give a general idea of the hazard inside that particular container.

57. Which of the following chemicals requires identification with a placard, regardless of how many pounds the
shipment weighs?
A. air-reactive solids
B. flammable liquids
C. water-reactive solids
D. nonflammable gases

58. The reference used as a base for your initial actions at a HazMat incident is/are:
A. the bill of lading.
B. your local EMS protocols.
C. the material safety data sheet (MSDS).
D. the Emergency Response Guidebook.

59. Which of the following statements regarding hazardous materials is correct?

A. Most hazardous materials are odorless and colorless, even when a substantial leak or spill has occurred.
B. Some substances are not hazardous by themselves, but become toxic when mixed with another chemical.
C. Identifying the presence of a hazardous material is generally very easy because of the consistent use of
placards.
D. A package or truck need only contain small quantities of a hazardous chemical before it must bear a placard
or label.

60. The MOST appropriate location to park your ambulance at a HazMat incident is:
A. downwind at least 200′ from the scene.
B. downhill at least 100′ from the incident.
C. uphill at least 25′ from the incident site.
D. upwind at least 100′ from the incident.

61. After recognizing that an incident involves a hazardous material, you should contact the hazardous materials
team and then:
A. don standard equipment before gaining access to any patients.
B. not allow anyone within 25′ to 50′ of the incident scene.
C. take measures to ensure the safety of yourself and others.
D. identify the chemical using the Emergency Response Guidebook.

62. You are approaching an overturned tanker truck to assess the driver, who appears to be unconscious. As you
get closer to the vehicle, you note the smell of noxious fumes and find that you are in the midst of a vapor
cloud. What should you do?
A. Remain where you are and perform a visual assessment of the patient.
B. Cover your face with your shirt and quickly extricate the injured driver.
C. Exit the area immediately and gather information for the HazMat team.
D. Realize that you are in the danger zone and prevent others from entering.

63. During a HazMat incident, you are working in the treatment area. As patients are removed from the danger
zone, you should:
A. remain where you are and have the patients brought to you.
B. quickly decontaminate the patients and begin assessing them.
C. perform a rapid assessment and then have them decontaminated.
D. retrieve patients from the decontamination area and begin treatment.

64. Which of the following activities occurs in the warm zone?

A. command
B. personnel staging
C. decontamination
D. medical monitoring

65. The process of removing or neutralizing and properly disposing of a hazardous material is called:
A. neutralization.
B. decontamination.
C. antidotal treatment.
D. chemical containment.

66. Which of the following is NOT a role of the EMT at the scene of a HazMat incident?
A. rehabilitation
B. decontamination
C. transportation
D. triage and treatment

67. Level _____ hazardous materials would cause irritation on contact but only mild residual injury, even
without treatment.
A. 0
B. 1
C. 2
D. 3

68. A Level 4 hazardous material:

A. causes temporary damage or injury unless prompt medical care is provided.
B. requires protective gear to ensure that no part of the skin’s surface is exposed.
C. is mildly toxic but still requires the use of a self-contained breathing apparatus (SCBA).
D. requires specialized gear designed for protection against that particular hazard.

69. Following proper decontamination, a 30-year-old male is brought to you. He is semiconscious and has rapid,
shallow respirations. A quick visual assessment reveals no obvious bleeding. You should:
A. begin some form of positive-pressure ventilation.
B. ask a fire fighter what the patient was exposed to.
C. administer 100% oxygen via a nonrebreathing mask.
D. perform a rapid assessment to locate critical injuries.
70. A 49-year-old man has been removed from his overturned tanker, which was carrying a hazardous material.
The tank ruptured and he was exposed to the material. When rescue personnel bring him to the
decontamination area, they note that he is unconscious and has slow, shallow breathing. They should:
A. decontaminate the patient as they would any other patient and then move him to the area where EMTs are
waiting.
B. cut away all of the patient’s clothing and do a rapid rinse to remove as much of the contaminating matter as
they can.
C. defer the decontamination procedure and bring the patient directly to awaiting EMS personnel for
immediate treatment.
D. request that EMS personnel don standard precautions, enter the warm zone, and begin immediate treatment
of the patient.

71. Your work uniform is an example of what level of protection?

A. Level A protection
B. Level B protection
C. Level C protection
D. Level D protection

CHAPTER 41: A TEAM APPROACH TO HEALTHCARE

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