NREMT Test Bank Multiple Choice Latest Exam Pack with Answers 2025

NREMT Test Bank Multiple Choice Latest Exam Pack with Answers 2022/ NREMT Test Bank Multiple Choice 2022 Answered 1. Hypoglycemia and acute is- chemic stroke can present simi- larly because: • A:both oxygen and glucose are needed for brain function. • A:both oxygen and glucose are needed for brain function. • B:the majority of stroke patients have a history of diabetes. • C:the most common cause of a stroke is hypoglycemia. • D:they are both caused by low levels of glucose in the blood. Reason: Although stroke and hypo- glycemia are two distinctly different con- ditions, their signs and symptoms are often similar. This is because the brain requires both oxygen and glucose to function normally. An acute ischemic stroke is caused by a lack of oxygen to a part of the brain due to a blocked cerebral artery, whereas hypoglycemia (low blood glucose level) deprives the entire brain of glucose. In either case, the patient presents with signs of im- paired brain function (ie, slurred speech, weakness, altered mental status). Both conditions may lead to permanent brain damage or death if not treated promptly. 2. When dealing with an emotional- ly disturbed patient, you should be MOST concerned with: • A:gathering all of the patient's medications. • B:safely transporting to the hospital. • C:whether the patient could harm you. • D:obtaining a complete medical history. You selected C; This is correct! Reason: When managing any patient with an emotional or psychiatric crisis, your primary concern is your own safe- ty. Safely transporting the patient to the hospital is your ultimate goal. If possi- ble, you should attempt to obtain a med- ical history and should take any of the patient's prescribed medications to the hospital. However, this should not su- percede your own safety or interfere with safely transporting the patient. 3. You are at the scene where a man panicked while swimming in a small lake. Your initial attempt to rescue him should include: • A:rowing a small raft to the vic- You selected B; This is correct! Reason: General rules to follow when at- tempting to rescue a patient from the wa- ter include "reach, throw, row, and then tim. • B:reaching for the victim with a long stick. • C:throwing a rope to the victim. go." In this case, you should attempt to reach the victim by having him grab hold of a large stick or similar object. If this is unsuccessful, throw the victim a rope or • D:swimming to the victim to res- flotation device (if available). If these are cue him. not available, row to the patient in a small raft (if available). Going into the water to retrieve the victim is a last resort. The rescuer must be a strong swimmer because patients who are in danger of drowning are in a state of blind panic and will make every attempt to keep them- selves afloat, even if it means forcing the rescuer underwater. 4. How should you classify a pa- tient's nature of illness if he or she has a low blood glucose lev- el, bizarre behavior, and shallow breathing? • A:Behavioral emergency • B:Altered mental status • C:Respiratory emergency • D:Cardiac compromise The correct answer is B; Reason: The nature of illness (NOI) is the medical equivalent to mechanism of injury (MOI). Altered mental status should be the suspected NOI in any patient with any fluctuation in level of consciousness, which can range from bizarre behavior to complete unrespon- siveness. Causes of an altered mental status include hypo- or hyperglycemia, head trauma, stroke, behavioral crises, drug overdose, and shock, among oth- ers. 5. A young female is unresponsive after overdosing on an unknown type of drug. Her respirations are slow and shallow and her pulse is slow and weak. Which of the following drugs is the LEAST likely cause of her condition? • A:Seconal • B:Heroin The correct answer is C; Reason: Of the drugs listed, cocaine would be the least likely cause of the patient's condition. Cocaine is a cen- tral nervous system (CNS) stimulant; you would expect her to be hyperten- sive, tachycardic, tachypneic, and per- haps even violent. Heroin, Valium, and • C:Cocaine • D:Valium Seconal are all CNS depressants and could explain her condition. Heroin is an illegal narcotic (opiate), Valium is a benzodiazepine sedative-hypnotic drug, and Seconal is a barbiturate. Narcotics, benzodiazepines, and barbiturates are all CNS depressants. When taken in ex- cess, they cause a decreased level of consciousness, respiratory depression, bradycardia, and hypotension. 6. Activated charcoal is contraindi- cated for a patient who is: • A:conscious and alert and has ingested a large amount of Motrin. • B:emotionally upset and has in- gested two bottles of aspirin. • C:agitated and claims to have ingested a bottle of Tylenol. • D:awake and alert and has swal- lowed a commercial drain clean- er. You selected D; This is correct! Reason:Activated charcoal adsorbs (sticks to) many ingested substances, preventing them from being absorbed into the body by the stomach or in- testines. In some cases, you may give activated charcoal to patients who have ingested certain substances, if approved by medical control or local protocol. Ac- tivated charcoal is contraindicated for patients who have ingested an acid or alkali (ie, drain cleaner) or a petroleum product (ie, gasoline), who have a de- creased level of consciousness and can- not protect their own airway, or who are unable to swallow. 7. The MOST obvious way to reduce you selected D; This is correct! heat loss from radiation and convection is to: • A:move away from a cold ob- ject. • B:increase metabolism by shiv- ering. • C:wear a thick wind-proof jack- et. Reason:In a cold environment, the body has two ways of staying warm: generat- ing heat (thermogenesis) and reducing heat loss. Radiation is the transfer of heat by radiant energy. The body can lose heat by radiation, such as when a person stands in a cold room. Convec- tion occurs when heat is transferred to • D:move to a warmer environ- ment. circulating air, as when cool air moves across the body's surface. A person standing in windy cold weather, wear- ing lightweight clothing, is losing heat to the environment mostly by convection. The quickest and most obvious way to decrease heat loss from radiation and convection is to move out of the cold environment and seek shelter from wind. Shivering increases the body's metabo- lism and is a mechanism for generating heat, not reducing heat loss. Layers of clothing trap air and provide excellent in- sulation; thus, layered clothing decreas- es heat loss better than a single, thick jacket. Conduction is the direct transfer of heat from a part of the body to a colder object by direct contact, as when a warm hand touches cold metal or ice. The most obvious way to decrease heat loss by conduction is to remove your hand from the cold object. 8. A near-drowning is MOST accu- rately defined as: • A:complications within 24 hours following submersion in water. • B:immediate death due to pro- longed submersion in water. • C:survival for at least 24 hours following submersion in water. • D:death greater than 24 hours following submersion in water. You selected C; This is correct! Reason:Collectively, drowning and near-drowning are referred to as sub- mersion injuries. Drowning is defined as death after submersion in a liquid medium, usually water. In a drowning, death is either immediate or occurs within 24 hours following submersion. Near-drowning is defined as survival, at least temporarily (24 hours), after sub- mersion. It should be noted, however, that complications such as pneumonia and pulmonary edema can cause death greater than 24 hours following submer- sion. For this reason, all patients with a submersion injury should be transported to the hospital, even if they appear fine at the scene. 9. A young woman reports sig- nificant weight loss over the last month, persistent fever, and night sweats. When you assess her, you note the presence of dark purple lesions covering her trunk and upper extremities. You should suspect: • A:end-stage cancer. • B:HIV/AIDS. • C:tuberculosis. • D:rheumatic fever. You selected B; This is correct! Reason:Weight loss, fever, and night sweats could indicate tuberculosis or HIV/AIDS; however, the dark purple le- sions on the skin, which are called Ka- posi's sarcoma, are malignant skin tu- mors and are a classic finding in patients in the later stages of AIDS. 10. A 48-year-old male became acutely hypoxic, experienced a seizure, and is now postictal. The MOST effective way to prevent another seizure is to: • A:dim the lights in the back of the ambulance. • B:place him in the recovery po- sition. • C:administer high-flow supple- mental oxygen. • D:give him oral glucose if he can swallow. You selected C; This is correct! Reason:You should administer high-flow oxygen to all patients who are actively seizing and to patients who experienced a seizure and are postictal. This is es- pecially true if the seizure was caused by hypoxia. Increasing the oxygen con- tent of the blood, which minimizes hy- poxia, may prevent another seizure. The recovery position is appropriate for un- injured patients with a decreased level of consciousness and adequate breath- ing; it will help maintain the airway and facilitate drainage of secretions from the mouth, but will not prevent another seizure. Oral glucose may prevent an- other seizure if hypoglycemia was the cause of the seizure. You should dim the lights in the back of the ambulance to help prevent any seizure, not just those that are caused by hypoxia. 11. Which of the following condi- tions would be the LEAST likely to be present in a patient who was submerged in water? • A:Spinal injury • B:Gastric distention • C:Hyperglycemia • D:Laryngospasm You selected C; This is correct! Reason: Many factors can contribute to or result from a submersion injury (eg, drowning, near-drowning). It is not un- common for a person to experience a spinal injury after diving head first into shallow water, especially if he or she is under the influence of alcohol. When a swimmer panics, he or she initially swal- lows large amounts of water, resulting in gastric distention. Gastric distention can cause aspiration if the patient re- gurgitates water during rescue breath- ing; protect the airway! During the panic phase, the victim expends a tremendous amount of energy (and glucose) from flailing around in the water, possibly re- sulting in hypoglycemia. Inhaling even a small amount of fresh or salt water can severely irritate the larynx, which sends the muscles of the larynx and vocal cords into spasm (laryngospasm), resulting in airway blockage and hypox- ia. 12. A 42-year-old male presents with fever, a severe headache, and a stiff neck. He is conscious, but confused. His wife tells you that he does not have any med- ical problems and does not take any medications. You should be MOST suspicious for: • A:acute stroke. • B:influenza. • C:meningitis. • D:tuberculosis. ( You selected C; This is correct! Reason:Meningitis is an inflammation of the protective coverings of the brain and spinal cord (meninges). Common signs and symptoms of meningitis include fever, headache, neck stiffness (nuchal rigidity), and vomiting. An altered men- tal status is common in severe cas- es. Meningococcal meningitis, caused by a bacterium, is the most contagious and potentially fatal type of meningitis. The patient's signs and symptoms are not consistent with acute stroke, tuber- culosis (TB), or influenza (the flu). Al- though fever is common with both TB and the flu, neither causes neck stiff- ness. Acute stroke may be associated with a headache, especially a hemor- rhagic stroke; however, stroke patients typically do not have a fever. 13. All of the following are signs of gastrointestinal bleeding, EX- CEPT: • A:melena. • B:hematemesis. • C:tachycardia. • D:hemoptysis. You selected D; This is correct! Reason:Signs and symptoms of gas- trointestinal (GI) bleeding include ab- dominal pain; vomiting blood (he- matemesis); the passage of dark, tarry stools (melena); and bright red rectal bleeding (hematochezia). If blood loss is significant, the patient may have signs of shock (eg, tachycardia, diaphore- sis, tachypnea, hypotension). Hemopty- sis (coughing up blood) is a sign of a pulmonary injury, not GI bleeding. 14. A 24-year-old female presents with a rash to her left leg and swollen, painful knee joints. She You selected C; This is correct! Reason:The patient's symptoms and her history of a recent hiking trip are contells you that she and her friends sistent with Lyme disease, which was returned from a hiking trip in the mountains a week ago. She is conscious and alert with a blood pressure of 112/62 mm Hg, a pulse of 84 beats/min, and res- pirations of 14 breaths/min. Her symptoms are MOST likely the result of: • A:Rocky Mountain spotted fever. • B:tetanus. • C:Lyme disease. • D:a localized allergic reaction. the result of a tick bite. Ticks can car- ry two infectious diseases: Lyme dis- ease and Rocky Mountain spotted fever. Both are spread through the tick's sali- va, which is injected into the skin when the tick attaches itself. The first symp- tom of Lyme disease, a rash that may spread to several parts of the body, be- gins about 3 days after the bite of an infected tick. The rash may eventually re- semble a target bull's-eye pattern in one third of patients. After a few more days or weeks, painful swelling of the joints, particularly the knees, occurs. If recog- nized and treated promptly with antibi- otics, many patients recover completely. Rocky Mountain spotted fever, which is not limited to the Rocky Mountains, oc- curs within 7 to 10 days after being bitten by an infected tick. Its symptoms include nausea, vomiting, headache, weakness, paralysis, and possibly cardiopulmonary failure. 15. A 50-year-old woman who is con- scious and alert complains of a severe migraine headache. When caring for her, you should gener- ally avoid: • A:transporting her in a supine position. • B:shining a light into her pupils. • C:dimming the lights in the am- bulance. You selected B; This is correct! Reason:Patients with migraine or cluster headaches typically have photophobia (light sensitivity). Any type of bright light, especially if shone directly into the eyes, will cause the patient with a headache unnecessary severe pain. Dimming the lights in the ambulance and making the patient as comfortable as possible are the treatments of choice for a patient • D:applying ice packs to her fore- with a headache. Some patients benefit head. from ice packs applied to the forehead; just be sure to wrap the ice pack with roller gauze. Oxygen also should be ad- ministered as needed. Typically, the pa- tient will prefer to lie supine or on the side 16. A patient who overdosed on heroin would be expected to pre- sent with: • A:tachycardia. • B:hyperpnea. • C:hypotension. • D:dilated pupils. The correct answer is C; Reason:Heroin is a Schedule I (illegal) narcotic that is typically injected. As with all narcotics, legal or illegal, overdose causes depression of the central ner- vous system (CNS), resulting in a de- creased level of consciousness; brady- cardia; hypotension; and slow, shallow (reduced tidal volume) breathing. Hy- perpnea (deep breathing) would not be present in a patient who overdosed on a narcotic. In a narcotic overdose, the pupils are typically constricted (mio- sis). Barbiturates, such as phenobar- bital, are also CNS depressants and cause the same symptoms seen with narcotic overdose. The patient's pupils, however, are typically dilated (mydria- sis), not constricted. 17. When caring for any patient with a decreased level of con- sciousness, your primary con- cern should be the: • A:potential for airway compro- mise. • B:patient's blood glucose level. • C:possibility of a spinal injury. • D:possibility of a drug over- dose. You selected A; This is correct! Reason:Altered mental status could be caused by a high or low blood glu- cose level, drug overdose, or head in- jury, among other causes. Furthermore, the possibility of a spinal injury should be considered if the patient was injured. However, your primary concern should be the status of the patient's airway. Patients with a decreased level of con- sciousness are at risk for aspiration if vomiting occurs. Unless spinal trauma is present or the patient is breathing inad- equately (eg, fast or slow rate, shallow breathing [reduced tidal volume]), place him or her in the recovery position to facilitate drainage if vomiting occurs. Re- member this: no airway, no patient! 18. A 16-year-old, 125-pound male ingested a bottle of aspirin approximately 20 minutes ago. Medical control orders you to ad- minister activated charcoal in a dose of 1 g/kg. How much activat- ed charcoal should you adminis- ter? You selected D; This is correct! Reason: First, you must determine the patient's weight in kilograms (kg). Either of the following formulae can be used to convert pounds to kilograms: Formula 1: weight (in pounds) ÷ 2.2 = weight in kg. Formula 2: weight (in pounds) ÷ 2 • A:54 g • B:60 g • C:51 g • D:57 g - 10% = weight in kg. On the basis of the above formulae, a 125-pound patient weighs 57 kg. Using formula 1, the equa- tion is as follows: 125 (weight in pounds) ÷ 2.2 = 56.81 (57 [rounded to the nearest tenth]). Using formula 2, the equation is as follows: 125 (weight in pounds) ÷ 2 = 62.5 (63 [rounded to the nearest tenth] - 6.3 (10% of 63) = 56.7 (57 [rounded to the nearest tenth]). Since the drug order is for 1 g/kg, you should administer 57 g of activated charcoal to your 125-pound patient. 19. Which of the following is the MOST significant finding in a pa- tient with a severe headache? • A:Pain in both legs • B:Chest discomfort • C:Unilateral weakness • D:Abdominal tenderness You selected C; This is correct! Reason: Unilateral weakness (weak- ness on one side of the body) is a clin- ically significant finding in a patient with a headache because it could indicate a stroke (ischemic or hemorrhagic). Ab- dominal, chest, and leg pain are not common complaints associated with a headache, although they should be not- ed and investigated if they are present. 20. When caring for a patient with se- vere hypothermia who is in car- diac arrest, you should: • A:perform rescue breathing only. • B:perform BLS and transport. • C:avoid using the AED. • D:hyperventilate the patient. The correct answer is B; Reason:Patients with severe hypother- mia (core body temperature < 86°F) who are in cardiac arrest should be managed with basic life support (chest compres- sions and ventilations), passive external rewarming (ie, removal of wet clothing, applying warm blankets) and rapid trans- port to the hospital where they can be actively rewarmed. Because cold mus- cle is a poor conductor of electricity, de- fibrillation, if indicated, should be limited to 1 attempt until the patient's body tem- perature has been increased. Cardiac arrest patients with severe hypothermia generally do not respond to defibrillation. Hyperventilation should be avoided as this may increase intrathoracic pressure and impair blood flow back to the heart. 21. You should not attempt to active- ly rewarm a patient with moder- ate or severe hypothermia in the field because: • A:rewarming too quickly can cause a fatal cardiac dysrhyth- mia. • B:the risk of inadvertently in- ducing hyperthermia is too high. You selected A; This is correct! Reason:When caring for a patient with hypothermia, your goal is to prevent fur- ther heat loss; this involves removing wet clothing, applying warm blankets, and allowing the patient's body temperature to rise gradually and naturally (passive rewarming). If the patient is moderate- • C:it is painful for the patient and ly or severely hypothermic, you should you cannot give analgesic drugs. • D:active rewarming has been shown to cause severe hyperten- sion. not try to rewarm him or her actively (placing heat on or into the body). Re- warming too quickly may cause a fatal cardiac dysrhythmia, such as ventricular fibrillation (VFib). Active rewarming may also cause rewarming shock, a condition in which the blood vessels dilate when heat is applied to the body, resulting in significant hypotension. For these rea- sons, active rewarming should only be performed in the controlled setting of a hospital. 22. You respond to a grocery store where a 39-yearold man report- edly experienced a seizure. When you arrive at the scene, a clerk begins to escort you to the pa- tient. She tells you that the man stopped seizing about 5 minutes ago. If the patient truly experi- You selected D; This is correct! Reason: Most seizures are followed by a postictal phase, in which the patient is unresponsive at first and then gradual- ly regains consciousness. In most cas- es, the postictal patient appears dazed, confused, or disoriented; in some cases, enced a seizure, you will MOST likely find that he: • A:has a slow heart rate. • B:is fully conscious and alert. • C:is not breathing and is cyan- otic. • D:is confused and disoriented. he or she is combative. The postictal phase typically lasts from 5 to 30 min- utes. During the seizure, the patient is often not breathing or is breathing in- adequately; however, when the seizure stops, breathing usually resumes. You will also find that most postictal patients are tachycardic; this is the result of an adrenalin surge that occurs during the tonic-clonic phase of the seizure. 23. You are called to a local park for an ill person. It is a hot day and the humidity is high. When you arrive, a bystander directs you to the patient, a young male who is semiconscious. His skin is flushed, hot, and moist. Your FIRST action in the management of this patient should be to: • A:begin rapid cooling mea- sures. • B:ensure an open airway. • C:administer high-flow oxygen. • D:move him to a cool area. You selected D; This is correct! Reason:Your first action in a heat-relat- ed emergency is to move the patient to a cooler environment. Once you have moved the patient to a cooler place, you should begin your assessment and treat the patient accordingly. Remember, you must FIRST prevent further harm to the patient. 24. A known diabetic female is found unresponsive. Her respirations are rapid and shallow; her skin is cool, clammy, and pale; and her pulse is rapid and weak. Which of the following would BEST ex- plain the likely cause of her con- dition? • A:Failure to take insulin • B:Insulin overdose • C:Excessive eating • D:High blood sugar The correct answer is B; Reason:The patient has classic signs of insulin shock, a condition caused by a low blood glucose level (hypoglycemia). Common causes of insulin shock in- clude insulin overdose (accidental or in- tentional), failure to eat (or not eating enough), and excessive exertion. The patient's symptoms are not consistent with diabetic ketoacidosis (DKA), a con- dition that results from a high blood glucose level (hyperglycemia). Signs of DKA include deep, rapid breathing with a fruity or acetone breath odor (Kussmaul respirations), and warm, dry skin. Unlike insulin shock, which can result from an insulin overdose, DKA can occur if a patient fails to take his or her insulin or takes too little. 25. You are dispatched to a resi- dence for a 20-yearold male with respiratory distress. When you arrive, you find that the patient has a tracheostomy tube and is ventilator dependent. His mother tells you that he was doing fine, but then suddenly began expe- riencing breathing difficulty. You should: • A:detach the ventilator, suction the tracheostomy tube, and re- assess the patient. • B:remove the ventilator tubing and place an oxygen mask over the tracheostomy tube. • C:remove him from the mechan- ical ventilator and ventilate him manually. • D:check the settings on the ven- tilator to ensure that it is func- tioning properly. you selected C; This is correct! Reason:If a ventilator-dependent patient experiences a sudden onset of respi- ratory distress, you should first remove him or her from the mechanical venti- lator and begin manual ventilation with a bag-mask device; if the patient im- proves, you will know that the problem was a malfunction with the mechani- cal ventilator. If the patient does not improve, the tracheostomy tube is like- ly plugged with thick mucus secretions and requires suctioning. Unless you are familiar with the mechanical ventilator (most EMTs are not), do not attempt to troubleshoot the device by checking the settings; this only wastes time. 26. A middle-aged man was found floating facedown in a small pond. When you arrive at the scene, bystanders are present, but nobody has removed him from the water because they thought he was dead. After reaching the victim, you should: The correct answer is B; Reason:After safely reaching a drown- ing victim, you should first turn him to a supine position by rotating the entire upper half of the body as a single unit; protect the cervical spine as you do this because a spinal injury cannot be ruled • A:float a buoyant backboard un- der him, remove him from the pond, and begin rescue breath- ing. out. Open the patient's airway, without manipulating the neck, and begin rescue breathing while still in the water. Float a buoyant backboard under the patient, • B:move him to a supine position secure him to it, and remove him from by rotating the entire upper half of his body as a single unit. • C:stabilize his head as you re- move it from the water and open his airway by tilting his head back. • D:grab him by his clothing, re- move him from the pond, and as- sess for breathing and a pulse. the water. After removing the victim from the water, assess for a pulse. If the victim is pulseless, begin CPR, dry him off, and apply the AED as soon as possible. 27. Which of the following patients with diabetes is the BEST candi- date for oral glucose? • A:A confused patient who has cool, clammy skin • B:A semiconscious patient with pale, clammy skin • C:An unresponsive patient who took too much insulin • D:A confused patient with sus- pected hyperglycemia You selected A; This is correct! Reason:Oral glucose is indicated for pa- tients with diabetes who are in insulin shock (hypoglycemic crisis), or for any patient with symptomatic hypoglycemia (as documented by glucometer). The patient must be conscious and alert enough to be able to swallow the glu- cose, which comes in a tube of gel. If the patient is unresponsive or otherwise un- able to swallow the glucose, you should provide rapid transport, providing the ap- propriate airway management en route, and consider an ALS intercept. 28. A 40-year-old woman presents with widespread hives that she noticed about 45 minutes af- ter taking penicillin. She is con- scious and alert and denies difficulty breathing. Her breath sounds are clear to auscultation bilaterally, her vital signs are sta- You selected C; This is correct! Reason:The patient is experiencing an allergic reaction, but she is not in ana- phylactic shock. Urticaria (hives) is com- mon to all allergic reactions, regardless of severity; however, wheezing and hy- potension, which she does not have, are ble, and her oxygen saturation is 94%. She tells you she is allergic to wasps and has an epinephrine auto-injector. You should: • A:assist her in administering specific to anaphylaxis. Although she carries an epinephrine auto-injector for her allergy to wasps, she was not stung by a wasp. Furthermore, the absence of wheezing and hypotension negates epinephrine via her auto-injector. epinephrine administration. Give supple- • B:give high-flow oxygen and ad- mental oxygen (in a concentration sufminister 100 mg of Benadryl. • C:give supplemental oxygen and transport her to the hospital. • D:advise her that she can prob- ably drive herself to the hospital. ficient to maintain an SpO2 of greater than 94%) and transport her to the hos- pital. Because it can take up to an hour for signs of a severe allergic reaction to manifest, the patient should not dri- ve herself. Diphenhydramine (Benadryl), an antihistamine, is an appropriate drug based on her presentation; however, it is not typically carried on a BLS unit. Furthermore, the correct dose is 25 to 50 mg. 29. Immediately following a general- ized motor seizure, most patients are: • A:hyperactive. • B:confused. • C:apneic. • D:awake and alert. You selected B; This is correct! Reason:After a generalized (grand mal) motor seizure, the patient typically will be confused, sleepy, or in some cases, combative. This is referred to as the pos- tictal phase. The patient's level of con- sciousness typically improves within 30 minutes. In many cases, the patient's respirations will be fast (tachypnea) fol- lowing a seizure; this is the body's at- tempt to eliminate excess carbon diox- ide that accumulated in the blood during the seizure. 30. When assessing a conscious pa- tient who overdosed on a drug, you should FIRST determine: • A:if there is a history of prior overdose. You selected C; This is correct! Reason: When assessing a patient who has overdosed on a drug, you should first determine what was ingested, which • B:the patient's weight in kilo- grams. • C:the type of medication ingest- ed. • D:when the medication was in- gested. will provide you with immediate infor- mation about whether or not the sub- stance is toxic. You should then find out when the medication was ingested. This information will provide medical control (or poison control) with the informa- tion needed to direct the most appropri- ate treatment. The patient's weight also should be estimated in kilograms in the event that an antidote is required. Infor- mation regarding prior drug overdoses would normally be obtained during the SAMPLE history. 31. Which of the following actions should be carried out during the primary assessment of an unre- sponsive patient? • A:Assessing the skin • B:Obtaining a blood pressure • C:Palpating the cranium • D:Auscultating the lungs You selected A; This is correct! Reason:Components of the primary as- sessment for both responsive and un- responsive patients include assessing and managing the airway and assess- ing and managing circulation, which in- cludes controlling any major bleeding; assessing the rate, regularity, and quali- ty of the pulse; and assessing the color, condition, and temperature of the skin. 32. When restraining a violent pa- tient, you should make sure that: • A:the patient is restrained using maximal force. You selected D; This is correct! Reason:If a violent patient needs to be restrained, you must ensure the pres- • B:at least two EMTs restrain the ence of at least four people (one per patient. • C:consent for restraint has been obtained from a family member. • D:someone talks to the patient during the process. extremity). One of the EMTs should con- tinuously talk to the patient to explain what is happening, even if the patient is not listening. Restraint is a last resort used to protect the EMT as well as the patient. Consent is not needed from a family member prior to restraining the patient. Just enough force to effectively restrain the patient is all that is required to prevent causing unnecessary injury. 33. Immediately following a gen- eralized seizure involving ton- ic-clonic activity, most patients: • A:have a slow heart rate be- cause of cardiac depression dur- ing the seizure. • B:are unresponsive but gradu- ally regain consciousness. • C:experience prolonged ap- nea and require positive-pres- sure ventilations. • D:return to a normal level of consciousness but cannot recall the event. You selected B; This is correct! Reason:Most generalized (grand mal) seizures last 3 to 5 minutes and are fol- lowed by a lengthy (5 to 30 minutes) pe- riod called the postictal phase, in which the patient is unresponsive at first but gradually regains consciousness. Dur- ing the seizure itself, the nervous system releases excess adrenaline (epineph- rine); therefore, tachycardia, even after the seizure has stopped, is common. Ap- nea is common during a seizure; howev- er, breathing usually resumes after the seizure has stopped. Many patients are tachypneic following a seizure; this is the body's attempt to eliminate excess carbon dioxide that accumulated in the blood during the seizure. Unlike grand mal seizures, petit mal seizures (also called absence seizures) can last for just a fraction of a minute, after which the pa- tient fully recovers immediately with only a brief lapse of memory of the event. 34. Which of the following organs are contained within the right up- per quadrant of the abdomen? • A:Liver and gallbladder • B:Stomach and gallbladder • C:Liver and spleen • D:Liver and stomach You selected A; This is correct! Reason:The liver and gallbladder lie within the right upper quadrant of the abdomen. Most of the stomach is within the left upper quadrant, as is the entire spleen. 35. You respond to a baseball field for a person who was struck by lightning. When you arrive, You selected D; The correct answer is A; Reason:The process of triaging multiple you see one patient who ap- pears confused and is ambulato- ry; a second patient who is con- scious, sitting on the ground, and holding his arm; and a third pa- tient who is supine and motion- less. After requesting additional responders, you should: • A:assess the motionless victim and perform CPR and defibrilla- tion if necessary. • B:assess and begin treating the sitting patient first because he is obviously injured. • C:treat the conscious patients because the motionless patient is likely deceased. • D:proceed to the ambulatory pa- tient, sit him down, and assess his mental status. victims of a lightning strike is different than the conventional triage methods used during a mass-casualty incident. When a person is struck by lightning, respiratory or cardiac arrest, if it occurs, usually occurs immediately. Those who are conscious following a lightning strike are much less likely to develop delayed respiratory or cardiac arrest; they usual- ly survive. Therefore, you should focus your efforts on those who are in res- piratory or cardiac arrest. This process, called reverse triage, differs from con- ventional triage, where such patients would ordinarily be classified as de- ceased. 36. A 32-year-old man who was stung by a bee has diffuse hives, facial swelling, and difficulty breathing. When he breathes, you hear audible stridor. What does this indicate? • A:Narrowing of the two main- stem bronchi • B:Swelling of the upper airway structures • C:Narrowing of the bronchioles in the lungs • D:Swelling of the lower airway structures You selected B; This is correct! Reason:This patient is experiencing a severe allergic reaction (anaphylaxis). Stridor, which is a high-pitched sound heard on inhalation, indicates swelling of the structures and tissues of the up- per airway. If not promptly treated, the patient's airway may close completely, resulting in respiratory arrest. Narrowing of the bronchioles in the lungs causes wheezing, a whistling sound that may be heard during inhalation, exhalation, or both. 37. A behavioral crisis is MOST ac- curately defined as: • A:any reaction to an event that You selected A; This is correct! Reason:The definition of a behavioral interferes with the activities of daily living or has become unac- ceptable to the patient, family, or community. • B:an acute psychiatric emer- gency characterized by violent behavior, mood swings, and a loss of connection to reality. • C:a persistent feeling of sad- ness, despair, or hopelessness crisis or emergency is any reaction to an event that interferes with the activities of daily living (eg, bathing, dressing, eat- ing) or has become unacceptable to the patient, his or her family, or the general community. Some patients react to an event with violent behavior or suicidal thoughts; others react with depression. Regardless of the reaction, it significant- ly interferes with the patient's life or is that incapacitates the patient and unacceptable to his or her family and/or prevents him or her from inter- acting socially. • D:a chronic mental health prob- lem in which the patient experi- ences frequent thoughts of sui- cide or other self-destructive be- havior. the community 38. You are called to an assisted liv- ing center where an attendant found a 72-year-old man unre- sponsive. The patient had recent hip surgery and has been tak- ing Vicodin for pain. His respira- tions are slow and shallow and his pulse is slow and weak. You should: • A:apply the AED in case he de- velops cardiac arrest. • B:request an ALS ambulance to respond to the scene. • C:begin ventilation assistance with a bagmask device. • D:apply high-flow oxygen via a nonrebreathing mask. You selected C; This is correct! Reason:Vicodin is a combination of hy- drocodone and acetaminophen (APAP), the active ingredient in Tylenol. Hy- drocodone is a potent narcotic anal- gesic. When taken in excess, it can sup- press the central nervous system and cause respiratory depression, bradycar- dia, and hypotension. Initial manage- ment of any patient who has overdosed on a medication of this type is to ensure a patent airway and support breathing. Because the patient is breathing inad- equately (slow and shallow), immediate ventilation assistance is needed. Con- sider requesting an ALS ambulance if transport time to the nearest hospital will be lengthy. Paramedics can administer a drug called naloxone (Narcan) to re- verse the effects of narcotic drugs. The AED is not indicated for this patient; it is only applied to patients in cardiac arrest. 39. In the patient with diabetes, in- sulin shock typically presents with: • A:clammy skin and a rapid on- set. • B:dry skin and a slow onset. • C:dry skin and a rapid onset. • D:clammy skin and a slow on- set. The correct answer is A; Reason:In the patient with diabetes, in- sulin shock (hypoglycemic crisis) pre- sents with cool, clammy skin and a rapid onset. The brain is critically depen- dent on glucose and responds quickly when the body is in short supply. Diabet- ic coma (hyperglycemic crisis) typically presents with warm, dry skin and a slow onset, sometimes occurring over a peri- od of days. 40. Your FIRST action in managing a patient with an altered mental status should be to: You selected A; This is correct! • A:determine if the patient is breathing adequately. • B:administer one tube of oral glucose. • C:administer high-flow supple- mental oxygen. Reason:When treating a patient with an altered mental status, you must first en- sure a patent airway and determine if the patient is breathing adequately. If the pa- tient is breathing adequately, administer supplemental oxygen and continue your assessment. If the patient is not breath- ing adequately (ie, fast or slow rate, shal- • D:ask a family member how the low breathing [reduced tidal volume]), patient normally acts. assist his or her ventilations. It is impor- tant to ask a family member, if available, how the patient normally acts; this will help establish a baseline. Before admin- istering oral glucose, you should assess the patient's blood glucose level to de- termine if hypoglycemia is the cause of his or her problem and then decide if the patient is able to swallow the glucose, if indicated. If the patient is unable to swal- low, do not administer oral glucose, even if he or she is hypoglycemic. Request a paramedic ambulance if possible so the patient can receive intravenous glucose. 41. A patient who overdosed on methamphetamine would be ex- You selected C; The correct answer is D; pected to have all of the following Reason:Methamphetamine, an upper, clinical signs, EXCEPT: • A:agitation. • B:hypertension. • C:dilated pupils. • D:bradycardia. stimulates the central nervous system, causing it to release excessive amounts of adrenaline (epinephrine). Epineph- rine increases heart rate and blood pres- sure; therefore, the patient would ex- perience tachycardia and hypertension. Other signs of methamphetamine over- dose, which also indicate an adrena- line surge, include pupillary dilation, ag- itation, and hyperthermia. Bradycardia would be expected in patients who have overdosed on drugs that suppress, not stimulate, the central nervous system (eg, narcotics, benzodiazepines, barbi- turates). 42. A 50-year-old woman with a his- tory of epilepsy is actively seiz- ing. Care for this patient should focus primarily on: • A:protecting her from injury and ensuring adequate ventilation. • B:administering high-flow oxy- gen and requesting an ALS am- bulance. • C:frequently suctioning her air- way and carefully restraining her. • D:placing a bite block in be- tween her molars and giving her oxygen. You selected A; This is correct! Reason:Seizure deaths are most fre- quently the result of hypoxia. When a person is actively seizing, he or she is not breathing adequately. Your prima- ry focus when treating a seizure pa- tient is to protect him or her from in- jury and to ensure adequate ventilation and oxygenation. Many seizing patients require assisted ventilation. Suction the oropharynx only if the patient has secre- tions in his or her mouth. Do NOT in- sert anything into the mouth of a seizing patient; doing so may cause an airway obstruction or damage the soft tissues of the mouth, resulting in bleeding. Do not attempt to restrain an actively seizing patient; doing so may result in muscu- loskeletal injuries. Request an ALS am- bulance per your local protocols. 43. When you arrive at a residence for a man who is "not acting right," you enter the house and find him sitting on his couch. Which of the following findings would be MOST indicative of an altered mental status? • A:Slurred speech. • B:Tired appearance. • C:Odor of alcohol. • D:Eyes are closed. You selected A; This is correct! Reason:Often, an altered mental status can be difficult to assess, especially if you do not know how the patient nor- mally acts. However, there are key find- ings that should increase your index of suspicion. An abnormal speech pattern, such as slurring or incoherent words, can be the result of a diabetic problem, alcohol intoxication, or drug ingestion. All of these can cause an altered men- tal status. The odor of alcohol suggests intoxication as a potential cause of his problem, but cannot be quantified. Just because the patient's eyes or closed or he has a tired appearance does not nec- essarily indicate that he has an altered mental status. 44. Hypoxia-induced unresponsive- ness during a submersion injury is usually the result of: • A:a cardiac dysrhythmia. • B:associated hypothermia. • C:laryngospasm. • D:water in the lungs. You selected C; This is correct! Reason: When a patient falls into the water or becomes panicked when in the water, he or she begins to swallow large amounts of water. Even a small amount of water near the larynx can cause a spasm, which closes off the airway. This results in hypoxia, loss of conscious- ness, and cardiac dysrhythmias. If the patient is not removed from the water at once and treated aggressively, hypoxia and acidosis will eventually result in car- diac arrest. 45. Which of the following condi- tions would MOST likely cause flushed skin? • A:Low blood pressure • B:Blood loss • C:Hypothermia • D:Exposure to heat You selected D; This is correct! Reason:Whenever the body tempera- ture rises (ie, heat exposure, fever), the peripheral blood vessels dilate, which draws warm blood to the skin and gives it a flushed (red) appearance. Blood loss, shock, low blood pressure (hypoten- sion), and hypothermia generally cause the skin to become pale; these condi- tions cause peripheral vasoconstriction, which shunts blood away from the skin. 46. Which of the following mecha- nisms cause respiratory and cir- culatory collapse during anaphy- lactic shock? • A:Bronchodilation and vasodi- lation • B:Bronchoconstriction and vasoconstriction • C:Bronchoconstriction and va- sodilation • D:Bronchodilation and vaso- constriction You selected C; This is correct! Reason:During anaphylaxis, histamines released from the immune system cause two negative effects that result in shock (hypoperfusion): vasodilation, which causes the blood pressure to fall and bronchoconstriction, which impairs breathing. 47. A 50-year-old female complains of severe pain to the right low- er quadrant of her abdomen. You should: • A:palpate the left upper quad- rant of her abdomen first. You selected A; This is correct! Reason:When assessing a patient with abdominal pain, determine where the pain is most severe (in this case, the right lower quadrant) and then palpate • B:keep her supine with her legs the quadrant furthest from that area first fully extended. • C:quickly palpate that area first to assess for rigidity. (in this case, the left upper quadrant). If you palpate the painful area first, the pa- tient is less likely to allow you to assess • D:suspect that she has an acute the remainder of his or her abdomen; problem with her liver. it also causes the patient unnecessary pain. Pain to the right lower quadrant suggests a problem with the appendix (eg, appendicitis), not the liver. Patients with abdominal pain commonly prefer to lie on their side with their legs drawn into their abdomen; this position often pro- vides pain relief by taking pressure off of the abdominal muscles. If the patient prefers this position, do not discourage it. 48. A 30-year-old man with a history of schizophrenia cut his wrists and is bleeding profusely. He is confused, combative, and has slurred speech. With the assis- tance of law enforcement person- nel, you and your partner physi- cally restrain him in order to pro- vide care and transport. In this situation, a court of law would MOST likely: • A:conclude that you should have had a court order to re- strain. • B:determine that the patient had decisionmaking capacity. • C:agree that you and your part- ner are guilty of assault and bat- tery. • D:consider your actions in pro- viding care to be appropriate. You selected D; This is correct! Reason:An adult with decision-making capacity (ie, a mentally competent adult) has the legal right to refuse medical treatment, even if that treatment in- volves lifesaving care. In psychiatric cas- es, however, a court of law would likely consider your actions in providing life- saving care to be appropriate, particu- larly if you have a reasonable belief that the patient would harm him- or herself or others without your intervention. In addition, a patient who is in any way im- paired, whether by mental illness, med- ical condition, or intoxication, may not be considered competent to refuse treat- ment and transport. If you are unsure of a patient's decision-making capacity, err on the side of treatment and transport. Few would argue that it would be easier to defend why you treated a patient than to justify or defend why you abandoned a patient. 49. After removing a patient from the water, your assessment reveals that he is not breathing and is continuously regurgitating large amounts of water. You should: • A:perform abdominal thrusts to remove the water. • B:begin rescue breathing after he stops regurgitating. • C:alternate suctioning with arti- ficial ventilations. • D:place him on his side and press on his abdomen. You selected C; This is correct! Reason:In cases where a patient is not breathing and is regurgitating (passively vomiting) secretions at the same time, you must address both issues. This is accomplished most effectively by suc- tioning for 15 seconds and then venti- lating for 2 minutes. This alternating se- quence should be repeated until all se- cretions are cleared from the airway. You should turn the patient onto his side to facilitate drainage of liquid, but do not apply pressure to his abdomen. Manual gastric decompression, which involves applying pressure to the patient's ab- domen, is a dangerous maneuver be- cause it will force more water from the stomach, which the patient could po- tentially aspirate. Manual gastric decom- pression should ONLY be performed if gastric distention is so severe that it is impossible to ventilate a patient AND a paramedic is not present to insert a gastric tube into the stomach. Abdomi- nal thrusts are used to remove a solid foreign body from the airway, not liquid. 50. Approximately 5 minutes af- ter being stung by a bee, a 21-year-old male develops hives and begins experiencing difficul- ty breathing. When you arrive at the scene, you note that his level of consciousness is decreased, his breathing is labored, and wheezing can be heard without a stethoscope. The patient has a bee sting kit, but has not used it. You selected C; This is correct! Reason: The patient is in anaphylac- tic shock and needs epinephrine im- mediately. Epinephrine is given to pa- tients with anaphylactic shock because it constricts the blood vessels and dilates the bronchioles, thus improving perfu- sion and breathing. Begin assisting his ventilations with a bag-mask device; his breathing is inadequate (eg, decreased You should: • A:give him high-flow oxygen via a nonrebreathing mask, cover him with a blanket and elevate his legs, and assist him in swal- lowing the antihistamine tablets that are in his bee sting kit. • B:provide positive-pressure ventilations, initiate rapid trans- port, and coordinate a ren- LOC, wheezing, labored breathing). Af- ter receiving permission from medical control, give the epinephrine from his bee sting kit (AnaKit) via intramuscular injection and transport at once. Some EMS protocols may not require you to contact medical control before giving ep- inephrine to a patient whose condition is critical. Ordinarily, you would instruct the patient to chew and swallow the an- dezvous with a paramedic unit so tihistamine tablets after giving epinephthey can administer the epineph- rine from his bee sting kit. • C:assist his ventilations with a bag-mask device, administer epi- nephrine from his bee sting kit af- ter receiving approval from med- ical control, and prepare for im- mediate transport. • D:administer high-flow oxygen via a nonrebreathing mask, ap- ply a chemical cold pack to the sting, transport at once, and be prepared to administer the epi- nephrine from his bee sting kit. rine. However, the patient's level of con- sciousness contraindicates placing any- thing in his mouth. 51. Which of the following signs is LEAST suggestive of a diabetic emergency? • A:Fruity breath odor • B:Bradycardia • C:Combativeness • D:Tachycardia You selected B; This is correct! Reason:Bradycardia is not commonly associated with either hyperglycemia or hypoglycemia. Tachycardia and combat- iveness can occur in patients with hy- perglycemia or hypoglycemia. A fruity breath odor is noted exclusively in pa- tients with diabetic ketoacidosis (diabet- ic coma, hyperglycemic crisis). 52. A 46-year-old man presents with generalized weakness and short- The correct answer is C; ness of breath after he was bit- ten on the leg by a rattlesnake. His blood pressure is 106/58 mm Hg and his pulse rate is 112 beats/min. In addition to supple- mental oxygen, further treatment for this patient should include: • A:ice packs to the wound and splinting. • B:proximal arterial constricting band and splinting. • C:splinting and lowering of the affected part. • D:elevation of the affected part and ice packs. Reason:Care for a patient with a bite from a pit viper (rattlesnake, copper- head, water moccasin) includes keep- ing the patient calm, administering sup- plemental oxygen, splinting the affected part, and keeping it below the level of the heart. Do NOT apply ice to a snakebite; this will cause local vasoconstriction and may force the venom deeper into the pa- tient's circulation. If a constricting band is applied, it should be proximal to the bite and should be tight enough to slow venous return only, not cut off arterial supply. 53. Which of the following is a later sign of hepatitis? • A:Fever and vomiting • B:Jaundice • C:Loss of appetite • D:Fatigue You selected B; This is correct! Reason: Early signs and symptoms of viral hepatitis include loss of appetite (anorexia), vomiting, fever, fatigue, and muscle and joint pain. Jaundice (yellow sclera and skin) and right upper quad- rant abdominal pain are not common early manifestations of hepatitis; they usually develop within 1 to 2 weeks into the disease process. 54. A 60-year-old male complains of a tearing sensation in his ab- domen. He tells you the pain began suddenly and feels like someone is sticking a knife into his abdomen. He is conscious and alert with a blood pressure of 148/88 mm Hg, a pulse of 120 beats/min, and respirations of 22 breaths/min. In addition to administering highflow oxygen, The correct answer is D; Reason:Given the onset and nature of the patient's pain (eg, sudden onset, tearing sensation), you should suspect that he has an acute dissection of the abdominal aorta. Administer high-flow oxygen and transport him at once. Acute aortic dissection can quickly cause an aneurysm, which could rupture and cause profound shock. Therefore, you you should: • A:perform a rapid head to toe assessment and prepare for transport. • B:auscultate over his epigastri- um to assess for bowel sounds. • C:vigorously palpate his ab- domen to assess for a pulsating mass. • D:transport at once and be pre- pared to treat him for severe shock. must carefully monitor him and be pre- pared to treat him accordingly. Unnec- essary or vigorous palpation of his ab- domen could cause his aorta to rup- ture and should be avoided. A rapid head-to-toe assessment is indicated for trauma patients with a significant mech- anism of injury and unresponsive med- ical patients; this patient falls into neither of these categories. Auscultating bowel sounds in the field is time-consuming, will yield little information, and only de- lays transport. 55. Which of the following state- ments regarding the function of insulin is correct? • A:It stimulates the liver to re- lease glucose into the blood- stream. • B:It facilitates the uptake of glu- cose from the bloodstream into the cell. • C:It causes the pancreas to produce glucose based on the body's demand. • D:It promotes the entry of glu- cose from the cell into the blood- stream. You selected B; This is correct! Reason:Insulin is a hormone produced by the beta cells in the Islets of Langer- hans of the pancreas. It promotes the uptake of glucose from the bloodstream into the cells where it is used in the production of energy. Glucagon, a hor- mone produced by the alpha cells in the pancreas, facilitates the conversion of glycogen to glucose (glycogenolysis) in the liver. The liver does not produce glu- cose; it produces glycogen, a complex sugar that the body cannot utilize until it has been converted to glucose, a simple sugar. 56. A 72-year-old woman is found un- You selected C; This is correct! responsive in her poorly ventilat- ed home. Her skin is flushed, hot, Reason: The patient's signs and sympand dry, and her respirations are rapid and shallow. She is wear- ing a medical alert bracelet that states she is a diabetic and is al- lergic to sulfa drugs. You should toms are consistent with classic heat stroke. Unlike exertional heat stroke, which usually affects otherwise healthy people who exert themselves in the heat for long periods of time, classic heat be MOST suspicious for: • A:acute ischemic stroke. • B:a diabetic complication. • C:heat stroke. • D:anaphylactic shock. stroke commonly affects children and older adults, and typically occurs when the patient is in a hot, poorly ventilated space for a prolonged period of time. Significant underlying medical problems (eg, hypertension, diabetes, heart dis- ease) increase the patient's risk for clas- sic heat stroke. Both exertional and clas- sic heat stroke present with hot, flushed skin; however, patients with exertional heat stroke may have moist skin, usu- ally from residual perspiration, whereas patients with classic heat stroke typically have dry skin. 57. A 36-year-old male, who is a known diabetic, presents with se- vere weakness, diaphoresis, and tachycardia. He is conscious, but confused. His blood pres- sure is 110/58 mm Hg, pulse is 120 beats/min and weak, and respirations are 24 breaths/min. The glucometer reads error af- ter several attempts to assess his blood glucose level. In ad- dition to high-flow oxygen, med- ical control will MOST likely order you to: • A:transport only and closely monitor him. • B:assist the patient in taking his insulin. • C:give him a salt-containing so- lution to drink. • D:give at least one tube of oral glucose. You selected D; This is correct! Reason:The patient's signs and symp- toms indicate hypoglycemia. When you are in doubt as to a patient's blood glu- cose level, you should err on the side of caution and give sugar; this is what med- ical control will likely order you to do. The patient, although confused, is conscious and will likely be able to swallow. Insulin is not administered to patients in the field, even if hyperglycemia is document- ed; EMTs and paramedics are usually not familiar with all of the different types of insulin and their respective doses, and profound hypoglycemia, potentially re- sulting in death, can occur if too much insulin is given. After giving oral glucose, reassess the patient's mental status and vital signs. 58. After moving a hypothermic pa- tient to a warmer area, your pri- mary focus should be to: • A:prevent further body heat loss. • B:provide rapid rewarming. • C:assess his or her body tem- perature. • D:give warm, humidified oxy- gen. You selected A; This is correct! Reason:After moving a hypothermic pa- tient to a warmer area, your primary fo- cus should be to prevent further body heat loss. Remove wet or damp cloth- ing and cover the patient with blankets (passive rewarming). It is especially im- portant to cover the patient's head; most heat is lost around the head and neck. You should not, however, try to active- ly rewarm the patient (ie, placing heat on or into the body). Rewarming too quickly may induce a lethal cardiac dys- rhythmia and cardiac arrest. For this rea- son, active rewarming should be done in the controlled setting of a hospital. In some areas, medical control may call for the administration of warm, humidi- fied oxygen; follow your local protocols. Assessing a hypothermic patient's core body temperature requires a special hypothermia thermometer, which many EMS systems do not carry. 59. Rapid transport of a patient who ingested a large dose of Tylenol is important because: • A:it only takes a small dose of Tylenol to cause cardiopul- monary arrest. • B:liver failure usually occurs within 6 hours following a Tylenol overdose. • C:an antidote may prevent liv- er failure if administered early enough. • D:activated charcoal cannot be You selected C; This is correct! Reason:Acetaminophen (APAP), the ac- tive ingredient in Tylenol, is a safe drug if taken as directed. However, ingestion of more than 140 mg/kg in an adult can cause liver failure and death. Symptoms of APAP overdose do not present acute- ly; it can take up to a week before signs of liver failure are apparent. The antidote for acetaminophen poisoning is acetyl- cysteine (Acetadote, Mucomyst), which is only given at the hospital. However, it must be given promptly if liver failure is given to patients who ingested Tylenol. to be avoided. Activated charcoal can be given to patients with APAP overdose; however, it is only effective if the drug is still in the stomach. After 1 to 2 hours following ingestion, activated charcoal would likely be ineffective. 60. Which of the following struc- tures is responsible for regulat- ing body temperature? • A:Cerebrum • B:Medulla oblongata • C:Hypothalamus • D:Cerebellum You selected B; The correct answer is C; Reason:The hypothalamus, which is lo- cated within the brainstem, regulates body temperature by acting as the body's thermostat. During a heat-related emergency, the hypothalamus can "re- set" the body's normal temperature to a much higher temperature in response to the environment and the body's inability to eliminate heat. 61. A young male experienced a syncopal episode after working in the heat for several hours. He is conscious and alert; has cool, clammy skin; and com- plains of nausea and lighthead- edness. You should: • A:provide rapid cooling. • B:give him cold water to drink. • C:advise him to go home and rest. • D:transport him on his side. The correct answer is D; Reason:The patient is experiencing heat exhaustion and should be transport- ed to the hospital for evaluation, espe- cially since he experienced a syncopal episode (fainting). Because he is nause- ated, he should not be given anything to drink and should be placed on his side during transport to prevent aspiration if he vomits. Loosen any restrictive cloth- ing that may trap heat. Rapid cooling is indicated for patients with heatstroke, the signs of which include an altered mental status and hot, flushed skin (dry or moist). 62. Which of the following is a physiologic effect of epinephrine when used to treat anaphylactic You selected D; This is correct! Reason:Epinephrine possesses dual ef- fects. As a bronchodilator, it relaxes the shock? • A:As a vasodilator, it increases the blood pressure. • B:As an antihistamine, it blocks chemicals that cause the reac- tion. • C:As a vasoconstrictor, it low- ers the blood pressure. • D:As a bronchodilator, it im- proves the patient's breathing. smooth muscle of the bronchioles and improves the patient's breathing. As a vasoconstrictor, it constricts the blood vessels and increases the patient's blood pressure. Diphenhydramine (Be- nadryl) is an antihistamine; it blocks H1 histamine receptor sites, which blocks the release of the chemicals (hista- mines) that are causing the allergic re- action. 63. A 73-year-old male presents with confusion; cool, pale, clammy skin; absent radial pulses; and a blood pressure of 70/40 mm Hg. The patient's wife tells you that he has had abdominal pain for a week and began vomiting a coffee-ground substance yester- day. His past medical history in- cludes hypertension and gastric ulcer disease. Yo